Form CMS-10479 Recruitment Script

ATTACHMENT C
SCREENER AND TELEPHONE SCRIPT FOR RECRUITMENT

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TELEPHONE INTRODUCTION
Script for incoming calls. Thank you for responding to our letter. My name is _____________
from The Henne Group. As mentioned in our letter, we are working with RTI International on a
research study funded by the Centers for Medicare and Medicaid Services (CMS) to evaluate the
Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration. The letter asked if you
would be interested in taking part in a focus group.
Script for Henne-initiated calls. May I speak with [BENEFICIARY NAME]? Hello, my name
is _____________ from The Henne Group. We are working with RTI International on a research
study funded by the Centers for Medicare and Medicaid Services (CMS) to evaluate the Multipayer Advanced Primary Care Practice (MAPCP) Demonstration. We recently sent you a letter
asking if you would be interested in participating in a focus group.
Continue for all calls.
FOR BENEFICIARIES: The purpose of these focus groups is to share your experiences
receiving health care services from your primary care provider.
FOR CAREGIVERS: The purpose of these focus groups is to share your experiences with the
health care services provided by the primary care practice for the person for which you care.
ALL:
Your opinions will help us to understand how to improve health care access and coordination for
people who are insured by Medicare and/or Medicaid.
If you are interested in participating in the study and you meet our eligibility requirements, we
will invite you to attend a group interview, sometimes called a focus group, at [INSERT
LOCATION]. The interview will take about two hours of your time, and we will give you a $50
gift card for participating.
May I ask you a few questions to see if you are eligible to participate?
IF YES, CONTINUE TO QUESTION 1 ON NEXT PAGE.
IF NO, THANK AND END.

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SCREENER
[Note: Screener will be tailored based on the information that we have available in the Medicare
claims data (except for caregivers). Medicare claims data will be used to track the mix of
participants’ gender and ethnicity. For Medicaid enrollees, the script includes demographic
questions such as gender and ethnicity because we will not be using claims to recruit these
participants. The script will be tailored to accommodate the situation where potential participants
call The Henne Group, as well as for The Henne Group to call potential participants.]
Since we need to include people who have a mix of different backgrounds and experiences,
there are some questions that I need to ask you to see if you meet the requirements for
participating in the focus group.
1.

Please tell me your full name.
______________________________ [full name of caller]

2.

Are you an adult age 18 or older?
____ Yes → GO TO Q3
____ No → GO TO Q2a
2a. Do you have someone else who helps you with your health decisions or takes
you to doctors’ appointment such as a guardian, parent, or caregiver?
____ Yes →Would this person be interested in speaking with us? We can either speak
with them today or take their number and call them at a later time.
____ No →THANK AND END

3.

Are you calling for yourself or someone you take care of?
____ Caller is the beneficiary → Please tell me your birthdate:
________________________________ (birthdate)→ GO TO Q4
____ Calling for someone else → Please tell me their full name and birthdate:
________________________________ (name)
________________________________ (birthdate)→ GO TO Q3a

[For Medicare and Medicare-Medicaid enrollees, the recruiter will use the birthdate to confirm
that they have identified the correct patient record in the claims database]
3a. Are you the primary caregiver for [beneficiary name]? By primary caregiver, I
mean are you the main person responsible for [beneficiary name]’s healthcare?
____ Yes → GO TO Q4
____ No → THANK AND END
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4.

The focus group will be conducted in English. Are you comfortable understanding
and speaking English?
____ Yes→ GO TO Q5
____ No → THANK AND END

5.

One of the requirements for participating in this research study is that the
participant, [or someone they care for], is insured through Medicare or Medicaid, also
known as [state-specific name]. Can you tell me which of the following types of health
insurance [you / beneficiary name] has? [ASK EACH ONE, EVEN IF THEY
INDICATE ‘YES’ TO ONE QUESTION.]
____ Medicare
____ Medicaid
____ Both Medicare and Medicaid
____ Private insurance → THANK AND END

6.

[For caregivers only:]
6a.

What is your relationship to the beneficiary who received services at [names of
primary care facilities]?
____ Spouse (husband or wife)
____ Child (son or daughter)
____ Parent
____ Friend
____ Other—please describe: ____________________________________________

6b. How often do you go with [beneficiary name] to their primary care practice
and/or provider? Would you say…
____ Always
____ Usually
____ Sometimes→ THANK AND END
____ Seldom→ THANK AND END
____ Never→ THANK AND END
7.

Have you participated in a focus group, sometimes called a group interview, in the
past 12 months?
____ Yes → THANK AND END
____ No
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THE NEXT SET OF QUESTIONS SHOULD BE TAILORED FOR THE ROLE OF THE
POTENTIAL PARTICIPANT, AS THE BENEFICIARY OR AS THE BENEFICIARY THAT
THE CAREGIVER REPRESENTS.
8.

[For Medicaid beneficiaries only] What State do you live in?
____ Maine
____ Minnesota
____ Michigan
____ New York
____ North Carolina
____ Pennsylvania
____ Rhode Island
____ Vermont
____ Other: please describe: _____________________________

9.

[For Medicaid beneficiaries only] Do you attend either of these primary care
practices? [the Henne Group will use the respondent’s State to select the list of
practices where our sample was drawn]
____ State Practice 1 and Address
____ State Practice 2 and Address
____ Not one of the practices listed→ THANK AND END

10.

How long [have you/has beneficiary name] been receiving services from [your/his/her]
current primary care practice? Would you say…
____ Less than one year
____ 1 to 3 years
____ More than 3 years

11.

[For Medicaid beneficiaries only] In the past 12 months, how often did [you
visit/beneficiary name] visit [your/his/her] current primary care practice? Would you
say…
____ 1 time
____ 2 to 6 times
____ 7–12 times
____ More than 12 times
____ Did not visit current primary care practice in past 12 months

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12.

When [you go/beneficiary name goes] to [your/his/her] primary care practice, how
often [do you/does she/he] see the same provider, that is, the same doctor, nurse, or
physician’s assistant? Would you say…
____ Always
____ Most of the time
____ Sometimes
____ Hardly ever
____ Never

13.

[For Medicaid beneficiaries only] [Have you/has beneficiary name] seen a specialist
for treatment or diagnosis, such as a surgeon, heart doctor, allergy doctor, skin
doctor, foot doctor, or others who specialize in specific types of care, in the past 12
months?
____ Yes
____ No
____ Not sure

14.

Chronic conditions are health problems that are continuous and long-lasting. How
many chronic conditions would you say that [you/beneficiary name] currently has?
____ None
____ 1
____ 2
____ 3 or more
____ Not sure

15.

How would you rate [your/beneficiary’s name] overall health, in general? Would you
say…
____ Excellent
____ Very good
____ Good
____ Fair
____ Poor

16.

[For Medicaid beneficiaries only] How many times have [you/beneficiary name]
received care at a hospital, including the emergency room, or an urgent care facility
in the past 12 months? [AT LEAST 25% SHOULD HAVE AT LEAST TWICE.]
________________ [number of times]
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THE NEXT SET OF QUESTIONS FOCUS ON PERSONAL CHARACTERISTICS THAT
HELP US UNDERSTAND THE BACKGROUND OF INDIVIDUALS WHO MAY BE
PARTICIPATING IN THE FOCUS GROUPS.
17.

[For Medicaid beneficiaries and caregivers only] What gender are you?
______ Female
______ Male

18.

[For Medicaid beneficiaries and caregivers only] Which categories, if any, best
describe your race and ethnicity?
______ White
______ Hispanic
______ Asian
______ Black
______ North American Indian or Alaskan Native
______ Other, Please describe: _______________

19.

What is the last or highest grade that you finished in school? DO NOT READ
OPTIONS.
____ High school degree or GED or less [RECRUIT TO GET AT LEAST 25%]
____ Some college, two-year degree or college graduate
____ More than 4-year college degree [RECRUIT TO GET NO MORE THAN 25%]

END OF SCREENER. IF PARTICIPANT MEETS CRITERIA, MOVE ON TO INVITATION
TO PARTICIPATE.

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INVITATION TO PARTICIPATE
Thank you for answering all of my questions. You meet the requirements to participate in
the focus group interview. If you agree to participate, you will be allowed to skip any
questions that you don’t want to answer for any reason. You will not be asked to tell us any
personal information about your medical condition or health status.
Are you interested in participating?
IF YES, CONTINUE
IF NO, THANK AND END
We are conducting the focus group on [TIME AND DATE] at [LOCATION]. Are you
available then? Do you have a way of getting there?
IF YES, CONTINUE
IF NO, THANK AND END
Would you like directions to [LOCATION]?
IF YES, PROVIDE DIRECTIONS OR OFFER TO EMAIL THEM.
I will call you a few days before your appointment to confirm the date, time and location of
your appointment. Again, this should take about two hours of your time. At the end, you
will receive $50 as a thank you for your participation.
Let me mention three additional things:
1.
2.
3.

If you wear reading glasses, please be sure to bring them, as you will be asked to
read some materials during the group interview;
Please be aware that we have a no-smoking policy; and
If you care for children please do not bring them with you because there is no
child-care available at the facility.

Now, let me confirm the spelling of your name, address, and phone number in case we need
to get in touch with you. RECORD RESPONDENT’S INFORMATION
Name: ______________________________ Telephone: _______________________________
Address: ______________________________________________________________________
City, State: _________________________________________ Zip: ______________________
If you have any questions or find that you can’t attend, please call us right away at [phone
number] so that we can find a replacement. Thank you for your time and for agreeing to
help with this important research study.

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