Hospice Experience of Care Survey

Attachment E

Hospice Experience Survey
Telephone Script
Overview
This telephone interview script is provided to assist interviewers while attempting to
reach the caregiver and complete the telephone interview. The script explains the
purpose of the survey.
General Interviewing Conventions and Instructions
• All text that appears in lowercase letters must be read out loud.
• Text in UPPERCASE letters must not be read out loud.
• All questions and all answer categories must be read exactly as they are worded.
• All transitional statements must be read.
• Text that is underlined must be emphasized.
• Characters in < > must not be read.
• [Square brackets] are used to show programming instructions that must not
actually appear on electronic telephone interviewing system screens.
• Only one language (i.e., English or Spanish) will appear on the electronic
interviewing system screen.
• MISSING/DON’T KNOW (DK) is a valid response option for each item in the
electronic telephone interviewing system scripts. This allows the telephone
interviewer to go to the next question if a patient is unable to provide a response
for a given question (or refuses to provide a response).
• Skip patterns will be programmed into the electronic telephone interviewing
system.

Hospice Experience Survey – Telephone Script

Attachment E

INITIATING CONTACT
START

Hello, may I please speak to [SAMPLED CAREGIVER NAME]?
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from the RAND Corporation.
We are working with [HOSPICE NAME] and Medicare to conduct a
survey about hospice care.
IF ASKED WHY WE ARE CALLING ABOUT A HOSPICE SURVEY:
[HOSPICE NAME] gave us [SAMPLED CAREGIVER NAME]’s name
because they were the caregiver for someone who recently received
hospice services.
IF ASKED WHETHER PERSON WHO ANSWERED THE PHONE (IF
NOT THE SAMPLED CAREGIVER) CAN SERVE AS PROXY FOR
SAMPLED CAREGIVER:
For this survey, we need to speak with a person who is knowledgeable
about the hospice care received by [HOSPICE PATIENT NAME].
Would you be able to answer specific questions about [HOSPICE
PATIENT NAME]’s hospice care?
IF THE SAMPLED CAREGIVER IS NOT AVAILABLE:
Can you tell me a convenient time to call back to speak with (him/her)?
IF THE SAMPLED CAREGIVER SAYS THIS IS NOT A GOOD TIME:
If you don’t have the time now, when is a more convenient time to call
you back?
IF THE SAMPLED CAREGIVER HAS COMMENTS CONCERNING THE
ACCURACY OF TIME ESTIMATE(S) OR SUGGESTIONS FOR IMPROVING
THE SURVEY:

Please write to CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 212441850.
<1>
<2>
<3>
<4>

YES [GO TO INTRO]
PROXY IDENTIFIED – [COLLECT PROXY INFORMATION THEN
RETURN TO INTRO]
REFUSED [REFUSAL]
NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]

Hospice Experience Survey – Telephone Script

Attachment E

SPEAKING WITH POSSIBLE RESPONDENT
INTRO

Hi, my name is [INTERVIEWER NAME] and I’m calling from the
RAND Corporation.
IF SPEAKING WITH THE SAMPLED CAREGIVER: We received
your name from [HOSPICE NAME] because you were listed as
the caregiver for [PATIENT NAME].
IF SPEAKING WITH PROXY FOR SAMPLED CAREGIVER: We
received your name from [SAMPLED CAREGIVER] because
he/she indicated that you were knowledgeable about the hospice
care received by [PATIENT NAME].
[HOSPICE NAME] is one of many hospices working with the Centers
for Medicare & Medicaid Services, a federal government agency, and
the RAND Corporation, a private non-profit research company.
Together, we are conducting a survey about the hospice services that
patients and their families receive. The information from this survey
will be used to help ensure that all Americans get the highest quality
hospice care.
We recently sent you a survey in the mail. Did you receive it?
<1> YES – [GO TO INTRO2]
<2> NO – [GO TO INTRO2]
<3> DON’T KNOW/REMEMBER – [GO TO INTRO2]
<4> REFUSE – [GO TO REFUSAL MODULE]

INTRO2

We realize this may be a difficult time for you, but we hope that you will
help us learn about the quality of hospice care by taking a few minutes to
answer some questions about your experiences. The interview will take
less than 20 minutes, and we encourage you to answer only the questions
that you are comfortable responding to.
I’d like to begin the survey now, is this a good time for us to continue?
IF ASKED WHETHER SOMEONE ELSE CAN COMPLETE SURVEY:
For this survey, we need to speak with a person who is knowledgeable
about the hospice care received by [HOSPICE PATIENT NAME].
Would he/she be able to answer specific questions about [HOSPICE
PATIENT NAME]’s hospice care?
<1> YES – [GO TO CONTINUE]

Hospice Experience Survey – Telephone Script

Attachment E

<2> PROXY IDENTIFIED – [COLLECT PROXY INFORMATION THEN
RETURN TO INTRO]
<3> NO WILL RETURN COMPLETED MAILED SURVEY - [GO TO
CALLBACK MODULE]
<4> NO, CALL BACK - [GO TO CALLBACK MODULE]
<5> NO, R UNABLE – [GO TO STANDARD ITEM TO CODE UNABLE, ETC.]
<6> REFUSE – [GO TO REFUSAL MODULE]
CONTINUE We will hold your identifying information and all information you provide in
confidence, and your information is protected by U.S. federal law under
the Privacy Act of 1974. We will not share your information with anyone
other than authorized persons at the Centers for Medicare & Medicaid
Services, except as required by law. We will not share your individual
survey with any hospice. Your help is voluntary, and you do not have to
participate in this survey.
This call may be monitored for quality improvement purposes.
<1> YES – [BEGIN SURVEY]
<2> NO, CALL BACK - [GO TO CALLBACK MODULE]
<3> NO, R UNABLE – [GO TO STANDARD ITEM TO CODE UNABLE, ETC.]
<4> REFUSE – [GO TO REFUSAL MODULE]

Hospice Experience Survey – Telephone Script