2012 CSBS Process Documentation Form

Attachment 5

CSBS Process Documentation Form

Process Documentation Form for the 2012 Case-Surveillance-Based Sampling (CSBS) Demonstration Project of the Medical Monitoring Project (MMP)

Do not use in field until July 2012

VERSION 1.1.0

This survey is intended for completion by CSBS staff only and not for administration to the public. _____________________________________________________________________________________________

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

Atlanta, GA 30333

2012 CSBS Process Documentation Form

Process Indicators(P) 3

General notes for QDS programmer (additional programming notes are located throughout the questionnaire):

1. Use version 2.4 of QDS.

2. Every question requires a response to move forward in the application unless otherwise noted.

3. Use the following values: .D = 8, .R = 7, NA = 6.

4. For all “other-specify” variables in “check all that apply” questions, use the “other” variable name (which should end in “O”) and add an “S” on the end. If the variable name becomes too long, then drop the letter immediately preceding the consecutive letter at the end of the main part of the variable name. For example, if the “other” variable is named “KINDG_9O”(where KIND is the stem variable name and G denotes the lettered response option) the “specify” variable should be named “KING_9OS”

5. QDS programming notes are not included in the application; they are merely there to help with coding.

6. Interviewer instructions and inconsistency checks are notes for the interviewers, but may also include coding instructions.

7. Code book should have a brief description of the variable. This includes all calculated variables.

8. Calculate version number using variable name VERSION.

9. Calculate data collection cycle using variable name PCYCYR. PCYCYR = 2012/2013.

10. For all date variables also create an automatic variable that is a copy of the date variable. For example, if the variable for date was called DATE, then the automatic variable would look like: a. variable name: TXFORM, b. type of date: String Expression, c. numeric calculation/string expression: DATE

11. Calculate time to conduct each module.

12. Add a calculated variable PMODE to distinguish between HAPI and CAPI users.

Process Indicators(P)

Interviewer instructions: Enter Preliminary Information prior to interview.

P1a. Participant ID [PARID]:

Site ID [PSITEID] ___ ___ ___ ___

Respondent ID [PINDID] ___ ___ ___ ___

QDS programming note for P1a: Please put P1a and P1b on separate screens so that the information may not be simply copied.

QDS programming note for P1a: Site ID, and Respondent ID must be 4 digits with leading 0s. [PARID] is a 12 digit calculated variable based on [PSITEID] +”0000”+ [PINDID]. “0000” is used to fill the space formerly held by the facility ID.

P1b. Confirm Site ID [PSITEID2] ___ ___ ___ ___

Confirm Respondent ID [PINDID2] ___ ___ ___ ___

Inconsistency check: [PSITEID] and [PSITEID2] must be the same to advance. [PINDID] and [PINDID2] must be the same to advance.

P2a. Interviewer ID: ___ ___ ___

[PINTID]

QDS programming note for P2a: Range 0-999

P2b. Handheld and computer device ID: ___ ___ ___

[PDEVICID]

QDS programming note for P2b: Range 0-999

P3. Was this person also selected for standard MMP? [SELMMPC2]

No  0

Yes  1

Don’t Know  8

P4a. Were any of the patient addresses in eHARS the sampled person’s current address or the address of someone who knew how to locate the sampled person? [RTADDC2]

No  0

Yes  1

Don’t Know  8

P4b. Were any of the patient phone numbers in eHARS the sampled person’s current phone number or the phone number of someone who knew how to locate the sampled person?

[RTPHNC2]

No  0

Yes  1

Don’t Know  8

P5. Were any of the facilities in eHARS one of the sampled person’s current care facilities? [RTFACC2]

No/Person not in care  0

Yes  1

Don’t Know  8

P6. In which of the following places did you look for contact information for this person? [CHECK ALL THAT APPLY]:

eHARS  1 [CKCOC2A]

Care facility associated with this person  2 [CKCOC2B]

Ryan White clinical database/CareWare  3 [CKCOC2C]

ADAP lists  4 [CKCOC2D]

Pharmacy records  5 [CKCOC2E]

Medicare database  6 [CKCOC2F]

Medicaid database  7 [CKCOC2G]

Other clinical database (Specify:______) [CKC2H_OS]  8 [CKCOC2H]

STD or partner services database  9 [CKCOC2I]

Prison or jail database  10 [CKCOC2J]

Lexis-Nexis/Accurint  11 [CKCOC2K] Department of Motor Vehicles Records  12 [CKCOC2L]

Integrated disease surveillance system database  13 [CKCOC2M]

Other internet-based data source (Specify:______)

[CKC2N_OS]  14[CKCOC2N]

Other non-internet-based data source

(Specify:__________) [CKC2O_OS]  15 [CKCOC2O]

Interview Complete

P7. Did you make contact with the sampled person?: [MADECOC2]

No  0

Yes  1

QDS programming note for P7: If [MADECOC2] = No, please display the interview complete message.

P8. In which of the following places did you find the correct contact information for this person or information that led to the correct contact information? [CHECK ALL THAT APPLY]:

eHARS  1 [FDCOC2A]

Care facility associated with this person  2 [FDCOC2B]

Ryan White clinical database/CareWare  3 [FDCOC2C]

ADAP lists  4 [FDCOC2D]

Pharmacy records  5 [FDCOC2E]

Medicare database  6 [FDCOC2F]

Medicaid database  7 [FDCOC2G]

Other clinical database (Specify:______) [FDC2H_OS]  8 [FDCOC2H]

STD or partner services database  9 [FDCOC2I]

Prison or jail database  10 [FDCOC2J]

Lexis-Nexis/Accurint  11 [FDCOC2K] Department of Motor Vehicles Records  12 [FDCOC2L]

Integrated disease surveillance system database  13 [FDCOC2M]

Other internet-based data source (Specify:______)

[FDC2N_OS]  14[FDCOC2N]

Other non-internet-based data source

(Specify:__________) [FDC2O_OS]  15 [FDCOC2O]

QDS programming note for P8: Please show only a list of options selected in P6 (where did you look for contact information).

P9. Was the sampled person aware of his or her HIV diagnosis prior to contact?: [KNEWDXC2]

No  0

Yes  1

Don’t Know  8

P10. Were staff from a health facility associated with the sampled person involved in contacting the person? [FACCONC2]

No  0

Yes  1

Interview Complete

QDS programming note for Interview Complete: Display message: “You have finished the last process indicator question. Are you sure you want to end the survey.” Options: “Yes” or “No”. If no, allow the program to return to question.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	OMB Number: 0920-0740
Author	Centers for Disease Control & Prevention
File Modified	0000-00-00
File Created	2021-02-03