Attachment C:
CAHPS® Health Literacy Item Set Field Test
Cover Letter, Reminder Post Card, Reminder Letter and Telephone Introductory Script
[English Version]
Initial Letter (mailed with first survey)
DATE
FIRST AND LAST NAME
Dear {Mr./Ms.} [LAST NAME]
We at [NAME OF PROVIDER ORGANIZATION] need your help. Our records indicate that you have visited [DOCTOR’S NAME] in the last 12 months, and we would like you to tell us about the care you received from this doctor. We are enclosing a brief questionnaire that should only take about [TIME] minutes or less of your time to complete. The information you provide could help improve the quality of care you receive from this doctor.
The information that you provide will be kept completely private and confidential and your answers will never be matched with your name. Your individual answers will never be seen by your doctor or anyone else involved with your care. We will combine your answers with information from other people who complete the survey to create a summary report that tells us about our patients’ experiences with their doctors and medical offices.
We hope you will take this chance to tell us about your experiences with health care. Please return the completed survey in the enclosed postage-paid envelope by [MONTH/DAY/YEAR]. You may choose to participate or not, but the more people who respond, the greater our ability to improve the quality of care you receive. If you would like your name removed from the mailing list, please return the blank survey in the enclosed envelope.
If you have any questions about this survey, please call [CONTACT NAME] at (XXX) [XXX-XXXX]. All calls to this number are free. Thank you for helping to make health care at [NAME OF PROVIDER GROUP] better for everyone!
Sincerely,
Beverly Weidmer O. Survey Director
Nota: Si quiere una encuesta en español, por favor llame al (XXX) [XXX-XXXX].
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First Reminder (4 x 6 Postcard)– Mail 2 weeks after mailing of first survey
[NAME OF SURVEY]
Hello!
Recently we sent you a questionnaire asking about your experiences with your doctor. It should take only a few minutes to complete and your answers will help us improve the health care you get from your doctor
When you have completed the questionnaire, please mail it back in the postage-paid envelope that came with it. If you have already sent back a completed questionnaire, thank you!
If you did not get the questionnaire or have lost it, please call [CONTACT NAME] toll-free at (XXX) [XXX-XXXX], and we’ll send you another. You can also call that number if you have any questions.
THANK YOU!
Beverly Weidmer Survey Director
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Second reminder; mail with survey two weeks after mailing of reminder post card
DATE
FIRST AND LAST NAME
Dear {Mr./Ms.} [LAST NAME]
We need your help. Recently, we sent you a questionnaire asking about your experiences with [NAME OF DOCTOR]. If you have already responded, we thank you for your feedback. If you have not had time to respond or you have lost the questionnaire, please take a few minutes to complete the enclosed questionnaire now. By answering the questions, you will provide information that could help improve the quality of care your doctor provides patients such as yourself. It should take only [TIME] minutes to answer these questions.
The information that you provide will be kept completely private and confidential and your answers will never be matched with your name. Your individual answers will never be seen by your doctor or anyone else involved with your care.
We hope you will take this chance to tell us about your experiences with health care. You may choose to participate or not, but the more people who respond, the greater our ability to improve the quality of care you receive.
If you have any questions about this survey, please call [CONTACT NAME] at (XXX) [XXX-XXXX]. All calls to this number are toll free. Thank you for helping to make health care at [NAME OF PROVIDER GROUP] better for everyone!
Sincerely,
Beverly Weidmer O. Survey Director RAND Corporation
Nota: Si quiere una encuesta en español, por favor llame al (XXX) [XXX-XXXX].
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Hello, this is {INTERVIEWER NAME} calling from the RAND Corporation. May I please speak to {SAMPLE MEMBER’S NAME}?
[IF SPEAKING WITH SAMPLE MEMBER, GO TO INTRO1.]
[IF SAMPLE MEMBER IS NOT AVAILABLE, GO TO INTRO2.]
INTRO1. The RAND Corporation is conducting a study to learn about your experiences with {NAME OF DOCTOR}. The results of this study will be used to help {PROVIDER ORGANIZATION} improve the quality of care and services it provides to patients like you.
[GO TO CONSENT STATEMENT BELOW]
INTRO2. [SCHEDULE TIME TO CALL BACK:]
Can you tell me a convenient time to call back to speak with (him/her)?
[RECORD CALLBACK TIME ON CALL RECORD [IF CATI, ENTER ON CALLBACK/APPOINTMENT SCREEN).]
[CONSENT STATEMENTS]
We recently sent you a brief survey that asked about your experiences with your doctor. I’m calling because we still have not received your completed survey and wanted to give you an opportunity to complete the survey by phone. Just in case you didn’t receive the survey, let me tell you a little about the study before we continue. We have randomly selected you and other people to represent all the people who get health care from {PROVIDER ORGANIZATION}. Your answers are very important to our study.
You may choose to do this survey interview or not – it is entirely optional. Whether you decide to be interviewed or not, the health care you receive will not be affected. If you do choose to participate, your responses will be kept private. Your doctor will never know how you answered. The questions should take about [TIME] to answer.*
I will ask about the health care you receive from {NAME OF DOCTOR} and how you feel about {NAME OF DOCTOR}. Other people who get care from {PROVIDER ORGANIZATION} will be asked the same questions. {PROVIDER ORGANIZATION} will use this information to learn how well they have been doing in serving their patients, and how they can improve their care and services.
I’d like to begin the survey interview now, but before we begin, do you have any questions about the survey?
[ANSWER ANY QUESTIONS, THEN GO TO QUESTION 1.]
[IF SAMPLE MEMBER DOES NOT HAVE TIME TO PARTICIPATE IN INTERVIEW NOW, GO TO CALL BACK SCREEN AND ARRANGE AN APPOINTMENT TO CALL BACK.]
CAHPS® Health Literacy Item Set Field Test
Cover Letter, Reminder Post Card, Reminder Letter and Telephone Introductory Script
[SPANISH VERSIONS]
Initial Letter (mailed with first survey)
First Reminder (4 x 6 Postcard)– Mail 2 weeks after mailing of first survey
[NAME OF SURVEY] ¡Hola!
Hace poco le enviamos un cuestionario sobre sus experiencias con su doctor. Solo le va a tomar unos cuantos minutos llenar el cuestionario y sus respuestas nos ayudarán a mejorar los servicios de salud que recibe de su doctor.
Una vez que haya llenado el cuestionario, por favor mándenoslo por correo en el sobre con el porte o franqueo pagado que venía con la encuesta. Si ya envió su cuestionario completado, ¡muchas gracias!
Si no recibió el cuestionario o si lo perdió, por favor llame a {CONTACT NAME} al (XXX) {XXX-XXXX} y le mandaremos otro. También puede llamar a este número si tiene alguna pregunta.
¡GRACIAS!
Beverly Weidmer Directora de la encuesta
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Second reminder; mail with survey two weeks after mailing of reminder post card
DATE
FIRST AND LAST NAME
Estimado/a {Sr./Sra.} [Last name]:
Necesitamos su ayuda. Hace poco, le enviamos un cuestionario sobre sus experiencias con el Dr. [NAME OF DOCTOR]. Si ya nos envió el cuestionario, le agradecemos su ayuda. Si no ha tenido tiempo de llenar el cuestionario o si lo perdió, por favor tome unos minutos ahora para completar el cuestionario adjunto. Al contestar estas preguntas, nos está ayudando a mejorar la calidad de la atención médica que su doctor le proporciona a las personas como usted. Solamente le va a tomar unos [TIME] contestar las preguntas del cuestionario.
La información que usted proporcione será completamente privada y confidencial y sus respuestas nunca se van a asociar con su nombre. Su doctor u otras personas que participen en su cuidado de salud jamás podrán ver sus respuestas individuales.
Esperamos que aproveche esta oportunidad para contarnos sobre sus experiencias con la atención médica que recibe. Usted es libre de decidir si quiere participar o no en la encuesta pero entre más gente participe, más aumenta nuestra habilidad de mejorar la calidad de los servicios de salud que recibe.
Si tiene alguna pregunta sobre esta encuesta, por favor llame a {CONTACT NAME} al (XXX) {XXX‑XXXX}. Todas las llamadas a este número de teléfono son gratis. ¡Gracias por ayudar a mejorar los servicios de salud de [NAME OF PROVIDER GROUP] para todos!
Atentamente,
Beverly Weidmer O. Directora de la encuesta
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Buenos días/tardes/noches, me llamo {INTERVIEWER NAME} y estoy llamando de la Corporación RAND. ¿Me permite hablar con {SAMPLE MEMBER’S NAME} por favor?
[IF SPEAKING WITH SAMPLE MEMBER, GO TO INTRO1.]
[IF SAMPLE MEMBER IS NOT AVAILABLE, GO TO INTRO2.]
INTRO1. La Corporación RAND está llevando a cabo una encuesta para aprender sobre sus experiencias con el Dr. {NAME OF DOCTOR}. Los resultados de este estudio se van a utilizar para ayudar a {PROVIDER ORGANIZATION} a mejorar la calidad de los servicios de salud y de la atención médica que le ofrece a las personas como usted.
[GO TO CONSENT STATEMENT BELOW]
INTRO2. [SCHEDULE TIME TO CALL BACK:]
¿Cuál sería el mejor momento para llamarle de nuevo?
[RECORD CALLBACK TIME ON CALL RECORD [IF CATI, ENTER ON CALLBACK/APPOINTMENT SCREEN).]
[CONSENT STATEMENTS]
Recientemente le enviamos un cuestionario breve que tenía preguntas sobre sus experiencias con este doctor. Le estoy llamando porque todavía no hemos recibido su encuesta y le quería dar la oportunidad de completar la encuesta por teléfono. En caso de que no haya recibido la encuesta, me gustaría darle un poco más de información sobre el estudio antes de continuar. Le hemos escogido a usted y a otras personas al azar (como en una lotería) para que representen a toda la gente que recibe atención médica de {PROVIDER ORGANIZATION}. Sus respuestas son muy importantes para el estudio.
Usted es libre de decidir si quiere participar en la encuesta o no. Es su decisión. Ya sea si decide participar o no en la encuesta, esto no va a afectar la atención médica que recibe. Si decide participar, sus respuestas serán privadas. Su doctor jamás va a saber lo que usted contestó. Las preguntas toman unos 20 minutos.
Le voy a hacer preguntas sobre la atención médica que recibió de {NAME OF DOCTOR} y sobre su opinión del Doctor {NAME OF DOCTOR}. A otras personas que reciben cuidado de {PROVIDER ORGANIZATION} también se les van a hacer estas mismas preguntas. {PROVIDER ORGANIZATION} va a utilizar esta información para evaluar la calidad de la atención que le están ofreciendo a sus pacientes y para ver como pueden mejorar la atención y los servicios de salud que ofrecen.
Me gustaría empezar la encuesta ahora pero antes de empezar, ¿tiene usted alguna pregunta sobre la encuesta?
[ANSWER ANY QUESTIONS, THEN GO TO QUESTION 1.]
[IF SAMPLE MEMBER DOES NOT HAVE TIME TO PARTICIPATE IN INTERVIEW NOW, GO TO CALL BACK SCREEN AND ARRANGE AN APPOINTMENT TO CALL BACK.]
| File Type | application/msword |
| File Title | Initial Letter (mailed with first survey) – Home Health Patient Survey |
| Author | wcarroll |
| Last Modified By | wcarroll |
| File Modified | 2008-01-16 |
| File Created | 2008-01-16 |