595 2012 595 Compare Web Sites Nov 27 2012

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Overview

Welcome and Thank You Text
Current Model Qsts
Current CQs

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
Medicare Compare Web Sites
MID:	New Measure - DOT will fill in
Date:	11/27/2012
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting our web site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.
					Thank You Text Example
	DEFAULT Thank You Text
	“Thank you for taking our survey - and for helping us serve you better. We appreciate your input!”
	ALTERNATE WEB Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 2: Current Model Qsts

Model Instance Name:
Medicare Compare Web Sites
MID:		New Measure - DOT will fill in
Partitioned (Y/N)?		Yes
NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.
Date:		11/27/2012
Medicare Compare Web Sites
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Information (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
		Please rate the amount of information provided.			What is your overall satisfaction with the compare web site? (1=Very Dissatisfied, 10=Very Satisfied)			How likely are you to recommend the compare web site to someone else?
		Please rate the usefulness of the information provided.			How well does the compare web site meet your expectations? (1=Falls Short, 10=Exceeds)			Use Medicare.gov (1=Very Unlikely, 10=Very Likely)
		Please rate your perception of the accuracy of the information on this compare web site.			How does the Medicare quality compare web site compare to your idea of an ideal comparison web site? (1=Not Very Close, 10=Very Close)			How likely are you to visit Medicare.gov (Medicare's web site) for future Medicare-related needs?
		Results(1=Poor, 10=Excellent, Don't Know)						Trust
		Please rate how well the results provided match your request.						I can count on Medicare to act in my best interests. (=1 Very Unlikely, 10=Very Likely)
		Please rate the relevance of the results to your specific needs.						I consider Medicare to be trustworthy. (=1 Very Unlikely, 10=Very Likely)
		Please rate the listing/ranking order of compare web site results.						Medicare can be trusted to do what is right. (=1 Very Unlikely, 10=Very Likely)
		Look & Feel (1=Poor, 10=Excellent, Don't Know)
		Please rate the visual appeal of the compare web site.
		Please rate the balance of graphics and text on the compare web site.
		Please rate the readability of the pages on the compare web site.
		Process (1=Poor, 10=Excellent, Don't Know)
		Please rate the how well this web site streamlines the process of finding information.
		Please rate the features available for finding information.
		Please rate how well this web site minimizes the amount of time needed to get useful information.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
		Please rate how quickly pages load.
		Please rate the consistency of speed from page to page.
		Please rate the ability to load pages without getting error messages.

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Sheet 3: Current CQs

Model Instance Name:			red & strike-through: DELETE
Medicare Compare Web Sites			underlined & italicized: RE-ORDER
MID:	New Measure - DOT will fill in		pink: ADDITION
Date:	11/27/2012		blue + -->: REWORDING
Medicare Compare Web Sites CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label	Compare Web Sites
		Which Quality Compare Web Site did you use today?	Nursing Home Compare	A, B, C	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Compare Web Site
			Hospital Compare	P, Q
			Home Health Compare	EE, FF, GG, HH
			Dialysis Facility Compare	UU, VV
	A	What best describes your role in using the Nursing Home Compare?	Consumer		Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH Role	Nursing Home Compare
			Caregiver (family member or friend)
			Caregiver (paid)
			Nursing Home staff member	D
			Discharge Planner
			Researcher
			Other Health Care Provider
			Other (please specify:)	E
	E	What other role best describes you while using the Nursing Home Compare?			Text field, <100 char		N	Skip Logic Group*	NH Other_Role	Nursing Home Compare
	D	Have you ever used information from Nursing Home Compare to inform an internal quality review or improvements?	Yes	F	Radio button, one-up vertical	Single	Y		NH Inform Improv	Nursing Home Compare
			No
	F	What information did you use? Please be specific about your experience.			Text area, no char limit		N	Skip Logic Group*	NH Information Used	Nursing Home Compare
	B	What was your primary purpose in visiting Nursing Home Compare today?	Choose a Nursing Home for myself or a family member	G, H, I	Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH Purpose	Nursing Home Compare
			Research Nursing Homes for myself or family members, but not choose one today.	G, H, I
			Download data about Nursing Homes	M, N
			Other (please specify:)	P
	P	What was your other primary purpose in visiting Nursing Home Compare?			Text area, no char limit		N	Skip Logic Group*	NH Other_Purpose	Nursing Home Compare
	G	How helpful was the information you found on Nursing Home Compare in your choice and research?	1 = Very helpful		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	NH Helpful	Nursing Home Compare
			2
			3
			4	J
			5 = Not very helpful / Very unhelpful	J
	J	What would have made the information more helpful?			Text area, no char limit		N	Skip Logic Group*	NH More Helpful	Nursing Home Compare
	H	Does the information on Nursing Home Compare give you a full picture of the quality of the Nursing Homes?	Yes	K	Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH Picture	Nursing Home Compare
			No	L
	K	What was most helpful in determining quality?			Text area, no char limit		N	Skip Logic Group*	NH Most Helpful	Nursing Home Compare
	L	What information should be added to give a more complete picture of quality?			Text area, no char limit		N	Skip Logic Group*	NH Info Added	Nursing Home Compare
	I	Based on your experience with Nursing Home Compare, how confident are you about choosing a Nursing Home using this information?	1 = Very confident		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	NH Confident	Nursing Home Compare
			2
			3
			4
			5 = Not very confident
	M	When you accessed the data, did you:	Download the database from the site.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH Access Data	Nursing Home Compare
			Access the data using data.medicare.gov
	N	Have you ever used data.medicare.gov to access data?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH data.medicare	Nursing Home Compare
			No, but I know that it’s available
			No, and I didn’t know that the data was available through data.medicare.gov
	C	Have you ever used another web site to compare Nursing Home quality?	Yes	O	Radio button, one-up vertical	Single	Y	Skip Logic Group*	NH Another Web site	Nursing Home Compare
			No, but I am aware of other web sites that compare Nursing Home quality.
			No, and I was not aware of other web sites that compare Nursing Home quality.
	O	Which web site did you use?			Text area, no char limit		N	Skip Logic Group*	NH Other_Web site	Nursing Home Compare
	P	What best describes your role in using the Hospital Compare?	Consumer		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Role	Hospital Compare
			Caregiver (family member or friend)
			Caregiver (paid)
			Hospital staff member	R, S
			Physician	R, S
			Researcher	R, S
			Other Health Care Provider	R, S
			Other (please specify:)	T
	T	What other role best describes you while using the Hospital Compare?			Text field, <100 char		N	Skip Logic Group*	Hosp Other_Role	Hospital Compare
	R	In your visit to Hospital Compare, did you:	Review only one measure set or measure.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Measures	Hospital Compare
			Review multiple measure sets.
	S	Have you ever used information from Hospital Compare to inform an internal quality review or improvements?	Yes	U	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Inform Improv	Hospital Compare
			No
	U	What information did you use? Please be specific about your experience.			Text area, no char limit		N	Skip Logic Group*	Hosp Information Used	Hospital Compare
	Q	What was your primary purpose in visiting Hospital Compare today?	Choose a Hospital for myself or a family member	V, W, X	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Purpose	Hospital Compare
			Research Hospitals for myself or family members, but not choose one today.	V, W, X
			Download data about Hospitals	BB, CC
			Other (please specify:)	DD
	DD	What was your other primary purpose in visiting Hospital Compare?			Text area, no char limit		N	Skip Logic Group*	Hosp Other_Purpose	Hospital Compare
	V	How helpful was the information you found on Hospital Compare in your choice and research?	1 = Very helpful		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	Hosp Helpful	Hospital Compare
			2
			3
			4	Y
			5 = Not very helpful / Very unhelpful	Y
	Y	What would have made the information more helpful?			Text area, no char limit		N	Skip Logic Group*	Hosp More Helpful	Hospital Compare
	W	Does the information on Hospital Compare give you a full picture of the quality of Hospitals?	Yes	Z	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Picture	Hospital Compare
			No	AA
	Z	What was most helpful in determining quality?			Text area, no char limit		N	Skip Logic Group*	Hosp Most Helpful	Hospital Compare
	AA	What information should be added to give a more complete picture of quality?			Text area, no char limit		N	Skip Logic Group*	Hosp Info Added	Hospital Compare
	X	Based on your experience with Hospital Compare, how confident are you about choosing a Hospital using this information?	1 = Very confident		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	Hosp Confident	Hospital Compare
			2
			3
			4
			5 = Not very confident
	BB	When you accessed the data, did you:	Download the database from the site.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp Access Data	Hospital Compare
			Access the data using data.medicare.gov
	CC	Have you ever used data.medicare.gov to access data?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Hosp data.medicare	Hospital Compare
			No, but I know that it’s available
			No, and I didn’t know that the data was available through data.medicare.gov
	EE	What best describes your role in using the Home Health Compare?	Consumer		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Role	Home Health Compare
			Caregiver (family member or friend)
			Caregiver (paid)
			Home Health Agency staff member	II
			Discharge Planner
			Researcher
			Other Health Care Provider
			Other (please specify:)	KK
	KK	What other role best describes you while using the Home Health Compare?			Text field, <100 char		N	Skip Logic Group*	HH Other_Role	Home Health Compare
	II	Have you ever used information from Home Health Compare to inform an internal quality review or improvements?	Yes	JJ	Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Inform Improv	Home Health Compare
			No
	JJ	What information did you use? Please be specific about your experience.			Text area, no char limit		N	Skip Logic Group*	HH Information Used	Home Health Compare
	FF	What was your primary purpose in visiting Home Health Compare today?	Choose a Home Health Agency for myself or a family member	LL, MM, NN	Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Purpose	Home Health Compare
			Research Home Health Agencies for myself or family members, but not choose one today.	LL, MM, NN
			Download data about Home Health Agencies	RR, SS
			Other (please specify:)	TT
	TT	What was your other primary purpose in visiting Home Health Compare?			Text area, no char limit		N	Skip Logic Group*	HH Other_Purpose	Home Health Compare
	LL	How helpful was the information you found on Home Health Compare in your choice and research?	1 = Very helpful		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	HH Helpful	Home Health Compare
			2
			3
			4	OO
			5 = Not very helpful / Very unhelpful	OO
	OO	What would have made the information more helpful?			Text area, no char limit		N	Skip Logic Group*	HH More Helpful	Home Health Compare
	MM	Does the information on Home Health Compare give you a full picture of the quality of Home Health Agencies?	Yes	PP	Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Picture	Home Health Compare
			No	QQ
	PP	What was most helpful in determining quality?			Text area, no char limit		N	Skip Logic Group*	HH Most Helpful	Home Health Compare
	QQ	What information should be added to give a more complete picture of quality?			Text area, no char limit		N	Skip Logic Group*	HH Info Added	Home Health Compare
	NN	Based on your experience with Home Health Compare, how confident are you about choosing a Home Health Agency using this information?	1 = Very confident		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	HH Confident	Home Health Compare
			2
			3
			4
			5 = Not very confident
	RR	When you accessed the data, did you:	Download the database from the site.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Access Data	Home Health Compare
			Access the data using data.medicare.gov
	SS	Have you ever used data.medicare.gov to access data?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH data.medicare	Home Health Compare
			No, but I know that it’s available
			No, and I didn’t know that the data was available through data.medicare.gov
	GG	In your visit to Home Health Compare, did you:	Compare Patient Survey Results for Home Health Agencies		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Measures	Home Health Compare
			Compare Quality Measures for Home Health Agencies
			Compare both Patient Survey Results and Quality Measures for Home Health Agencies
			Compare neither Patient Survey Results nor Quality Measures for Home Health Agencies
	HH	When you came to Home Health Compare, were you looking for:	Professional Services, such as a nurse or therapist.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HH Looking For	Home Health Compare
			Custodial Services, such as a companion or home health aide.
			Both Professional Services and Custodial Services.
			Neither Professional Services nor Custodial Services.
	UU	What best describes your role in using the Dialysis Facility Compare?	Consumer		Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF Role	Dialysis Facility Compare
			Caregiver (family member or friend)
			Caregiver (paid)
			Dialysis Facility staff member	XX
			Discharge Planner
			Researcher
			Other Health Care Provider
			Other (please specify:)	WW
	WW	What other role best describes you while using the Dialysis Facility Compare?			Text field, <100 char		N	Skip Logic Group*	DF Other_Role	Dialysis Facility Compare
	XX	Have you ever used information from Dialysis Facility Compare to inform an internal quality review or improvements?	Yes	YY	Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF Inform Improv	Dialysis Facility Compare
			No
	YY	What information did you use? Please be specific about your experience.			Text area, no char limit		N	Skip Logic Group*	DF Information Used	Dialysis Facility Compare
	VV	What was your primary purpose in visiting Dialysis Facility Compare today?	Choose a Home Health Agency for myself or a family member	ZZ, AAA, BBB	Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF Purpose	Dialysis Facility Compare
			Research Home Health Agencies for myself or family members, but not choose one today.	ZZ, AAA, BBB
			Download data about Home Health Agencies	FFF, GGG
			Other (please specify:)	HHH
	HHH	What was your other primary purpose in visiting Dialysis Facility Compare?			Text area, no char limit		N	Skip Logic Group*	DF Other_Purpose	Dialysis Facility Compare
	ZZ	How helpful was the information you found on Dialysis Facility Compare in your choice and research?	1 = Very helpful		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	DF Helpful	Dialysis Facility Compare
			2
			3
			4	CCC
			5 = Not very helpful / Very unhelpful	CCC
	CCC	What would have made the information more helpful?			Text area, no char limit		N	Skip Logic Group*	DF More Helpful	Dialysis Facility Compare
	AAA	Does the information on Dialysis Facility Compare give you a full picture of the quality of Dialysis Facilities?	Yes	DDD	Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF Picture
			No	EEE
	DDD	What was most helpful in determining quality?			Text area, no char limit		N	Skip Logic Group*	DF Most Helpful	Dialysis Facility Compare
	EEE	What information should be added to give a more complete picture of quality?			Text area, no char limit		N	Skip Logic Group*	DF Info Added	Dialysis Facility Compare
	BBB	Based on your experience with Dialysis Facility Compare, how confident are you about choosing a Dialysis Facility using this information?	1 = Very confident		Radio button, scale, no don't know	Single	Y	Skip Logic Group*	DF Confident	Dialysis Facility Compare
			2
			3
			4
			5 = Not very confident
	FFF	When you accessed the data, did you:	Download the database from the site.		Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF Access Data	Dialysis Facility Compare
			Access the data using data.medicare.gov
	GGG	Have you ever used data.medicare.gov to access data?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	DF data.medicare	Dialysis Facility Compare
			No, but I know that it’s available
			No, and I didn’t know that the data was available through data.medicare.gov
		Is this your first time using this Quality Compare Web Site?	Yes		Radio button, one-up vertical	single	Y		First Time
			No
		What is your age?	Under 18		Radio button, one-up vertical	Single	Y		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65 or older
			Prefer not to answer
		Which of the following best describes the highest level of education you have attained?	I have not graduated from high school.		Radio button, one-up vertical	Single	Y		Education
			High school graduate
			Some college, trade, technical or vocational training
			College graduate
			Post graduate degree
			Prefer not to answer
		Where did you learn about this Quality Compare Web Site?	From a Search Engine		Radio button, one-up vertical	Single	Y	Skip Logic Group	Learn of Web Site
			Saw it on the Medicare.gov web site
			Read about it in an article
			Other, please specify	A
	A	Where else did you learn about this?			Text area, no char limit		N	Skip Logic Group	Other_Learn of Web Site
		Did you find the information you were looking for?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Did You Find
			No	S, T
	S	What information were you unable to find?			Text area, no char limit		N	Skip Logic Group	Unable to Find
	T	What will you do next?			Text area, no char limit		N	Skip Logic Group	Do Next
		What was your experience using the Quality Compare Web Site? (Please select all that apply.)	The Quality Compare Web Site met my needs today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Web Site Experience
			Results were not relevant
			Too many results
			Not enough results
			Returned no results
			Got error message(s) / Session timed out
			Speed was too slow
			I encountered a different experience:	F
	F	What other experience did you have while using the Quality Compare Web Site?			Text area, no char limit		N	Skip Logic Group*	Other_Web Site Exp
		If you could change or improve one thing about the Quality Compare Web Site, what would it be?			Text area, no char limit		N		Improvement