Nonsub Change Request - Attachment A

Dental Utilization (DUQ)
Variable Name
MR Screen Name Question type Question text/description
The next questions are about any medical care
[you/(SP)] may have had between (REFERENCE
DATE) and (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION).
DUINT

DUINTRO

no entry

Code list

(Now would be a good time to get out the planner
that [you/(SP)] may have used to record health care
visits or other medical expenses. We will also refer
to any statements you may have received since the
last interview.)

Text Fill Logic

Input mask

Routing

[you] respondent is SP
[(SP)] respondent is proxy
[today] respondent is SP or proxy, SP alive and not institutionalized
[DATE OF DEATH] respondent is proxy, SP deceased
[DATE OF INSTITUTIONALIZATION] respondent is proxy, SP
institutionalized

DU1 - DUPROBE

(01) DU2 PROVIDER_DU
(02) BOX DU6 DU15 DVNEED
(03) DO NOT
DISPLAY. DATA
EDITING ONLY.
(-8) BOX DU6
(-9) BOX DU6

(01-N) BOX DU1
(N+1) DU2BPROVNAME

First we’ll talk about dental care.

(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP
(-8) Don't Know
(-9) Refused

[Since (REFERENCE DATE)] respondent is SP or proxy, SP alive and not
institutionalized
[Between (REFERENCE DATE) and (DATE OF DEATH)] respondent is
proxy, SP deceased
[Between (REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)]
respondent is proxy, SP institutionalized
[you] respondent is SP
[(SP)] respondent is proxy

(01-N) LIST ALL PROVIDERS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

[you] respondent is SP
[(SP)] respondent is proxy

DUPROBE

DU1

yes/no

[Since (REFERENCE DATE)/Between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] go to a
dentist or any other person for dental care? [Dental
providers include dentists, dental surgeons,
endodontists, periodontists, and dental hygienists.]

PROVIDER_DU

DU2

roster

Who did [you/(SP)] see?
SELECT OR ADD ONLY ONE PROVIDER.

DU2B - GRPNAME
PROVSPEC

PROVNAME

DU2B

verbatim text

ENTER THE NAME OF THE PROVIDER AND THE
BILLING GROUP OR PRACTICE NAME BELOW.
NAME:

GRPNAME

DU2B

verbatim text

GROUP:

PROVSPEC

DU2C

code one

What kind of (health practitioner/mental health
professional/therapist/medical person) dental
provider is [PROVNAME]?

(01) GENERAL DENTIST
(02) DENTAL HYGIENIST
(03) DENTAL TECHNICIAN
(04) DENTAL/ORAL SURGEON
(05) ORTHODONTIST
(06) ENDODONTIST
(07) PERIDONTIST
(08) PROSTHODONTIST
(09) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX DU2
(02) BOX DU2
(03) BOX DU2
(04) BOX DU2
(05) BOX DU2
(06) BOX DU2
(07) BOX DU2
(08) BOX DU2
(09) DU2C PROVSPECOTH

(01) DENTIST/DENTAL PROVIDER (DO NOT DISPLAY
(02) MEDICAL DOCTOR
(03) AUDIOLOGIST
(04) CHIROPRACTOR
(05) CLINICAL SOCIAL WORKER
(06) DIETITIAN-NUTRITIONIST
(07) HEARING THERAPIST
(08) HOME HEALTH/HEALTH AIDE
(09) HOMEMAKER
(10) HOSPICE WORKER
(11) I.V. THERAPIST
(12) NURSE (RN)
(13) NURSE PRACTITIONER
(14) NURSE'S AIDE
(15) OCCUPATIONAL THERAPIST (OT)
(16) OPTOMETRIST (OD)
(17) OSTEOPATH (DO)
(18) PARAMEDIC
(19) PHYSICAL THERAPIST (PT)
(20) PHYSICIAN'S ASSISTANT
(21) PODIATRIST (FOOT DOCTOR)
(22) PSYCHOLOGIST
(23) RESPIRATORY THERAPIST
(24) SOCIAL/CASE WORKER
(25) SPEECH THERAPIST
(26) THERAPIST (MENTAL HEALTH)
(27) X-RAY TECHNICIAN
(28) LICENSED PRACTICAL NURSE (LPN)
(29) ACUPUNCTURIST

(01) DO NOT DISPLAY
(02) BOX DU2
(03) BOX DU2
(04) BOX DU2
(05) BOX DU2
(06) BOX DU2
(07) BOX DU2
(08) BOX DU2
(09) BOX DU2
(10) BOX DU2
(11) BOX DU2
(12) BOX DU2
(13) BOX DU2
(14) BOX DU2
(15) BOX DU2
(16) BOX DU2
(17) BOX DU2
(18) BOX DU2
(19) BOX DU2
(20) BOX DU2
(21) BOX DU2
(22) BOX DU2
(23) BOX DU2
(24) BOX DU2
(25) BOX DU2
(26) BOX DU2
(27) BOX DU2
(28) BOX DU2
(29) BOX DU2

(01) [Continuous answer.]

BOX DU2

PROVSPECOTH

DU2C

code one

What kind of (health practitioner/mental health
professional/therapist/medical person) is
[PROVNAME]?

PROVSPOS

DU2D

verbatim text

OTHER MEDICAL PROVIDER (SPECIFY)

BOX DU1

VAPLACE

DU3

BOX DU2

HMOASSOC

HMOREFER

EVENT_DU

NAVIGATOR

DU4

DU5

DU6

DU6_IN

routing

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES
THROUGH V.A. IN THE CURRENT ROUND OR ANY
PREVIOUS ROUND) AND (IF THIS PROVIDER IS
ASSOCIATED WITH V.A. IS UNKNOWN), GO TO DU3 VAPLACE.
ELSE GO TO BOX DU2.

yes/no

(01) YES
Is (PROVIDER NAME) associated with a Department (02) NO
of Veterans Affairs, or V.A., facility?
(-8) Don't Know
(-9) Refused

routing

IF (SP COVERED BY A MANAGED CARE PLAN
ANYTIME DURING THE CURRENT ROUND) AND (IF
THIS PROVIDER IS ASSOCIATED WITH A MANAGED
CARE PLAN IS UNKNOWN), GO TO DU4 HMOASSOC.
ELSE IF (SP COVERED BY A MANAGED CARE PLAN
ANYTIME DURING THE CURRENT ROUND) AND (THIS
PROVIDER IS NOT ASSOCIATED WITH A MANAGED
CARE PLAN), GO TO DU5 - HMOREFER.
ELSE GO TO DU6 - EVENT_DU.

BOX DU2

yes/no

Is (PROVIDER NAME) associated with [your/(SP’s)]
[READ MANAGED CARE PLAN NAME(S) BELOW]
plan?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[your] respondent is SP
[(SP's)] respondent is proxy

(01) DU6 - EVENT_DU
(02) DU5 HMOREFER
(-8) DU5 HMOREFER
(-9) DU5 HMOREFER

yes/no

[Were you/Was (SP)] referred to (PROVIDER NAME)
by [READ MANAGED CARE PLAN NAME(S) BELOW]?
[INCLUDE REFERRALS BY THE SAMPLE PERSON’S
PRIMARY CARE PHYSICIAN (PCP).]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Were you] respondent is SP
[Was (SP)] respondent is proxy

DU6 - EVENT_DU

roster

When did [you/(SP)] see (PROVIDER NAME)? Please
tell me all the dates [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
(01) continuous answer
DEATH/DATE OF INSTITUTIONALIZATION)].
(-8) Don't Know
ENTER ALL DATES.
(-9) Refused
[IF THE RESPONDENT SAW THE SAME PROVIDER
TWICE ON THE SAME DAY, ENTER THE DATE ONLY
ONCE.]

[you] respondent is SP
[(SP)] respondent is proxy
[Since (REFERENCE DATE)] respondent is SP or proxy, SP alive and not
institutionalized
[Between (REFERENCE DATE) and (DATE OF DEATH)] respondent is
proxy, SP deceased
[Between (REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)]
respondent is proxy, SP institutionalized

DU6_IN NAVIGATOR

instance
navigator

(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED

(01) DU9 PRESMDCN DU7 DVPROCDR
(02) DU14 - DUMORE

SHOW CARD DU1
DVPROCDR

DU7

code all

For [your/(SP’s)] [VISIT ON EVENT DATE], what did
[you/(SP)] have done?
CHECK ALL THAT APPLY.

EVOSTEXT

PRESMDCN

PRESFILL

DU7A

DU9

DU10

BOX DU3B

DUPMMEDS

DU10A

(01) GENERAL EXAM, CHECKUP OR CONSULTATION
(02) CLEANING, PROPHYLAXIS, OR POLISHING
(03) X-RAYS, RADIOGRAPHS, OR BITEWINGS
(04) FLUORIDE TREATMENT
(05) SEALANT (PLASTIC COATINGS ON BACK TEETH)
(06) FILLINGS
(07) INLAYS
(08) CROWNS OR CAPS
(09) ROOT CANAL
(10) PERIODONTAL SCALING, ROOT PLANING, OR
GUM SURGERY
(11) PERIODONTAL RECALL VISIT (PERIODIC OR
REGULAR)
(12) EXTRACTION, TOOTH PULLED
(13) IMPLANTS
(14) ABSCESS OR INFECTION TREATMENT
(15) OTHER ORAL SURGERY
(16) FIXED BRIDGES
(17) DENTURES OR REMOVABLE PARTIAL DENTURES
(18) RELINING OR REPAIR OF BRIDGES OR
DENTURES
(19) ORTHODONTIA, BRACES, OR RETAINERS
(20) BOND, WHITEN, OR BLEACH
(21) TREATMENT FOR TMD OR TMJ
(95) OTHER (SPECIFY)
(-8) DON'T KNOW
(-9) REFUSED

OTHER PROCEDURE OR REASON DURING VISIT
(SPECIFY)

(01) [CONTINUOUS ANSWER]

yes/no

Were any medicines prescribed for [you/(SP)]
during (this visit/any of these visits)?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

yes/no

Were any of the prescriptions filled?
[COUNT A MEDICINE AS "FILLED" REGARDLESS OF
WHO OBTAINED IT FOR THE RESPONDENT,
WHETHER OR NOT THE PRESCRIPTION COST
ANYTHING, AND WHETHER OR NOT THE
RESPONDENT ACTUALLY TOOK THE MEDICINE.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

verbatim text

routing

no entry

IF THE PROBE FOR PRESCRIPTION MEDICINE
BOTTLES HAS NOT BEEN ASKED IN THE CURRENT
ROUND, GO TO DU10A - DUPMMEDS.
ELSE GO TO DU11 - MEDICINE_DU.
It would be helpful if I could look at any medicine
bottle(s), container(s), or bag(s) that you have so
that I can spell the medicine name correctly and
enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION
DRUG PLAN NAME) medicine statements, which
should have that same information on them.]
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that
same information for all of the medicines [you/(SP)]
obtained since the last interview, if you’d like to get
those bottles, too.

(01) INSTRUCTION WAS READ

[your] respondent is SP
[(SP's)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy

(01) DU9-PRESMDCN
(02) DU9-PRESMDCN
(03) DU9-PRESMDCN
(04) DU9-PRESMDCN
(05) DU9-PRESMDCN
(06) DU9-PRESMDCN
(07) DU9-PRESMDCN
(08) DU9-PRESMDCN
(09) DU9-PRESMDCN
(10) DU9-PRESMDCN
(11) DU9-PRESMDCN
(12) DU9-PRESMDCN
(13) DU9-PRESMDCN
(14) DU9-PRESMDCN
(15) DU9-PRESMDCN
(16) DU9-PRESMDCN
(17) DU9-PRESMDCN
(19) DU9-PRESMDCN
(20) DU9-PRESMDCN
(21) DU9-PRESMDCN
(22) DU9-PRESMDCN
(95) DU7A-EVOSTEXT

(01) DU9-PRESMDCN
(02) DU9-PRESMDCN
(03) DU9-PRESMDCN
(04) DU9-PRESMDCN
(05) DU9-PRESMDCN
(06) DU9-PRESMDCN
(07) DU9-PRESMDCN
(08) DU9-PRESMDCN
(09) DU9-PRESMDCN
(10) DU9-PRESMDCN
(11) DU9-PRESMDCN
(12) DU9-PRESMDCN
(13) DU9-PRESMDCN
(14) DU9-PRESMDCN
(15) DU9-PRESMDCN
(16) DU9-PRESMDCN
(17) DU9-PRESMDCN
(18) DU9-PRESMDCN
(19) DU9-PRESMDCN
(20) DU9-PRESMDCN
(21) DU9-PRESMDCN
(95) DU7A-EVOSTEXT
(-8) DU9-PRESMDCN
(-9) DU9-PRESMDCN

DU9 - PRESMDCN

[you] respondent is SP
[(SP)] respondent is proxy
[this visit] one visit to provider
[any of these visits] two or more visits to provider

(01) DU10 - PRESFILL
(02) BOX DU4
(-8) BOX DU4
(-9) BOX DU4

(01) BOX DU3B
(02) BOX DU4
(-8) BOX DU4
(-9) BOX DU4

[your] respondent is SP
[(SP's)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy

DU11 MEDICINE_DU

MEDICINE_DU

DUMORE

DVNEED

DU11

roster

BOX DU4

routing

DU14

DU15

Please tell me the names of these medicines.
ENTER ALL MEDICINES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR
SPELLING.
INCLUDE STRENGTH WITH NAME.
GO TO DU6_IN - NAVIGATOR.

(01) continuous answer

yes/no

[Since (REFERENCE DATE)/Between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] have any
other dental care visits to this or any other
provider?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

yes/no

Since (REFERENCE DATE), was there a time when
{you/SP} needed dental care but could not get it at
that time?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

DVNDRS

DU16

code all

(01) COULD NOT AFFORD THE COST
(02) DID NOT WANT TO SPEND THE MONEY
(03) INSURANCE DID NOT COVER RECOMMENDED
PROCEDURES
(04) DENTAL OFFICE IS TOO FAR AWAY
(05) DENTAL OFFICE IS NOT OPEN AT CONVENIENT
TIMES
(06) ANOTHER DENTIST RECOMMENDED NOT
What were the reasons that {you/SP} could not get DOING IT
the dental care {you/she/he} needed?
(07) AFRAID OR DO NOT LIKE DENTISTS
(08) UNABLE TO TAKE TIME OFF FROM WORK
(09) TOO BUSY
(10) I DID NOT THINK ANYTHING SERIOUS WAS
WRONG/EXPECTED DENTAL PROBLEMS TO GO
AWAY
(95) OTHER (SPECIFY)
(-8) DON'T KNOW
(-9) REFUSED

DVNDRSOS

DU16A

verbatim text

WHAT OTHER REASON (SPECIFY)

(01) continuous answer

[Since (REFERENCE DATE)] respondent is SP or proxy, SP alive and not
institutionalized
[Between (REFERENCE DATE) and (DATE OF DEATH)] respondent is
proxy, SP deceased
[Between (REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)]
respondent is proxy, SP institutionalized
[you] respondent is SP
[(SP)] respondent is proxy

(01) DU2 PROVIDER_DU
(02) BOX DU6
(-8) BOX DU6
(-9) BOX DU6

[you] respondent is SP
[(SP)] respondent is proxy

(01) DU16 - DVNDRS
(02) BOX DU6
(-8) BOX DU6
(-9) BOX DU6

[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[she] respondent is proxy, SP is female
[he] respondent is proxy, SP is male

(01) BOX DU6
(02) BOX DU6
(03) BOX DU6
(04) BOX DU6
(05) BOX DU6
(06) BOX DU6
(07) BOX DU6
(08) BOX DU6
(09) BOX DU6
(10) BOX DU6
(95) DU16A DVNDRSOS
(-8) BOX DU6
(-9) BOX DU6

BOX DU6