Attachment C:
CAHPS® Health Literacy Item Set Field Test
Pre-notification Letter, Cover Letter, Reminder Post Card, Reminder Letter and Telephone Introductory Script
[English Version]
Advance Notification Letter
DATE
FIRST AND LAST NAME
Dear {Mr./Ms.} [LAST NAME]
We need your help. We are conducting a survey that asks about the care you got through [NAME OF HOSPITAL]. This survey will help us provide information that will help improve the quality of services you get through this [HOSPITAL]. This is your chance to help us, and the [HOSPITAL], serve you better.
[NAME OF SPONSOR’S VENDOR] will soon mail you a copy of the survey. The survey will ask questions about the care you got through the [hospital] . You have been chosen as part of a sample of people who get care at this hospital. To get accurate results, we need to get answers from you and other people we ask to take part in this survey. The survey will take only 25 minutes. [To thank you for completing the survey, you will get a gift card for $5]. We hope you will take the time to answer these questions.
The information that you provide will be kept private and confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose. Your answers will be part of a pool of information from others like you. You may choose to fill out the survey or not. If you choose not to, this will not change the benefits you get.
We hope you will take this chance to tell us about the health care you got at this hospital. If you prefer not to take part in the survey, please call the number below. This will alert us to take your name off the list. If you have any questions, please call [CONTACT NAME] at (XXX) [XXX-XXXX]. All calls to this number are free. Thanks in advance for your help!
Sincerely,
[NAME OF PERSON REPRESENTING SPONSOR]
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Initial Letter (mailed with first survey)
DATE
FIRST AND LAST NAME
Dear {Mr./Ms.} [LAST NAME]
We need your help. Our records indicate that you were hospitalized at [HOSPITAL’S NAME] in the last 6 weeks, and we would like you to tell us about the care you received at this hospital. The short survey that came with this letter should only take about 25 minutes or less of your time to fill out. The information you give could help improve the quality of care you get from this hospital. [To thank you for completing the survey, we will send you a gift card for $5].
The information that you provide will be kept private and confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose.. Your doctors or anyone else involved with your care will never see your answers. We will combine your answers with information from other people who complete the survey to create a summary report about patients’ experiences at this hospital.
We hope you will take this chance to tell us about your experiences with hospital care. Once you finish the survey, please mail it back in the postage-paid envelope that came with it by [MONTH/DAY/YEAR]. You may choose to fill it out or not, but the more people who answer, the greater our ability to improve the quality of hospital care you receive. If you would like your name removed from the mailing list, please return the blank survey in the envelope that came with it.
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 [HOSPITAL NAME] 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 short survey asking about your experiences at [HOSPITAL NAME]. It should take only a few minutes to fill out and your answers will help us improve the health care provided by this hospital.
When you have completed the survey, please mail it back in the postage-paid envelope that came with it. If you have already filled out the survey and mailed it back, then thank you!
If you did not get the survey or if you 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 survey asking about your experiences with [NAME OF HOSPITAL]. If you have already filled out the survey and sent it back, we thank you. If you have not had time to do so or if you misplaced the survey, please take a few minutes now to fill it out. By answering the questions, you will give us information that could help improve the quality of care this hospital gives patients such as yourself. It should take only 25 minutes to answer these questions. [To thank you for completing the survey, we will send you a gift card for $5].
The information that you provide will be kept private and confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose . Your doctors or anyone else involved with your care will never see your answers.
We hope you will take this chance to tell us about your experiences at this hospital. You may choose to fill out the survey or not, but the more people who do so, the greater our ability to improve the quality of hospital 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 [DATA COLLECTION VENDOR NAME]. 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 {HOSPITAL}. The results of this study will be used to help {HOSPITAL NAME} 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 short survey that asked about your experiences when you were recently hospitalized at [HOSPITAL NAME]. I’m calling because we still have not received your survey and wanted to give you an opportunity to do 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 were hospitalized in {HOSPITAL NAME} recently. Your answers are very important to our study.
You may choose to do this survey interview or not – it is up to you to decide. Whether you decide to do the survey or not, the health care you receive will not be affected. If you do choose to take part, your answers will be kept private to the extent permitted by law. Your doctors and nurses will never know how you answered. The questions should take about 25 minutes to answer.*
[To thank you for completing the survey, we will send you a gift card for $5].
I will ask about the health care you received when you were hospitalized in {HOSPITAL NAME} and how you feel about {HOSPITAL NAME}. Other people who got care at this hospital will be asked to take part in this survey. {HOSPITAL NAME} will use this information to learn how well they have been doing in serving their patients, and how they can improve the quality of care they provide.
I’d like to begin the survey now, but before we begin, do you have any questions?
[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
Pre-notification Letter, Cover Letter, Reminder Post Card, Reminder Letter and Telephone Introductory Script
[SPANISH VERSIONS]
Advance letter for commercially insured (letter assumes active enrollment)
DATE
FIRST AND LAST NAME
Estimado/a {Mr./Ms.} [LAST NAME]:
¡Necesitamos su ayuda! Estamos llevando a cabo una encuesta sobre la atención que recibió cuando estuvo internado/a en [NAME OF HOSPITAL]. Esta encuesta nos dará información que ayudará a mejorar la calidad de los servicios que ofrece este hospital, y le da a usted la oportunidad de ayudarle al hospital a servirle major.
[NAME OF SPONSOR’S VENDOR] le va a mandar un cuestionario por correo en unos cuantos días. El cuestionario incluye preguntas sobre la atención que recibió cuando estuvo en el hospital. Usted fue seleccionado para formar parte de una muestra de personas que estuvieron internadas en este hospital. Para tener buenos resultados, necesitamos que usted y las demás personas que fueron seleccionadas llenen el cuestionario y nos lo manden por correo. Llenar el cuestionario solo toma unos 25 minutos. [Para darle las gracias por participar, le vamos a mandar una tarjeta de regalo con un valor de $5 dólares]. Esperamos que se tome el tiempo de contestar las preguntas.
La información que proporcione será privada y confidencial en la medida que lo permita la ley. Sus respuestas se van a juntar con las respuestas de todas las demás personas y sólo se van a usar para este estudio. Usted es libre de decidir si va a llenar la encuesta o no. Si decide no hacerlo, no va a afectar los beneficios que recibe.
Esperamos que aproveche esta oportunidad para contarnos sobre la atención que recibió en este hospital. Si no quiere participar en la encuesta, por favor llame al número de teléfono que aparece a continuación para que podamos quitar su nombre de nuestra lista.
Si tiene alguna pregunta, por favor llame a [CONTACT NAME] al (XXX) [XXX‑XXXX]. La llamada es gratis. De antemano, ¡muchas gracias por su ayuda!
Atentamente,
[NAME OF PERSON REPRESENTING SPONSOR]
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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 cuando estuvo internado en [HOSPITAL NAME]. Solo le va a tomar unos cuantos minutos llenar el cuestionario y sus respuestas nos ayudarán a mejorar los servicios de salud de este hospital.
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 cuando estuvo internado en [HOSPITAL NAME]. 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 hágalo ahora. Al contestar estas preguntas, nos está ayudando a mejorar la calidad de la atención médica que le proporciona este hospital a las personas como usted. Solamente le va a tomar unos 25 minutos contestar las preguntas del cuestionario. [Para darle las gracias por completar la encuesta, le vamos a mandar una tarjeta de regalo con un valor de $5].
La información que proporcione será privada y confidencial en la medida que lo permita la ley.. Sus doctores u otras personas que participen en su cuidado de salud jamás podrán ver sus respuestas.
Esperamos que aproveche esta oportunidad para contarnos sobre sus experiencias cuando estuvo internado en este hospital. Usted puede decidir si quiere participar o no en la encuesta pero entre más gente participe, más reinformación tendremos para mejorar la calidad de los servicios de salud de este hospital.
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 [HOSPITAL NAME] 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 [DATA COLLECTION VENDOR NAME]. ¿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 sobre sus experiencias cuando estuvo internado en {HOSPITAL N AME}. Los resultados de este estudio se van a utilizar para ayudarle a {HOSPITAL NAME} a mejorar la calidad de los servicios de salud 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 sobre sus experiencias cuando estuvo internado en este hospital. Le estoy llamando porque todavía no hemos recibido su cuestionario 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. Usted y otras personas fueron seleccionados al azar (como en una lotería) para representar a la gente que ha estado internada en {HOSPITAL NAME}. Sus respuestas son muy importantes para el estudio.
Usted puede 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. Sus doctores jamás van a saber lo que usted contestó. Las preguntas toman unos 25 minutos. [Para darle las gracias por completar la encuesta, le vamos a mandar una tarjeta de regalo con un valor de $5].
Le voy a hacer preguntas sobre la atención médica que recibió cuando estuvo internado/a en {HOSPITAL NAME} y sobre su opinión sobre {HOSPITAL NAME}. A otras personas que estuvieron internadas en {HOSPITAL NAME} también se les van a hacer estas mismas preguntas. {HOSPITAL NAME} 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 | 2009-07-28 |
| File Created | 2009-06-29 |