MEPS-HC Core Interview

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

Attachment 41 -- HC Event Roster Section

MEPS-HC Core Interview

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

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MEPS FAMES P12R5/P13R3/P14R1 Event Roster (EV) Section

December 8, 2008

Event Roster (EV) Section

BOX_00

======

----------------------------------------------------

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME, PROV.DRFNAM, PROV.LORPNAME |

| (IF EVNT.PROVNUM ^= -1), EVNT.EVNTTYPE (IF SET), |

| EVNT.EVNTBEGM,D (EVNTBEGM ONLY FOR HH), |

| (PRND.BEGREFMM, DD FOR OM), EVNT.EVNTENDM, D (IF |

| EVNT = HS), (PRND.ENDREFMM, DD FOR OM). |

----------------------------------------------------

BOX_01

======

----------------------------------------------------

| IF COMING FROM WITHIN PERSON LOOP IN PROVIDER |

| PROBES, CODE EV01 AUTOMATICALLY BY CAPI WITH THE |

| CORRECT PERSON NAME AND GO TO EV02 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH EV01 |

----------------------------------------------------

EV01

====

INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.

[1. First Name,[Middle Name],Last Name-65] ...

[2. First Name,[Middle Name],Last Name-65] ...

[3. First Name,[Middle Name],Last Name-65] ...

[Code One]

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_SELECTONE |

| |

| COL # 1 HEADER: PERSON-TYPE-PROVIDER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: THIS ITEM DISPLAYS THE |

| RU-MEMBERS-ROSTER FOR SELECTION OF RU MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. INTERVIEWER MAY SELECT ONE |

| FROM THE LISTED MEMBERS. |

| |

| 2. MULTIPLE SELECT DISALLOWED. |

| |

| 3. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| NONE. DISPLAY ALL. |

----------------------------------------------------

EV02

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

INTERVIEWER: WHAT TYPE OF EVENT IS IT?

HOSPITAL STAY ......................... HS {BOX_02}

HOSPITAL EMERGENCY ROOM ............... ER {BOX_02}

HOSPITAL OUTPATIENT DEPARTMENT ........ OP {BOX_02}

MEDICAL PROVIDER VISIT ................ MV {BOX_02}

DENTAL CARE ........................... DN {BOX_02}

HOME HEALTH ........................... HH {EV06}

OTHER MEDICAL EXPENSES ................ OM

INSTITUTIONAL/LONG TERM CARE STAY ..... IC {BOX_02}

HELP AVAILABLE FOR DEFINITION OF EVENT TYPES.

[Code One]

----------------------------------------------------

| IF ROUNDS 3 OR 5 AND EV02 IS CODED ‘OM’, GO TO |

| EV02A |

----------------------------------------------------

| IF ROUNDS 1, 2, OR 4 AND EV02 IS CODED ‘OM’, |

| GO TO EV03 |

----------------------------------------------------

BOX_02

======

----------------------------------------------------

| ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT |

----------------------------------------------------

| AT COMPLETION OF THE PV SECTION, GO TO BOX_03 |

----------------------------------------------------

EV02A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}

INTERVIEWER: SELECT GROUP TYPE OF OTHER MEDICAL EXPENSE (OM)

EVENT YOU NEED TO ADD:

NOTE: ONLY ONE OM GROUP TYPE MAY BE ADDED AT THIS SCREEN.

REGULAR (GLASSES OR CONTACTS, INSULIN,

OTHER DIABETIC SUPPLIES) .............. 1 {EV03}

ADDITIONAL (E.G., AMBULANCE SERVICES,

ORTHOPEDIC ITEMS, HEARING DEVICES,

MEDICAL EQUIPMENT, ETC.) .............. 2 {EV03A}

[Code One]

EV03

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}

{END-DT}

IF KNOWN, SELECT CORRECT OME ITEM GROUP.

OTHERWISE ASK: Did (PERSON) obtain glasses or contact

lenses, insulin, or other diabetic equipment or supplies

since (START DATE)?

GLASSES OR CONTACT LENSES .............. 1 {BOX_06}

INSULIN ................................ 2 {BOX_06}

OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3 {BOX_06}

[Code All That Apply]

----------------------------------------------------

| IF CODED ‘2’ (INSULIN), ADD ‘INSULIN’ TO |

| PERSON’S-PRESCRIBED-MEDICINES-ROSTER, CREATING |

| NECESSARY RECORDS FOR INSULIN. |

----------------------------------------------------

| IF CODED ‘3’ (OTHER DIABETIC EQUIPMENT OR |

| SUPPLIES), ADD ‘OTHER DIABETIC EQUIP/SUPPLIES’ |

| TO PERSON’S-PRESCRIBED-MEDICINES-ROSTER, CREATING |

| NECESSARY RECORDS FOR ‘OTHER DIABETIC |

| EQUIP/SUPPLIES’. |

----------------------------------------------------

EV03A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} JAN 01

DEC 31

SHOW CARD PP-4A OR PP-12

IF KNOWN, SELECT CORRECT ADDITIONAL OME ITEM GROUP

OTHERWISE ASK: Looking at this card, what type of other

medical expenses did (PERSON) obtain, purchase or rent during

the calendar year {YEAR}?

AMBULANCE SERVICES ....................... 1

ORTHOPEDIC ITEMS ......................... 2

HEARING DEVICES .......................... 3

PROSTHESES ............................... 4

BATHROOM AIDS ............................ 5

MEDICAL EQUIPMENT ........................ 6

DISPOSABLE SUPPLIES ...................... 7

ALTERATIONS/MODIFICATIONS ................ 8

OTHER ................................... 91

[Code All That Apply]

----------------------------------------------------

| (FOR SPECIFICATIONS ONLY, ‘YEAR’ IN PROGRAM IS |

| HARD-CODED.) IF ROUND 3, DISPLAY FIRST YEAR OF |

| PANEL FOR {YEAR}. IF ROUND 5, DISPLAY SECOND |

| YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER) ALONE OR IN COMBINATION |

| WITH ANY OTHER CODES, CONTINUE WITH EV03AOV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_06 |

----------------------------------------------------

EV03AOV

=======

OTHER GROUPING OF OTHER MEDICAL EXPENSES:

[Enter Other Specify] ................ {BOX_06}

REF .................................. -7 {BOX_06}

DK ................................... -8 {BOX_06}

BOX_03

======

----------------------------------------------------

| IF EVENT TYPE IS HS OR IC, CONTINUE WITH EV04 |

----------------------------------------------------

| OTHERWISE, GO TO EV05 |

----------------------------------------------------

EV04

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER

PAIR WITH THE EVENT TYPE (EV).

IF DATES NOT KNOWN, ASK: When (were/was) (PERSON) admitted to

and discharged from (PROVIDER)? Please tell me the dates of

all stays between (START DATE) and (END DATE).

IF NECESSARY, PROBE: On what date did (PERSON) enter

(PROVIDER)? On what date did (PERSON) leave (PROVIDER)?

PROBE: Any other stays?

-------------------------------------------------------

| [Enter Month,Day,Year-4] | [Enter Month,Day,Year-4] |

|---------------------------|---------------------------|

| [Enter Month,Day,Year-4] | [Enter Month,Day,Year-4] |

|---------------------------|---------------------------|

| [Enter Month,Day,Year-4] | [Enter Month,Day,Year-4] |

-------------------------------------------------------

----------------------------------------------------

| DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5, WHERE |

| ‘YEAR’ IS THE CALENDAR YEAR SUBSEQUENT TO THE |

| SECOND YEAR OF THE PANEL. OTHERWISE, USE A NULL |

| DISPLAY. |

----------------------------------------------------

| DISPLAY A RADIO BUTTON ON THE DATE ENTRY SCREEN |

| LABELED ‘CHECK IF STILL IN PROVIDER {OR RELEASED |

| IN {YEAR}}. |

----------------------------------------------------

| ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR |

| THE MONTH. |

----------------------------------------------------

| HARD CHECK: |

| EDIT CHECK: |

| |

| IN ROUND 1 ONLY, ALLOW AN ADMIT DATE ONE YEAR |

| PRIOR TO THE RU MEMBER’S REFERENCE PERIOD START |

| DATE. |

----------------------------------------------------

| GO TO BOX_06 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: PERS_EVNT_ADD_1 |

| |

| COL # 1 HEADER: ADMIT DATE |

| INSTRUCTIONS: DISPLAY EVENT BEGIN DATE |

| (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY) |

| |

| COL # 2 HEADER: DISCHARGE DATE |

| INSTRUCTIONS: DISPLAY EVENT END DATE |

| (EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY) |

| |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE PERSON'S-MEDICAL-EVENTS- |

| ROSTER FOR ADDING BEGIN AND END DATES. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. EDIT AND SELECT DISALLOWED. |

| |

| 2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD |

| RECORD THE EVENT BEGIN AND END DATES. |

| |

| 3. LIMITED DELETE ALLOWED. INTERVIEWER CAN DELETE |

| AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE |

| DELETE IS USED. THAT IS, AS LONG AS THE |

| INTERVIEWER HAS NOT LEFT THE SCREEN, THEY SHOULD |

| BE ABLE TO DELETE AN EVENT ENTERED IN ERROR. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY NO EVENTS ON ROSTER INITIALLY. THIS SCREEN|

| RELATES TO HS AND IC EVENT TYPES (EVNT.EVNTTYPE) |

| ONLY. |

----------------------------------------------------

EV05

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER

PAIR WITH THE EVENT TYPE (EV).

IF DATES NOT KNOWN, ASK: When did (PERSON) visit (PROVIDER)?

Please tell me all the dates between (START DATE) and

(END DATE).

PROBE: Any other dates?

----------------------------

| [Enter Month,Day,Year-4] |

|----------------------------|

| [Enter Month,Day,Year-4] |

|----------------------------|

| [Enter Month,Day,Year-4] |

----------------------------

----------------------------------------------------

| DISPLAY ‘ADD EVENT DATE’, ‘EDIT EVENT DATE’, AND |

| ‘DELETE EVENT DATE’ BUTTONS ON THIS SCREEN. |

----------------------------------------------------

| ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR |

| THE MONTH. |

----------------------------------------------------

| GO TO BOX_06 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: PERS_EVNT_ADD_2 |

| |

| COL # 1 HEADER: EVENT DATE |

| INSTRUCTIONS: DISPLAY EVENT BEGIN DATE |

| (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY) |

----------------------------------------------------

| ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON’S- |

| MEDICAL-EVENTS-ROSTER FOR ADDING EVENT BEGIN |

| DATES. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| THIS ITEM CAN COLLECT ONLY THOSE EVENTS THAT ARE |

| THE SAME PROVIDER, PERSON, AND EVENT TYPE AS THE |

| EVENT BEING ASKED ABOUT. |

| |

| 1. SELECT DISALLOWED. |

| |

| 2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD |

| RECORD THE EVENT BEGIN DATES. |

| |

| 3. LIMITED DELETE ALLOWED. INTERVIEWER CAN DELETE |

| AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE |

| DELETE IS USED. THAT IS, AS LONG AS THE |

| INTERVIEWER HAS NOT LEFT THE SCREEN, THEY SHOULD |

| BE ABLE TO DELETE AN EVENT ENTERED IN ERROR. |

| |

| 4. LIMITED EDIT ALLOWED. INTERVIEWER CAN EDIT AN |

| EVENT THAT WAS ENTERED ON THE SCREEN WHERE EDIT |

| IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS |

| NOT LEFT THE SCREEN, THEY SHOULD BE ABLE TO EDIT |

| AN EVENT. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY NO EVENTS ON ROSTER INITIALLY. |

----------------------------------------------------

EV06

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}

{END-DT}

Thinking about the health care (PERSON) received at home, was

the person who provided the care a friend or neighbor,

a relative, a volunteer, or some type of provider who was paid?

Please do not include health care received from friends

or relatives living here.

PROBE: Do you have a brochure, folder, binder of papers,

telephone listing, or anything which might help?

NOTE: select only one type of provider at this time.

FRIEND/NEIGHBOR ........................ 1 {EV08}

RELATIVE ............................... 2 {EV07}

VOLUNTEER .............................. 3 {EV08}

OTHER-PAID ............................. 4 {EV06A}

VOLUNTEERED: MEAL DELIVERY SERVICE .... 5 {BOX_06}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

[Code One]

----------------------------------------------------

| IF CODED ‘5’ (VOLUNTEERED: MEAL DELIVERY SERVICE),|

| DO NOT CREATE AN EVENT RECORD. |

----------------------------------------------------

EV06A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}

{END-DT}

Did this person work for a home health agency, hospital, or

nursing home or did they work for themselves?

PROBE: Do you have a brochure, folder, binder of papers,

telephone listing, or anything which might help?

WORKED FOR AGENCY, HOSPITAL, OR

NURSING HOME ........................... 1 {BOX_04}

WORKED FOR SELF ........................ 2 {BOX_04}

REF ................................... -7 {BOX_04}

DK .................................... -8 {BOX_04}

[Code One]

EV07

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}

{END-DT}

What is the relationship of the relative who provided home

care services to (PERSON)?

IF MORE THAN ONE DAUGHTER/DAUGHTER-IN-LAW/SON/SON-IN-LAW, CODE

ONLY ONE AT THIS TIME AND TREAT EACH AS A SEPARATE HOME HEALTH

EVENT.

INCLUDE ALL OTHER TYPES OF RELATIVES AS ONE GROUP AND CODE

‘OTHER-RELATIVE’ ONLY ONE TIME.

DAUGHTER ............................... 1 {BOX_04}

DAUGHTER-IN-LAW ........................ 2 {BOX_04}

SON .................................... 3 (BOX_04}

SON-IN-LAW ............................. 4 {BOX_04}

OTHER RELATIVE ......................... 5 {EV07OV1}

[Code One]

EV07OV1

=======

CODE RELATIONSHIPS OF ALL DIFFERENT TYPES OF RELATIVES WHO

PROVIDED HOME CARE SERVICES SINCE (START DATE) TO (PERSON).

MOTHER ................................. 1

FATHER ................................. 2

SISTER ................................. 3

BROTHER ................................ 4

GRANDPARENT ............................ 5

GRANDCHILD ............................. 6

AUNT/UNCLE ............................. 7

NIECE/NEPHEW ........................... 8

COUSIN ................................. 9

OTHER ................................. 91

REF ................................... -7

DK .................................... -8

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

[Code All That Apply]

----------------------------------------------------

| FOR SPECIFICATION PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘RF’ OR ‘DK’ IN COMBINATION WITH ANY OTHER |

| CODE. |

----------------------------------------------------

| IF EV07OV1 IS CODED ‘91’ (OTHER) ALONE OR IN |

| COMBINATION WITH ANY OTHER CODES, CONTINUE WITH |

| EV07OV2 |

----------------------------------------------------

| OTHERWISE, GO TO EV08 |

----------------------------------------------------

EV07OV2

=======

OTHER:

[Enter Other Specify] .................. {EV08}

REF ................................... -7 {EV08}

DK .................................... -8 {EV08}

EV08

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}

{END-DT}

How many different {friends or neighbors/volunteers/relatives,

other than daughters, daughters-in-law, sons, and sons-in-law}

provided home care services for (PERSON) since (START DATE)?

[Enter Number-2] ....................... {BOX_05}

REF ................................... -7 {BOX_05}

DK .................................... -8 {BOX_05}

----------------------------------------------------

| DISPLAY ‘friends or neighbors’ IF EV06 IS CODED |

| ‘1’ (FRIEND/NEIGHBOR). DISPLAY ‘volunteers’ IF |

| EV06 IS CODED ‘3’ (VOLUNTEER). DISPLAY ‘relatives,|

| other than daughters, daughters-in-law, sons, and |

| sons-in-law’ IF EV07 IS CODED ‘5’ |

| (OTHER-RELATIVE). |

----------------------------------------------------

| IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR): |

| |

| - ADD ‘FRIEND/NEIGHBOR’ TO THE |

| RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- |

| PROVIDER NAME COLUMN. NO ADDRESS INFORMATION |

| IS NECESSARY. |

| |

| - FLAG PROVIDER AS ‘INFORMAL’. |

----------------------------------------------------

| IF EV06 IS CODED ‘3’ (VOLUNTEER): |

| |

| - ADD ‘VOLUNTEER’ TO THE |

| RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- |

| PROVIDER NAME COLUMN. NO ADDRESS INFORMATION |

| IS NECESSARY. |

| |

| - FLAG PROVIDER AS ‘INFORMAL’. |

----------------------------------------------------

| IF EV07 IS CODED ‘5’ (OTHER RELATIVE): |

| |

| - ADD ‘OTHER RELATIVE’ TO THE |

| RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- |

| PROVIDER NAME COLUMN. NO ADDRESS INFORMATION |

| IS NECESSARY. |

| |

| - FLAG PROVIDER AS ‘INFORMAL’. |

----------------------------------------------------

BOX_04

======

----------------------------------------------------

| ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT |

----------------------------------------------------

| AT COMPLETION OF THE PV SECTION, CONTINUE WITH |

| BOX_05 |

----------------------------------------------------

BOX_05

======

----------------------------------------------------

| IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’ |

| (VOLUNTEER) AND ROUND 1, GO TO EV12 |

----------------------------------------------------

| IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’ |

| (VOLUNTEER) AND NOT ROUND 1, GO TO EV13 |

----------------------------------------------------

| IF EV06 IS CODED ‘2’ (RELATIVE), FLAG PROVIDER |

| JUST COLLECTED IN PV SECTION AS ‘INFORMAL’ AND |

| GO TO EV13 |

----------------------------------------------------

| IF EV06A IS CODED ‘2’ (WORKED FOR SELF), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW), FLAG PROVIDER |

| JUST COLLECTED IN PV SECTION AS ‘PAID INDEPENDENT’|

| AND GO TO EV10 |

----------------------------------------------------

| IF EV06A IS CODED ‘1’ (WORKED FOR AGENCY, |

| HOSPITAL, OR NURSING HOME), FLAG PROVIDER JUST |

| COLLECTED IN PV SECTION AS ‘AGENCY’ AND |

| CONTINUE WITH EV09 |

----------------------------------------------------

EV09

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

How many people from (PROVIDER) provided home care services for

(PERSON)?

[Enter Number-2] ......................

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF ROUND 1, GO TO EV12 |

----------------------------------------------------

| OTHERWISE, GO TO EV13 |

----------------------------------------------------

EV10

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

Is (PROVIDER) a companion, a professional homemaker, a home

health or nurse’s aide, a health professional, or something

else?

PROBE: Health professionals include people like nurses, social

workers, therapists of any type.

COMPANION .............................. 1

DOMESTIC WORKER/HOUSE CLEANER .......... 2

HEALTH PROFESSIONAL .................... 3 {EV11}

HOMEMAKER .............................. 4

HOME HEALTH AIDE ....................... 5

NURSE’S AIDE ........................... 6

PERSONAL CARE ATTENDANT ................ 7

OTHER ................................. 91 {EV10OV}

REF ................................... -7

DK .................................... -8

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

----------------------------------------------------

| IF EV10 NOT CODED ‘3’ (HEALTH PROFESSIONAL), OR |

| ‘91’ (OTHER), AND ROUND 1, GO TO EV12 |

| OTHERWISE, GO TO EV13 |

----------------------------------------------------

EV10OV

======

OTHER:

[Enter Other Specify] .................

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF ROUND 1, GO TO EV12 |

----------------------------------------------------

| OTHERWISE, GO TO EV13 |

----------------------------------------------------

EV11

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

What type of health professional is (PROVIDER)?

DIETITIAN/NUTRITIONIST ................. 1

HOME HEALTH AIDE ....................... 2

HOSPICE WORKER ......................... 3

I.V./INFUSION THERAPIST ................ 4

MEDICAL DOCTOR ......................... 5

NURSE/NURSE PRACTITIONER ............... 6

NURSE’S AIDE ........................... 7

OCCUPATIONAL THERAPIST ................. 8

PERSONAL CARE ATTENDANT ................ 9

PHYSICAL THERAPIST .................... 10

RESPIRATORY THERAPIST ................. 11

SOCIAL WORKER ......................... 12

SPEECH THERAPIST ...................... 13

OTHER ................................. 91 {EV11OV}

REF ................................... -7

DK .................................... -8

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

----------------------------------------------------

| IF EV11 NOT CODED ‘91’ (OTHER), AND ROUND 1, |

| GO TO EV12 |

----------------------------------------------------

| IF EV11 NOT CODED ‘91’ (OTHER), AND ROUNDS 2-5, |

| GO TO EV13 |

----------------------------------------------------

EV11OV

======

OTHER:

[Enter Other Specify] ..................

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF ROUND 1, CONTINUE WITH EV12 |

----------------------------------------------------

| OTHERWISE, GO TO EV13 |

----------------------------------------------------

EV12

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

Did {someone from} (PROVIDER) ever provide home care services

for (PERSON) before January 1, {YEAR}?

YES .................................... 1 {EV13}

NO ..................................... 2 {EV13}

REF ................................... -7 {EV13}

DK .................................... -8 {EV13}

----------------------------------------------------

| DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST |

| CALENDAR YEAR OF PANEL. |

----------------------------------------------------

EV13

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER......} {EV} {STR-DT}

{END-DT}

{Last time we recorded that (PERSON) received home care

services from (PROVIDER) during some part of {PRV RD INTV MTH}.

Did (PERSON) continue to receive home care services from

(PROVIDER) during the rest of {PRV RD INTV MTH}?}

Did {someone from} (PROVIDER) provide home care services for

(PERSON) during the month of (MONTH)?

How about in (MONTH)?

YES NO REF DK

EV13_01

=======

{MONTH} 1 2 -7 -8

EV13_02

=======

{MONTH} 1 2 -7 -8

EV13_03

=======

{MONTH} 1 2 -7 -8

EV13_04

=======

{MONTH} 1 2 -7 -8

----------------------------------------------------

| DISPLAY FIRST PARAGRAPH IF A HOME HEALTH EVENT FOR|

| THE MONTH OF THE PREVIOUS ROUND’S INTERVIEW |

| FOR THIS PERSON-PROVIDER PAIR WAS CREATED DURING |

| THE PREVIOUS ROUND. (HOWEVER, IT WOULD NOT HAVE |

| BEEN ASKED ABOUT.) OTHERWISE, USE A NULL DISPLAY.|

| |

| DISPLAY THE MONTH OF THE PREVIOUS ROUND’S |

| INTERVIEW DATE FOR ‘{PRV RD INTV MTH}’. |

| |

| DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| EV13 SCREEN DISPLAY SPECIFICATIONS: |

| |

| 1. THE NUMBER AND NAMES OF THE MONTHS LISTED ARE |

| DETERMINED BY THE NUMBER OF MONTHS BETWEEN THE |

| MONTH OF THE START DATE AND THE MONTH OF THE |

| END DATE FOR THIS PERSON. FOR EXAMPLE, IF THE |

| START DATE IS JANUARY 1 AND THE END DATE IS |

| APRIL 10 FOR THIS PERSON’S REFERENCE PERIOD, |

| ‘JANUARY’, 'FEBRUARY', 'MARCH', AND ‘APRIL’ |

| ARE DISPLAYED. THAT IS, THE MONTHS ARE ALL THE|

| MONTHS OF THE PERSON’S REFERENCE PERIOD. |

| |

| 2. ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ARE |

| ALLOWED FOR EV13_01, EV13_02, EV13_03, AND |

| EV13_04. HOWEVER, THEY WILL BE TREATED AS A |

| ‘NO’ WHEN CREATING EVENTS. |

| |

| 3. THE MONTHS ARE DISPLAYED IN GRID FORMAT WITH |

| YES/NO/DK/RF RADIO BUTTONS. |

| |

| 4. EV13 HAS TO ACCOMMODATE AT LEAST 10 MONTHS. |

| |

| 5. A SEAM MONTH WILL BE ASKED ONLY ONE HOME |

| HEALTH UTILIZATION SECTION WHENEVER IT |

| RECEIVES (OR RECEIVED) A CODE OF ‘1’ (YES) IN |

| EITHER THE CURRENT ROUND OR THE PREVIOUS ROUND.|

| |

| MESSAGE: IF CURRENT INTERVIEW MONTH IS CODED ‘1’ |

| (YES), DISPLAY THE FOLLOWING MESSAGE: “HOME |

| HEALTH UTILIZATION SEC FOR {INT MONTH} WILL NOT |

| BE ASKED UNTIL NEXT ROUND.” |

| |

| EACH MONTH CODED ‘1’ (YES) BECOMES A SEPARATE HOME|

| HEALTH EVENT FOR THIS PERSON-PROVIDER PAIR. |

| HOWEVER, IF THE CURRENT INTERVIEW MONTH IS CODED |

| ‘1’ (YES), IT WILL NOT BE ASKED ABOUT UNTIL THE |

| NEXT ROUND. IF THE MONTH OF THE PREVIOUS ROUND’S |

| INTERVIEW DATE IS CODED ‘1’ (YES), IT IS ASKED |

| ONE TIME. THAT IS, IT IS NOT A SEPARATE EVENT FOR|

| BOTH THE PREVIOUS ROUND AND THIS ROUND, IT IS |

| ONLY ONE EVENT. |

----------------------------------------------------

| HARD CHECK: |

| EDIT: CAPI REQUIRES A RESPONSE FOR EACH MONTH |

| DISPLAYED. ALL MONTHS DURING THE REFERENCE PERIOD|

| CANNOT BE CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ |

| (DON’T KNOW). IF ALL ARE, WVS ERROR HANDLER WILL |

| FORCE THE INTERVIEWER TO RECTIFY THE DATA. |

----------------------------------------------------

BOX_06

======

----------------------------------------------------

| RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN PP |

| OR ED. |

----------------------------------------------------

10-21

File Type	application/msword
File Title	MEPS Event Roster - P12R5/P13R3/P14R1
Subject	EV Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-09
File Created	2009-07-09