[Federal Register Volume 59, Number 57 (Thursday, March 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6907]
[[Page Unknown]]
[Federal Register: March 24, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
RIN 0905-ZA03
[CDC-416]
Announcement of a Cooperative Agreement to the Ambulatory
Sentinel Practice Network
Summary
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1994 funds for a sole source
cooperative agreement with the Ambulatory Sentinel Practice Network
(ASPN) for the Laboratory Medicine Quality Improvement Program.
Approximately $200,000 is available in FY 1994 to fund this cooperative
agreement. It is expected that the award will begin on May 1, 1994, and
will be made for a 12-month budget period within a project period of up
to 5 years. Funding estimates may vary and are subject to change.
Continuation awards within the project period will be made on the basis
of satisfactory progress and the availability of funds.
The purpose of this cooperative agreement is to increase the
ability of the primary care physician to determine: (1) Problems that
exist in the total process of laboratory testing, (2) how often
problems occur, (3) what impact these problems have on patient care,
and (4) what interventions can be developed to improve the total
testing process. Activities to achieve these ends will include two
primary focus areas. The first area of focus is studying the extent and
nature of problems in the diagnosis and treatment of patients caused by
inaccurate laboratory test results. The second area of focus is
studying the effect of errors on patient care in each component of the
clinical laboratory testing process to include the following: (a)
Communication between the attending physician and the clinical
laboratory which is to conduct the tests; (b) selection of the tests to
be performed; (c) limits applicable to the tests selected; (d)
acquisition of the specimen to be tested; (e) transportation of the
specimen to the laboratory, (f) storage of the specimen by the
laboratory, (g) analysis of the specimen by the laboratory; and, (h)
reporting of the results by the laboratory.
These studies will be addressed by individual primary care
physicians and others in the practices affiliated with ASPN using
investigative strategies established in cooperation with CDC. Specific
activities include the development of protocols and survey forms, data
analysis and creation of interventions to improve the total testing
process in primary care physicians' practices.
CDC will: (1) Collaborate in questionnaire development for
profiling ASPN clinicians and practices, problem identification, and
results analysis; (2) collaborate in the development and implementation
of surveillance for specific types of laboratory problems occurring in
the pre- and post-analytic phases of the testing process. This includes
collaborating on card questionnaire development, data analysis, and
writing summaries of the results; (3) collaborate in the development
and implementation of focused surveillance for problems occurring in
the analytic phase of the testing process. CDC will assist with card
questionnaire development, data analysis, and writing summaries of the
results; (4) collaborate in the development and implementation of a
patient-oriented sentinel method. CDC will assist with questionnaire
development, results analysis, and writing summaries of the results;
(5) collaborate in the development of recommendations for improving the
total testing process in ASPN practices. CDC will also collaborate in
developing the methods for testing these recommendations and measuring
changes in quality of the testing process. This will include developing
specific recommendations for quality improvement interventions,
assisting with developing measurement tools, analyzing results, and
writing summaries of the results; (6) assist ASPN staff with
presentations (including visuals, materials, etc.) of the progress
towards achieving objectives at each of the annual ASPN convocations.
CDC staff will also assist in the presentations at the annual ASPN
convocations; and (7) assist ASPN staff in the preparation of
manuscripts related to the activities in this project.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of ``Healthy People
2000,'' a PHS-led national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is related to
priority area 22 improving surveillance and data systems by the Year
2000. (For ordering a copy of ``Healthy People 2000,'' see the section
WHERE TO OBTAIN ADDITIONAL INFORMATION.)
Authority
This program is authorized under section 317(k)(3) of the Public
Health Service Act, 42 U.S.C. 247b(k)(3), as amended.
Eligible Applicant
Assistance will be provided only to the Ambulatory Sentinel
Practice Network (ASPN). No other applications are solicited. The
program announcement and application kit have been sent to ASPN.
ASPN is a non-profit organization of primary health care
practitioners in the United States and Canada. ASPN's goal is to
increase and refine the primary care knowledge base by studying the
problems that occur in the primary care setting.
ASPN is the most appropriate organization to conduct the work under
this cooperative agreement because:
1. It is more cost effective to utilize the services of ASPN since
the clinicians and the laboratories in this program are already members
of an organized network. To obtain a listing of clinicians and
establish a new network would require additional time (years) and
funds.
2. ASPN has established methods for routinely collecting and
reporting data from its membership. The systems, staff, and other
resources are in place, available to be used for this proposed project.
Patient records are accessible to ASPN for follow-up and investigative
purposes.
3. ASPN clinicians have participated in a replication of the
National Center for Health Statistics (NCHS) National Ambulatory
Medical Care Survey which allows for comparisons of ASPN practices with
a national sample.
4. The majority of in-office laboratory testing takes place in a
primary care setting. ASPN is the only national, primary care,
practice-based research network operating in the United States at the
present time.
5. Although other smaller primary care, practice-based research
networks have been established in the United States, ASPN has the most
diverse geographic distribution which enhances the generalizability of
the data collected in this study.
6. The composition of the ASPN network members includes a
significant number of rural practices, a feature not present in other
practice-based research networks operating in the United States at the
present time.
7. The ASPN network services approximately 350,000 active patients.
As laboratory errors are considered to be statistically rare events,
the large number of patients seen in the network greatly augments the
power of the studies.
8. ASPN has an established reporting rate of 93-98 percent. This is
markedly higher than what one would expect to be able to achieve
outside of a practice-based research network. The high reporting rate
is due to monitoring and follow-up protocols used by the research
support staff with ASPN. The high reporting rate makes the data
collection more efficient and complete.
9. The ASPN network contains a small number of practices in Canada.
This small subset of the network can be used as an internal control to
assess changes in the practice of laboratory medicine in the United
States compared to Canada.
10. All ASPN network physicians are required to endorse and support
the participation of their practices by recording and reporting
accurate data about patients collaboratively with other ASPN practices.
Accurate and current data are paramount in this project.
11. There is no other known provider which can provide this type of
investigative project.
Executive Order 12372 Review
This program is not subject to the Executive Order 12372 review.
Public Health System Reporting Requirements
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number (CFDA)
The Catalog of Federal Domestic Assistance Number is 93.283.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by the cooperative agreement will be subject to
review by the Office of Management and Budget (OMB) under the Paperwork
Reduction Act.
Where To Obtain Additional Information
If you are interested in obtaining additional information regarding
this project, please refer to Announcement Number 416 and contact
Carole J. Tully, Grants Management Specialist, Grants Management
Branch, Centers for Disease Control and Prevention (CDC), 255 East
Paces Ferry Road, NE., room 300, Mailstop E-09, Atlanta, Georgia 30305,
telephone (404) 842-6880.
A copy of ``Healthy People 2000'' (Full Report, Stock No. 017-001-
00474-0) or ``Healthy People 2000'' (Summary Report, Stock No. 017-001-
00473-1) referenced in the SUMMARY may be obtained through the
Superintendent of Documents, Government Printing Office, Washington, DC
20402-9325, telephone (202) 783-3238.
Dated: March 17, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC)
[FR Doc. 94-6907 Filed 3-23-94; 8:45 am]
BILLING CODE 4163-18-P
