MEPS-HC Core Interview

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

Attachment 56 -- HC Priority Conditions Enumeration Section

MEPS-HC Core Interview

OMB: 0935-0118

Document [doc]
Download: doc | pdf

MEPS FAMES P12R5/R13R3/P14R1 Priority Conditions Enumeration (PE) Section

December 8, 2008

Priority Conditions Enumeration (PE) Section




BOX_00A

=======


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

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME, {PRND.BEGREFMM, |

| PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, |

| PRND.ENDREFDD, PRND.ENDREFYY}. |

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




LOOP_01

=======


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

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK PE00A-END_LP01 |

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


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

| LOOP DEFINITION: LOOP_01 COLLECTS GENERAL HEALTH |

| RATINGS AND ENUMERATES THE PRIORITY HEALTH |

| CONDITIONS OF EACH PERSON IN THE RU. THIS LOOP |

| CYCLES ON EACH PERSON IN THE RU-MEMBERS-ROSTER |

| WHO MEETS THE FOLLOWING CONDITIONS: |

| |

| - PERSON IS A CURRENT OR INSTITUTIONALIZED RU |

| MEMBER |

| - PERSON IS NOT DECEASED |

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



PE00A

=====


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

{END-DT}


Please think about (PERSON)'s health between (START DATE) and

(END DATE).


In general, compared to other people of (PERSON)'s age, would

you say that (PERSON)'s health is excellent, very good, good,

fair, or poor?


EXCELLENT .............................. 1 {PE00B}

VERY GOOD .............................. 2 {PE00B}

GOOD ................................... 3 {PE00B}

FAIR ................................... 4 {PE00B}

POOR ................................... 5 {PE00B}

REF ................................... -7 {PE00B}

DK .................................... -8 {PE00B}


[Code One]




PE00B

=====


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

{END-DT}


In general, would you say that (PERSON)'s mental health is

excellent, very good, good, fair, or poor?


EXCELLENT .............................. 1 {BOX_00}

VERY GOOD .............................. 2 {BOX_00}

GOOD ................................... 3 {BOX_00}

FAIR ................................... 4 {BOX_00}

POOR ................................... 5 {BOX_00}

REF ................................... -7 {BOX_00}

DK .................................... -8 {BOX_00}


[Code One]


BOX_00

======


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

| IF: |

| - ROUND 1, 3 OR 5 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| |

| CONTINUE WITH PE01 |

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


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

| OTHERWISE, GO TO END_LP01 |

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




PE01

====


{PERSON'S FIRST MIDDLE AND LAST NAME}


Now I’m going to ask you about certain medical conditions (PERSON)

may have had. For these questions, please think about (PERSON)’s

health over (his/her) lifetime.


PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.




BOX_01

======


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

| IF PERSON IS > OR = 18 YEARS OF AGE OR IN AGE |

| CATEGORIES 4-9, CONTINUE WITH BOX_02 |

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


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

| OTHERWISE, GO TO BOX_14 |

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



BOX_02

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘HYPERTENSION - HI BLOOD PRESSURE’ IN THE PE |

| SECTION, |

| |

| CONTINUE WITH PE02 |

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


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

| OTHERWISE, GO TO BOX_03 |

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




PE02

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


{Other than during pregnancy, (have/has)/(Have/Has)} (PERSON)

ever been told by a doctor or other health professional that

(PERSON) had hypertension, also called high blood pressure?


YES .................................... 1 {PE03}

NO ..................................... 2 {BOX_03}

REF ................................... -7 {BOX_03}

DK .................................... -8 {BOX_03}


HELP AVAILABLE FOR DEFINITION OF HYPERTENSION.


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

| DISPLAY ‘Other than during pregnancy, (have/has)’ |

| IF PERSON BEING ASKED ABOUT IS FEMALE. DISPLAY |

| ‘(Have/Has)’ IF PERSON BEING ASKED ABOUT IS MALE. |

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


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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘HYPERTENSION - HI BLOOD PRESSURE’ TO PERSON’S- |

| MEDICAL-CONDITIONS-ROSTER. |

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

PE03

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the hypertension, also called

high blood pressure, was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {PE04}

REF ................................... -7 {PE04}

DK .................................... -8 {PE04}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




PE04

====


{PERSON'S FIRST MIDDLE AND LAST NAME}


(Were/Was) (PERSON) told on two or more different visits

that (PERSON) had hypertension, also called high blood pressure?


YES .................................... 1 {BOX_03}

NO ..................................... 2 {BOX_03}

REF ................................... -7 {BOX_03}

DK .................................... -8 {BOX_03}



BOX_03

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘CORONARY HEART DISEASE’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE05 |

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


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

| OTHERWISE, GO TO BOX_04 |

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




PE05

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had coronary heart disease?


YES .................................... 1 {PE06}

NO ..................................... 2 {BOX_04}

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

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



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘CORONARY HEART DISEASE’ TO PERSON’S-MEDICAL- |

| CONDITIONS-ROSTER. |

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



PE06

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the coronary heart disease

was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_04}

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

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



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_04

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘ANGINA’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE07 |

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


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

| OTHERWISE, GO TO BOX_05 |

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



PE07

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had angina, also called angina

pectoris?


YES .................................... 1 {PE08}

NO ..................................... 2 {BOX_05}

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

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



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘ANGINA’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER. |

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




PE08

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the angina, also called angina

pectoris, was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_05}

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

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



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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



BOX_05

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘HEART ATTACK - MYOCARDIAL INFARC’ IN THE PE |

| SECTION, |

| |

| CONTINUE WITH PE09 |

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


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

| OTHERWISE, GO TO BOX_06 |

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




PE09

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had a heart attack, also called

myocardial infarction or MI?


YES .................................... 1 {PE10}

NO ..................................... 2 {BOX_06}

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

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



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘HEART ATTACK - MYOCARDIAL INFARC’ TO PERSON’S- |

| MEDICAL-CONDITIONS-ROSTER. |

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



PE10

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the heart attack, also called

myocardial infarction or MI, was first diagnosed?


IF MORE THAN ONE HEART ATTACK, PROBE FOR AGE WHEN FIRST HEART

ATTACK DIAGNOSED.


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_06}

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

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



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_06

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘OTHER HRT COND – {SPECIFY TEXT}’ IN THE PE |

| SECTION, |

| |

| CONTINUE WITH PE11 |

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


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

| OTHERWISE, GO TO BOX_07 |

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



PE11

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had any other kind of heart condition

or heart disease, other than coronary heart disease, angina, or

heart attack?


YES .................................... 1 {PE11OV}

NO ..................................... 2 {BOX_07}

REF ................................... -7 {BOX_07}

DK .................................... -8 {BOX_07}



PE11OV

======


What did the doctor or other health professional call it?


[Enter Other Specify-45] ............... {PE12}

REF .................................... -7 {PE12}

DK ..................................... -8 {PE12}


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

| IF CODED ‘1’ (YES) AT PE11, ADD THE PRIORITY |

| CONDITION ‘OTH HRT COND - {SPECIFY TEXT.....}’ TO |

| PERSON’S-MEDICAL-CONDITIONS-ROSTER. USE THE FIRST|

| 17 CHARACTERS OF THE OTHER SPECIFY TEXT ENTERED AT|

| PE11OV AS PART OF THE CONDITION NAME. |

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


PE12

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the other kind of heart

condition, that is the {OTHER HEART CONDITION SPECIFY TEXT},

was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_07}

REF ................................... -7 {BOX_07}

DK .................................... -8 {BOX_07}



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

| FOR ‘OTHER HEART CONDITION SPECIFY TEXT’, DISPLAY |

| THE TEXT ENTERED AT PE11OV. |

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


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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_07

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘STROKE-TIA’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE13 |

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


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

| OTHERWISE, GO TO BOX_08 |

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



PE13

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had a stoke or TIA? A TIA is a

transient ischemic attack which is sometimes referred to as a

ministroke.


YES .................................... 1 {PE14}

NO ..................................... 2 {BOX_08}

REF ................................... -7 {BOX_08}

DK .................................... -8 {BOX_08}



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘STROKE-TIA’ TO PERSON’S-MEDICAL-CONDITIONS- |

| ROSTER. |

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




PE14

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the stroke or TIA was first

diagnosed?


IF MORE THAN ONE STROKE, PROBE FOR AGE WHEN FIRST STROKE

DIAGNOSED.


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_08}

REF ................................... -7 {BOX_08}

DK .................................... -8 {BOX_08}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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



BOX_08

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘EMPHYSEMA’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE15 |

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


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

| OTHERWISE, GO TO BOX_09 |

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




PE15

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had emphysema?


YES .................................... 1 {PE16}

NO ..................................... 2 {BOX_09}

REF ................................... RF {BOX_09}

DK .................................... -8 {BOX_09}



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘EMPHYSEMA’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER.|

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



PE16

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the emphysema was first

diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_09}

REF ................................... -7 {BOX_09}

DK .................................... -8 {BOX_09}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_09

======


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

| IF: |

| - ROUND 1, 3 OR 5 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| |

| CONTINUE WITH PE17 |

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


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

| OTHERWISE, GO TO BOX_10 |

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


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

| NOTE THAT WHETHER THE PERSON HAS BEEN DIAGNOSED |

| WITH ‘CHRONIC BRONCHITIS’ IN THE PAST 12 MONTHS IS|

| ASKED IN ROUNDS 3 AND 5 EVEN IF PERSON REPORTED |

| ‘CHRONIC BRONCHITIS’ IN A PREVIOUS ROUND. |

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

PE17

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


During the past 12 months, (have/has) (PERSON) been told by a

doctor or other health professional that (PERSON) had chronic

bronchitis?


Please do not include isolated instances of acute bronchitis.


YES .................................... 1

NO ..................................... 2 {BOX_10}

REF ................................... -7 {BOX_10}

DK .................................... -8 {BOX_10}


HELP AVAILABLE FOR DEFINITION OF ACUTE AND CHRONIC BRONCHITIS.



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

| IF CODED ‘1 (YES) AND: |

| - ROUND 1, 2, OR 4 |

| OR |

| - THE PRIORITY CONDITION ‘CHRONIC BRONICHITIS’ NOT|

| REPORTED IN A PREVIOUS ROUND IN THE PE SECTION, |

| ADD THE PRIORITY CONDITION ‘CHRONIC BRONCHITIS’ |

| TO PERSON’S-MEDICAL-CONDITIONS ROSTER. |

| |

| IF CODED ‘1’ (YES) AND: |

| - ROUND 3 OR 5 |

| AND |

| - THE PRIORITY CONDITION ‘CHRONIC BRONCHITIS’ |

| REPORTED IN A PREVIOUS ROUND IN THE PE SECTION, |

| THE PRIORITY CONDITION ‘CHRONIC BRONCHITIS’ SHOULD|

| BE FLAGGED AS ‘SELECTED’ THIS ROUND (WITH THE |

| ROUND STATUS). |

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


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

| IF: |

| - PE17 IS CODED ‘1’ (YES) |

| AND |

| - ROUND 1 OR [NOT ROUND 1 AND PE18 NOT ASKED IN A |

| PREVIOUS ROUND] |

| |

| CONTINUE WITH PE18 |

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


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

| OTHERWISE, GO TO BOX_10 |

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

PE18

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the chronic bronchitis was

first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_10}

REF ................................... -7 {BOX_10}

DK .................................... -8 {BOX_10}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_10

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘HIGH CHOLESTEROL’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE19 |

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


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

| OTHERWISE, GO TO BOX_11 |

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



PE19

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had high cholesterol?


YES .................................... 1 {PE20}

NO ..................................... 2 {BOX_11}

REF ................................... -7 {BOX_11}

DK .................................... -8 {BOX_11}



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘HIGH CHOLESTEROL’ TO PERSON’S-MEDICAL-CONDITIONS-|

| ROSTER. |

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




PE20

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the high cholesterol was first

diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_11}

REF ................................... -7 {BOX_11}

DK .................................... -8 {BOX_11}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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



BOX_11

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘CANCER – {ANY TYPE}’ AT PE22 OR PE22OV, |

| |

| CONTINUE WITH PE21 |

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


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

| OTHERWISE, GO TO BOX_12 |

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




PE21

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had cancer or a malignancy of any

kind?


YES .................................... 1 {PE22}

NO ..................................... 2 {BOX_12}

REF ................................... -7 {BOX_12}

DK .................................... -8 {BOX_12}



PE22

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


What kind of cancer was it?


IF RESPONDENT DOESN’T KNOW OR REFUSES THE KIND OF CANCER, SELECT

OTHER’ AND THEN SELECT ‘DON’T KNOW’ OR ‘REFUSAL.’


CHECK ALL THAT APPLY.


BLADDER ................................ 1

BLOOD .................................. 2

BONE ................................... 3

BRAIN .................................. 4

BREAST ................................. 5

CERVIX ................................. 6

COLON .................................. 7

ESOPHAGUS .............................. 8

GALLBLADDER ............................ 9

KIDNEY ................................ 10

LARYNX-WINDPIPE ....................... 11

LEUKEMIA .............................. 12

LIVER ................................. 13

LUNG .................................. 14

LYMPHOMA .............................. 15

MELANOMA .............................. 16

MOUTH/TONGUE/LIP ...................... 17

OVARY ................................. 18

PANCREAS .............................. 19

PROSTATE .............................. 20

RECTUM ................................ 21

SKIN NON-MELANOMA ..................... 22

SKIN DK WHAT KIND ..................... 23

SOFT TISSUE MUSCLE OR FAT ............. 24

STOMACH ............................... 25

TESTIS ................................ 26

THROAT-PHARYNX ........................ 27

THYROID ............................... 28

UTERUS ................................ 29

OTHER ................................. 91 {PE22OV}



[Code All That Apply]



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

| HARD CHECK: |

| EDITS: IF PE22 IS CODED ‘6’ (CERVIX), ‘18’ |

| (OVARY), OR ‘29’ (UTERUS), CHECK THAT PERSON IS |

| FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: |

| “CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.”|

| |

| IF PE22 IS CODED ‘20’ (PROSTATE) OR ‘26’ (TESTIS),|

| CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE |

| FOLLOWING MESSAGE: “CODE UNAVAILABLE FOR FEMALES.|

| VERIFY AND RE-ENTER.” |

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


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

| FOR EACH TYPE OF CANCER SELECTED AT PE22, ADD THE |

| PRIORITY CONDITION ‘CANCER-{SPECIFY TYPE........}’|

| TO PERSON’S-MEDICAL-CONDITIONS-ROSTER, WHERE |

| ‘SPECIFY TYPE’ IS THE NAME OF THE CANCER TYPE |

| SELECTED. SINCE THE LENGTH OF THE CONDNAM IS |

| LIMITED TO 30 CHARACTERS, ABBREVIATE ‘SOFT TISSUE’|

| OPTION TO ‘CANCER - SOFT TISSUE MUSCL/FAT’. FOR |

| EACH TYPE OF CANCER SELECTED, CREATE A CONDITION |

| AND CONDITION-BY-ROUND RECORD. |

| |

| REFUSED AND DON’T KNOW DISALLOWED. INTERVIEWER |

| MUST SELECT ‘91’ (OTHER) AND ENTER THE APPROPRIATE|

| TEXT STRING. |

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


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

| IF ‘OTHER’ SELECTED ALONE OR IN COMBINATION WITH |

| ANY OTHER RESPONSE, CONTINUE WITH PE22OV |

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


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

| OTHERWISE, GO TO LOOP_02 |

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



PE22OV

======


{PERSON’S FIRST MIDDLE AND LAST NAME}


SPECIFY OTHER TYPE OF CANCER:


[Enter Other Specify-23] .............. {LOOP_02}

REF ................................... -7 {LOOP_02}

DK .................................... -8 {LOOP_02}



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

| ALLOW UP TO 23 CHARACTERS FOR THIS FIELD. |

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


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

| ADD THE PRIORITY CONDITION ‘CANCER - {OTHER |

| SPECIFY}’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER. |

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


LOOP_02

=======


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

| FOR EACH ELEMENT IN PERSON’S-MEDICAL-CONDITIONS |

| ROSTER, ASK PE23-END_LP02 |

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


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

| LOOP DEFINITION: LOOP_02 CYCLES ON EACH TYPE OF |

| CANCER ENUMERATED AT PE22 OR PE22OV FOR PERSON. |

| LOOP_02 COLLECTS THE AGE THE CANCER WAS DIAGNOSED |

| AND WHETHER IT IS IN REMISSION. THIS LOOP CYCLES |

| ON EACH CONDITION IN PERSON’S-MEDICAL-CONDITIONS- |

| ROSTER THAT MEETS THE FOLLOWING CONDITIONS: |

| |

| - CONDITION WAS CREATED AT PE22 OR PE22OV IN THE |

| CURRENT ROUND |

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




PE23

====


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

CONDITION.}


How old (were/was) (PERSON) when the (CONDITION) was first

diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {PE25}

REF ................................... -7 {PE25}

DK .................................... -8 {PE25}



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

| {PERSON’S MEDICAL CONDITION}: IN THE HEADER, |

| DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR |

| PE22OV THAT IS CURRENTLY BEING CYCLED ON IN |

| LOOP_02. |

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


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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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



PE24

====

OMITTED.




PE25

====


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

CONDITION.}


Is (PERSON)’s (CONDITION) in remission, that is, the (CONDITION)

is under control?


YES .................................... 1 {END_LP02}

NO ..................................... 2 {END_LP02}

REF ................................... -7 {END_LP02}

DK .................................... -8 {END_LP02}


HELP AVAILABLE FOR DEFINITION OF REMISSION.



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

| {PERSON’S MEDICAL CONDITION}: IN THE HEADER, |

| DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR |

| PE22OV THAT IS CURRENTLY BEING CYCLED ON IN |

| LOOP_02. |

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




END_LP02

========


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

| CYCLE ON NEXT CONDITION IN PERSON’S-MEDICAL- |

| CONDITIONS-ROSTER THAT MEETS THE CONDITIONS STATED|

| IN THE LOOP DEFINITION |

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


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

| IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS,|

| END LOOP_02 AND CONTINUE WITH BOX_12 |

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




BOX_12

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘DIABETES’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE26 |

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


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

| OTHERWISE, GO TO BOX_13 |

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




PE26

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


{Other than during pregnancy, (have/has)/(Have/Has)} (PERSON)

ever been told by a doctor or other health professional that

(PERSON) had diabetes or sugar diabetes?


YES .................................... 1 {PE27}

NO ..................................... 2 {BOX_13}

REF ................................... -7 {BOX_13}

DK .................................... -8 {BOX_13}


HELP AVAILABLE FOR DEFINITION OF DIABETES.



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

| DISPLAY ‘Other than during pregnancy, (have/has)’ |

| IF PERSON BEING ASKED ABOUT IS FEMALE. DISPLAY |

| ‘(Have/Has)’ IF PERSON BEING ASKED ABOUT IS MALE. |

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


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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘DIABETES’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER. |

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



PE27

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the diabetes or sugar diabetes

was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_13}

REF ................................... -7 {BOX_13}

DK .................................... -8 {BOX_13}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_13

======


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

| IF: |

| - ROUND 1, 3 OR 5 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| |

| CONTINUE WITH PE28 |

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


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

| OTHERWISE, GO TO BOX_14 |

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


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

| NOTE THAT WHETHER THE PERSON HAS HAD JOINT PAIN |

| IN THE LAST 12 MONTHS IS ASKED IN ROUNDS 3 AND 5 |

| EVEN IF PERSON REPORTED JOINT PAIN IN THE PE |

| SECTION IN A PREVIOUS ROUND. |

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

PE28

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) had pain, aching, stiffness or swelling

around a joint in the past 12 months?


YES .................................... 1

NO ..................................... 2

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

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



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

| IF: |

| - ROUND 1, 2, OR 4 |

| OR |

| - ROUND 3 OR 5 AND THE PRIORITY CONDITION |

| ‘ARTHRITIS’ (OF ANY KIND) NOT REPORTED IN A |

| PREVIOUS ROUND IN THE PE SECTION, |

| |

| CONTINUE WITH PE29 |

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


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

| OTHERWISE, GO TO BOX_14 |

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



PE29

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) had arthritis?


YES .................................... 1 {PE30}

NO ..................................... 2 {BOX_14}

REF ................................... -7 {BOX_14}

DK .................................... -8 {BOX_14}



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

| IF PE28 IS CODED ‘1’ (YES) AND PE29 IS CODED ‘2’ |

| (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) AND ONE|

| OF THE FOLLOWING IS TRUE: |

| - ROUND 1, 2, OR 4 |

| OR |

| - ROUND 3 OR 5 AND THE PRIORITY CONDITION ‘JOINT |

| PAIN’ NOT REPORTED IN A PREVIOUS ROUND IN THE |

| PE SECTION |

| ADD THE PRIORITY CONDITION ‘JOINT PAIN’ TO THE |

| PERSON’S-MEDICAL-CONDITIONS-ROSTER |

| |

| IF PE28 IS CODED ‘1’ (YES) AND PE29 IS CODED ‘2’ |

| (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) IN |

| ROUND 3 OR 5 AND THE PRIORITY CONDITION ‘JOINT |

| PAIN’ REPORTED IN A PREVIOUS ROUND IN THE PE |

| SECTION, THE PRIORITY CONDITION ‘JOINT PAIN’ |

| SHOULD BE FLAGGGED AS ‘SELECTED’ THIS ROUND |

| (WITH ROUND STATUS). |

| |

| (NOTE THAT CONDITION RECORD FOR ARTHRITIS IS NOT |

| CREATED HERE BUT AT PE30.) |

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



PE30

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


What type of arthritis was that?


PROBE: (Were/Was) (PERSON) diagnosed with rheumatoid arthritis

or osteoarthritis?


CODE ‘NOT SPECIFIED’ IF RESPONDENT DOES NOT KNOW THE TYPE

OF ARTHRITIS.


RHEUMATOID ARTHRITIS ................... 1 {PE31}

OSTEOARTHRITIS ......................... 2 {PE31}

NOT SPECIFIED .......................... 3 {PE31}

REF ................................... -7 {PE31}


[Code One]


HELP AVAILAIBLE FOR DEFINITION OF RHEUMATOID ARTHRITIS AND

OSTEOARTHRITIS.



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

| IF CODED ‘1’ (RHEUMATOID ARTHRITIS), ADD THE |

| PRIORITY CONDITION ‘RHEUMATOID ARTHRITIS’ TO |

| PERSON’S-MEDICAL-CONDITIONS-ROSTER. |

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


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

| IF CODED ‘2’ (OSTEOARTHRITIS), ADD THE PRIORITY |

| CONDITION ‘OSTEOARTHRITIS’ TO PERSON’S-MEDICAL- |

| CONDITIONS-ROSTER. |

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


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

| IF CODED ‘3’ (NOT SPECIFIED) OR ‘-7’ (REFUSED), |

| ADD THE PRIORITY CONDITION ‘ARTHRITIS (NOT |

| SPECIFIED)’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER.|

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


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

| CODE ‘-8’ (DON’T KNOW) DISALLOWED. |

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



PE31

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the {rheumatoid arthritis/

osteoarthritis/arthritis} was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_14}

REF ................................... -7 {BOX_14}

DK .................................... -8 {BOX_14}



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

| DISPLAY ‘rheumatoid arthritis’ IF PE30 IS CODED |

| ‘1’ (RHEUMATOID ARTHRITIS). DISPLAY |

| ‘osteoarthritis’ IF PE30 IS CODED ‘2’ |

| (OSTEOARTHRITIS). DISPLAY ‘arthritis’ IF PE30 IS |

| CODED ‘3’ (NOT SPECIFIED) OR ‘-7’ (REFUSED). |

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


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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_14

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘ASTHMA’ IN THE PE SECTION, |

| |

| CONTINUE WITH PE32 |

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


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

| OTHERWISE, GO TO BOX_15 |

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



PE32

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


(Have/Has) (PERSON) ever been told by a doctor or other health

professional that (PERSON) (have/has) asthma?


YES .................................... 1 {PE33}

NO ..................................... 2 {BOX_15}

REF ................................... -7 {BOX_15}

DK .................................... -8 {BOX_15}


HELP AVAILABLE FOR DEFINITION OF ASTHMA.



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘ASTHMA’ TO PERSON’S-MEDICAL-CONDITIONS-ROSTER. |

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




PE33

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the asthma was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {BOX_15}

REF ................................... -7 {BOX_15}

DK .................................... -8 {BOX_15}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




BOX_15

======


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

| IF: |

| - ROUND 1, 3 OR 5 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| |

| CONTINUE WITH BOX_16 |

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


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

| OTHERWISE, GO TO BOX_17 |

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




BOX_16

======


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

| IF ‘ASTHMA’ (COLLECTED IN PE SECTION IN ANY ROUND)|

| ON PERSON’S-MEDICAL-CONDITIONS-ROSTER, CONTINUE |

| WITH PE33A |

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


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

| OTHERWISE, GO TO BOX_17 |

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



PE33A

=====


{PERSON’S FIRST MIDDLE AND LAST NAME}


{During an earlier interview, it was mentioned that (PERSON)

(have/has) asthma.} (Do/Does) (PERSON) still have asthma?


YES .................................... 1 {PE34}

NO ..................................... 2 {PE34}

REF ................................... -7 {PE34}

DK .................................... -8 {PE34}


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

| DISPLAY ‘During an earlier interview, it…’ IF |

| ASTHMA WAS ADDED DURING A PREVIOUS ROUND. |

| OTHERWISE (ASTHMA ADDED FOR PERSON IN THE CURRENT |

| ROUND), USE A NULL DISPLAY. |

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




PE34

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


During the past 12 months, (have/has) (PERSON) had an episode

of asthma or an asthma attack?


YES .................................... 1 {BOX_17}

NO ..................................... 2

REF ................................... -7 {BOX_17}

DK .................................... -8 {BOX_17}


HELP AVAILABLE FOR DEFINITION OF ASTHMA ATTACK.



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

| IF: |

| - PE34 IS CODED ‘2’ (NO) |

| AND |

| - ROUND 1 OR NOT ROUND 1 AND PE35 NOT ASKED IN A |

| PREVIOUS ROUND |

| |

| CONTINUE WITH PE35 |

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


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

| OTHERWISE, GO TO BOX_17 |

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

PE35

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


When did (PERSON) last have an episode of asthma or an asthma

attack?


WITHIN PAST 2 YEARS .................... 1 {BOX_17}

WITHIN PAST 3 YEARS .................... 2 {BOX_17}

WITHIN PAST 5 YEARS .................... 3 {BOX_17}

MORE THAN 5 YEARS ...................... 4 {BOX_17}

NEVER .................................. 5 {BOX_17}

REF ................................... -7 {BOX_17}

DK .................................... -8 {BOX_17}


[Code One]




BOX_17

======


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

| IF PERSON IS 5 - 17 YEARS OF AGE INCLUSIVE OR IN |

| AGE CATEGORIES 3 OR 4, CONTINUE WITH BOX_18 |

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


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

| OTHERWISE, GO TO END_LP01 |

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



BOX_18

======


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

| IF: |

| - ROUND 1 |

| OR |

| - ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- |

| ROSTER DURING THE CURRENT ROUND |

| OR |

| - ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A |

| PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH |

| ‘ATTEN DEFICIT/HYPERACTIVITY’ IN THE PE |

| SECTION, |

| |

| CONTINUE WITH PE36 |

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


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

| OTHERWISE, GO TO END_LP01 |

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




PE36

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


Have you or (PERSON) ever been told by a doctor or other health

professional that (PERSON) had Attention Deficit Hyperactivity

Disorder (ADHD) or Attention Deficit Disorder (ADD)?


YES .................................... 1 {PE37}

NO ..................................... 2 {END_LP01}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}



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

| IF CODED ‘1’ (YES), ADD THE PRIORITY CONDITION |

| ‘ATTEN DEFICIT/HYPERACTIVITY’ TO PERSON’S-MEDICAL-|

| CONDITIONS-ROSTER. |

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




PE37

====


{PERSON’S FIRST MIDDLE AND LAST NAME}


How old (were/was) (PERSON) when the Attention Deficit

Hyperactivity Disorder (ADHD) or Attention Deficit Disorder

(ADD) was first diagnosed?


IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.


[Enter Age-3] ......................... {END_LP01}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}



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

| HARD CHECK: |

| RANGE CHECK: 0 TO PERSON’S CURRENT AGE |

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




END_LP01

========


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

| CYCLE ON NEXT PERSON IN RU-MEMBERS-ROSTER WHO |

| MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION|

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


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

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_01 AND CONTINUE WITH BOX_19 |

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




BOX_19

======


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

| GO TO NEXT QUESTIONNAIRE SECTION |

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


4-37

File Typeapplication/msword
File TitleMEPS Priority Conditions Enumeration - P12R5/P13R3/P14R1
SubjectPE Section Item Specifications
AuthorAgency for Healthcare Research and Quality
Last Modified Bywcarroll
File Modified2009-07-10
File Created2009-07-10

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