Billing Code: 4160-90-P
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection; Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
SUMMARY: This notice announces the intention of the Agency for Healthcare Research and
Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve a
revision of the currently approved information collection project: ‘‘The AHRQ Safety Program
for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use.’’
This proposed information collection was previously published in the Federal Register on April
29th, 2024 and allowed 60 days for public comment. AHRQ received no substantive comments
from members of the public. The purpose of this notice is to allow an additional 30 days for
public comment.
DATES: Comments on this notice must be received by [INSERT DATE 30 DAYS AFTER
DATE OF PUBLICATION IN THE FEDERAL REGISTER].
ADDRESSES: Written comments and recommendations for the proposed information
collection should be sent within 30 days of publication of this notice to
www.reginfo.gov/public/do/ PRAMain. Find this particular information collection by selecting
‘‘Currently under 30-day Review—Open for Public Comments’’ or by using the search function.
Copies of the proposed collection plans, data collection instruments, and specific details on the
estimated burden can be obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports Clearance
Officer, (301) 427-1477, or by email at REPORTSCLEARANCEOFFICER@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project

AHRQ Safety Program for Telemedicine: Improving Antibiotic Use
This Information Collection Request (ICR) is for a revision to the AHRQ Safety Program for
Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use. These changes
include the removal of the Diagnostic Process Cohort, updates to the Improving Antibiotic Use
Data Collection Tools and changing the name of the project to the “AHRQ Safety Program for
Telemedicine: Improving Antibiotic Use.” The OMB control number for the AHRQ Safety
Program for Telemedicine is 0935-0265 and will expire on April 30, 2026. Supporting
documents can be downloaded from OMB’s website at:
https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202303-0935-001. AHRQ is
requesting a new expiration date, three years from approval.
Since the project received OMB approval, there have been two developments that require
changes to the project’s goals and design. First, the Improving the Diagnostic Process Cohort
was canceled because there was insufficient recruitment. Second, the materials approved by
OMB for the Improving Antibiotic Use Cohort included a single version of the Structural
Assessment and Participant Experience Survey, to be completed by all participants in the
improving antibiotic use cohort. However, following pre-recruitment discussions with AHRQ’s
Technical Expert Panel (TEP) and potential participants, it was learned that the target audience
for the improving antibiotic use cohort is comprised of healthcare providers from two distinctly
different settings (brick-and-mortar and telemedicine-only) settings. Providers that practice in
brick-and-mortar settings provide care both in-person and via telemedicine whereas providers
that practice in telemedicine-only settings provide care exclusively using telemedicine. Based on
this information AHRQ decided to create separate data collection tools, one for providers in a
brick-and-mortar setting, and one for providers in telemedicine only. Practices and providers
receive information about the program from newsletters, listservs, and direct outreach through
public and private organizations. They attend an information webinar and may join the program
if interested and eligible.

As in the currently approved design, the program will incorporate CUSP strategies to improve
antibiotic prescribing in telemedicine. The new program goals are to:
•

Identify best practices in implementing interventions to improve antibiotic use in
telemedicine.

•

Determine how best to adapt CUSP to enhance antibiotic use in telemedicine.

•

Use a CUSP approach to design and implement the interventions for improving antibiotic
use across telemedicine practices.

•

Reduce inappropriate antibiotic prescribing among telemedicine practices.

To achieve these goals the following data collections will be implemented:
1. Structural Assessment Antibiotic Use Cohort – There will be two versions of the Structural
Assessment, one for providers in a brick-and-mortar setting, and one for providers in
telemedicine only. Both versions ask the same questions but vary slightly in how they refer
to the practice. The assessment asks about the practice’s characteristics, experience related
to antibiotic stewardship activities, and any existing supports the practice may have in place
that are intended to improve antibiotic prescribing. The assessment will be administered to
the Safety Program leader/champion at each participating brick-and-mortar practice or
telemedicine-only organization at baseline (pre-intervention) and at the end of the
intervention. The results will be used to assess changes in the practice’s infrastructure and
capacity to implement the Safety Program over time. The data will provide information
about any existing quality improvement initiatives currently in place, their existing
infrastructure and capacity to carry out the program, as well as changes in the infrastructure
and quality improvement activities as a result of participation in the Safety Program.
2. Medical Office Survey on Patient Safety Culture (MOSOPS): As currently approved, the
Safety Program for Telemedicine included completion of the MOSOPS by all participating
staff across all participating practices. In this revision, AHRQ will administer the MOSOPS
to HCPs practicing in brick-and-mortar settings only. The MOSOPS was designed to assess

key characteristics of HCPs working in-person in a single medical office and results are
unlikely to be reliable or valid if administered among HCPs practicing in telemedicine-only
settings. The MOSOPS will be administered to all participating staff at brick-and-mortar
practices at baseline (pre-intervention) and at the end of the intervention. The survey collects
information on patient safety issues, patient safety culture, medical errors, and event
reporting. The data will be used to assess changes in safety culture following implementation
of the Safety Program.
3. Participant Experience Survey Antibiotic Use Cohort - Based on feedback from the TEP and
conversations with telemedicine-only organizations, this revision includes changes to the
Participant Experience Survey as well as unique versions for brick-and-mortar and
telemedicine-only participants. The survey will be administered to the clinical
leader/champion at each practice at the end of the program (post-intervention). The survey
will assess how participants approached implementation of the Safety Program.
4. Semi-Structured Interviews Antibiotic Use Cohort - A proportion of practices from both
brick-and-mortar practices and telemedicine-only organizations will be selected to participate
in telephone/virtual discussions to understand the facilitators and barriers to implementing
the Safety Program. This interview guide includes four core domains that are intended to
capture characteristics of health care providers (physicians, nurse practitioners, and physician
assistants) and their perception of the AHRQ Safety Program for Telemedicine: Improving
Antibiotic Use (“the Safety Program”) on pre- and post-implementation changes. All
interviews will occur at the end of the intervention period.
5. Antibiotic Prescription Data Template Antibiotic Use Cohort - Each month starting at
baseline (pre-intervention) until the end of the intervention, each participating practice will
extract antibiotic prescribing data from their electronic health record (EHR) system. The data
will be submitted quarterly using a secure online data submission portal. The prescribing data
will evaluate changes in antibiotic usage, clinical outcomes, and other effectiveness measures

resulting from participation in the Safety Program. Based on feedback from participants in
the prior AHRQ Safety Program, this updated version includes revisions to the EHR template
to simplify the data requested in the template from aggregate to visit-level. Participating
practices will submit two key types of data related to antibiotic prescribing: 1) Total
antibiotic prescriptions per 100 respiratory tract infection telemedicine visits and 2)
Antibiotic prescriptions per 100 antibiotic-inappropriate respiratory tract infection
telemedicine visits. This data will be an important way for the practice to monitor its
prescribing practices throughout the course of the program and will be used by the
assessment team to monitor and describe prescribing trends across practices enrolled in the
program.
This study is being conducted by AHRQ through its contractor, NORC at the University of
Chicago and Johns Hopkins Medicine, pursuant to AHRQ’s statutory authority to conduct and
support research on healthcare and on systems for the delivery of such care, including activities
with respect to the quality, effectiveness, efficiency, appropriateness, and value of healthcare
services and with respect to quality measurement and improvement. 42 U.S.C. 299a(a)(1) and
(2).
Method of Collection
To minimize respondent burden and to permit the electronic submission of survey responses and
data collection forms, the structural assessment, AHRQ MOSOPS, participant experience survey,
and antibiotic prescription data template will be web-based and deployed using a well-designed,
low burden, and respondent-friendly survey administration process. In addition, the EHR data
extracted by practice staff that are requested for this program may already be collected by
practices as part of their ongoing quality improvement initiatives. Practices will receive access
to the online data collection platform and detailed instructions on completing the online forms
and EHR data submissions.

Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the respondents’ time to participate in
this project.
1. Structural Assessment Antibiotic Use Cohort - The assessment will be administered twice
to the Safety Program leader/champion at each participating brick-and-mortar practice or
telemedicine-only organization, once at baseline (pre-intervention) and again at the end
of the intervention. AHRQ expects 188 respondents at each administration. The
Assessment requires 12 minutes to complete.
2. Medical Office Survey on Patient Safety (MOSOPS) – The MOSOPS will be completed
by all participating staff at brick-and-mortar practices to assess patient safety issues,
medical errors, and event reporting practices. The survey will be completed twice, once at
baseline (pre-intervention) and at the end of the intervention to measure the changes in
patient safety culture resulting from participation in the Safety Program. The survey will
be completed by 438 staff members at each administration and requires 30 minutes to
complete.
3. Participant Experience Survey Antibiotic Use Cohort - The Participant Experience
Survey will be administered once to the Safety Program leader/champion at the end of the
intervention to assess participant engagement and progress; understand providers’
experience using materials and participating in the Safety Program; and identify
processes used and changes made to implement and sustain the Safety Program. The
survey is estimated to require 20 minutes to complete.
4. Semi-Structured Interviews Antibiotic Use Cohort - Semi-structured interviews will be
conducted at the end of the intervention among clinical and professional support staff
from a sample of practices to collect qualitative information on the implementation of the

program. Interviews will be conducted with 18 participating practices/organizations and
requires one hour to complete.
5. Antibiotic Prescription Data Template Antibiotic Use Cohort - The Antibiotic
Prescription Data Template will be completed each month and submitted quarterly
starting in the baseline (pre-intervention) period until the end of the intervention to
measure changes in antibiotic usage resulting from the intervention. The data will be
extracted from the practice/organization’s electronic health records, by a staff member,
and entered into the data template. AHRQ expects 225 practices/organizations to extract
data monthly for 18 months. Each monthly data extraction should require one hour of a
staff members time.
The total burden for the respondents’ time to participate in this research is estimated to be 4,644
hours.
Exhibit 1. Estimated Annualized Burden Hours
Form Name

Number of
Respondents*

Number of
Hours per Total
Responses per Response Burden
Respondent
Hours

1. Structural Assessment

2

12/60

2. MOSOPS (brick-and-mortar
only)

2

30/60

3. Participant Experience Survey

1

20/60

4. Semi-structured interviews

1

18

5. Antibiotic Prescription Data
Template

18

4,050

1,057

na

na

4,644

Total

*Annualized number of respondents is based on maximum practices recruited, assuming
50% of the practices are telemedicine-only and 50% are brick-and-mortar, and 75%

response rate for forms 1 and 3, 50% response rate for form 2, and 90% response rate for
forms 4 and 5.
Exhibit 2 shows the estimated annualized cost burden based on the respondents’ time to
complete the data collection forms. The total cost burden is estimated to be $366,163.
Exhibit 2. Estimated Annualized Cost Burden
Form Name

Total
Burden
Hours

Average Hourly Total Burden
Wage Rate**
Cost

$119.54a

$8,966

a. Physicians

$119.54a

$26,179

b. Other Health Practitioners

$34.04b

$7,455

3. Participant Experience Survey

$119.54a

$7,115

4. Semi-structured qualitative interviews

$119.54a

$2,152

5. Antibiotic Prescription Data Template

4,050

$76.79c

$311,000

Total

4,644

1. Structural Assessment
2. AHRQ Medical Office Survey on
Patient Safety Culture MOSOPS (brickand-mortar only)

$366,163

** Annualized number of respondents is based on maximum practices recruited, assuming 50%
of the practices are telemedicine-only and 50% are brick-and-mortar, and 75% response rate for
forms 1 and 3, 50% response rate for form 2, and 90% response rate for forms 4 and 5.
**National Compensation Survey: Occupational wages in the United States May 2023 “U.S.
Department of Labor, Bureau of Labor Statistics:” https://www.bls.gov/oes/current/oes_stru.htm
a

Based on the mean wages for 29-1229 Physicians and Surgeons, All Other

b

Based on the mean wages for 29-9099 Other Healthcare Practitioners and Technical
Occupations: Healthcare Practitioners and Technical Workers, All Other
c

Based on an average of the mean wages for 29-1229 Physicians and Surgeons, All Other and
29-9099 Other Healthcare Practitioners and Technical Workers: Healthcare Practitioners and
Technical Workers, All Other

Request for Comments
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, comments on AHRQ’s
information collection are requested with regard to any of the following: (a) whether the
proposed collection of information is necessary for the proper performance of AHRQ’s health
care research and health care information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of AHRQ’s estimate of burden (including
hours and costs) of the proposed collection(s) of information; (c) ways to enhance the quality,
utility and clarity of the information to be collected; and (d) ways to minimize the burden of the
collection of information upon the respondents, including the use of automated collection
techniques or other forms of information technology.
Comments submitted in response to this notice will be summarized and included in the Agency’s
subsequent request for OMB approval of the proposed information collection. All comments
will become a matter of public record.
Dated: July 8, 2024.
Marquita Cullom,
Associate Director.
[FR Doc. 2024-15250 Filed: 7/10/2024 8:45 am; Publication Date: 7/11/2024]