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pdfUsual Source of Care (USQ)/Patient Perceptions of Integrated Care (PPIC): Sections have been merged and de-duplicated
Variable Name
MR Screen Name
Question type Question text/description
Code list
Text fills
Routing
[you] respondent is SP
[(SP)] respondent is proxy
PLACEPAR
US1
yes/no
Is there a particular medical person or a clinic [you/(SP)] usually [go/goes] to when [you are/he is/she is] sick or for advice about [your/his/her] health?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[go] respondent is SP
[goes] respondent is proxy
[you are] respondent is SP
[he is] respondent is proxy, SP is male
[she is] respondent is proxy, SP is female
(01) US2 - PLACEKND
(02) US39 - NUSNOTSK
(-8) PP57-RATECARE
(-9) PP57-RATECARE
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
What kind of place [do you/does (SP)] usually go to when [you are/he is/she is] sick or for advice about [your/his/her] health -- is that a managed care plan or HMO center, a clinic, a
medical provider's office, a hospital, or some other place?
PLACEKND
US2
code one
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
IF SOME OTHER PLACE, ASK: Where is this?
PLACEOS
PLACEMCP
CLNAME
US2
text
OTHER (SPECIFY)
BOX USB
routing
IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO US2A - PLACEMCP.
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
US2A
yes/no
Is this (medical provider/medical clinic) associated with (your/his/her) [READ MANAGED CARE PLAN NAME(S) BELOW] plan?
BOX USC
routing
IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
US3A
verbatim text
What is the complete name of the [place/managed care plan or HMO center/(US2 RESPONSE)] that [you go to/(SP) goes to)?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD, ETC., FOR COMPLETE INFORMATION.]
(01) DOCTOR'S OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
(05) FREESTANDING SURGICAL CENTER
(06) RURAL HEALTH CLINIC
(07) COMPANY CLINIC
(08) OTHER CLINIC
(09) WALK-IN URGENT CENTER
(10) DOCTOR COMES TO SP'S HOME
(11) HOSPITAL EMERGENCY ROOM
(12) HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
(13) VA FACILITY
(14) MENTAL HEALTH CENTER
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
[do you] respondent is SP
[does (SP)] respondent is proxy
[you are] respondent is SP
[he is] respondent is proxy, SP is male
[she is] respondent is proxy, SP is female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) CONTINUOUS ANSWER
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(01) BOX USB
(02) BOX USB
(03) US3A - CLNAME
(04) US3A - CLNAME
(05) US3A - CLNAME
(06) US3A - CLNAME
(07) US3A - CLNAME
(08) US3A - CLNAME
(09) US3A - CLNAME
(10) US5A - MDNAME
(11) US3A - CLNAME
(12) US3A - CLNAME
(13) US3A - CLNAME
(14) US3A - CLNAME
(91) US2 - PLACEOS
(-8) US3A - CLNAME
(-9) US3A - CLNAME
US3A - CLNAME
[medical provider] If US2 - PLACEKND=1/DoctorsOffice
[medical clinic] If US2 - PLACEKND is not equal to 1/DoctorsOffice
[your] - respondent is SP
[his] -respondent is proxy, SP is male
[her] - respondent is proxy, SP is female
[place] US2 - PLACEKND=DK or RF
[managed care plan or HMO center] US2 - PLACEKND=3/HMO
Else if US2 - PLACEKND=91/Other, display US2 Other specify response, US2 - PLACEOS.
Else display US2 - PLACEKND response.
BOX USC
US4 - USUALDOC
[you go to] respondent is SP
[(SP) goes to] respondent is proxy
[you usually see] respondent is SP
[(SP) usually sees] respondent is proxy
USUALDOC
US4
yes/no
Is there a particular medical provider [you usually see/(SP) usually sees] at this [place/managed care plan or HMO center/(US2 RESPONSE)] ?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
MDNAME
US5A
verbatim text
What is the complete name of that medical provider?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD, ETC., FOR COMPLETE INFORMATION.]
(01) CONTINUOUS ANSWER
US5B-MDSEX
Is (US5A PROVIDER NAME) a male or female?
(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED
US6A - MDSPEC
MDSEX
US5B
code one
[place] US2 - PLACEKND=DK or RF
[managed care plan or HMO center] US2 - PLACEKND=3/HMO
Else if US2 - PLACEKND=91/Other, display US2 Other specify response, US2 - PLACEOS.
Else display US2 - PLACEKND response.
(01) US5A - MDNAME
(02) BOX US1
(-8) US8 - GETUSHOW
(-9) US8 - GETUSHOW
MDSPEC
MDSPECOS
US6A
US6A
code one
SHOW CARD AC1
What is (US5A PROVIDER NAME)'s specialty?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC' SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY
AND THE GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE
SELECT 'OTHER DR SPECIALTY'.]
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/ METABOLISM (DIABETES, THYROID)
(08) FAMILY PRACTICE
(09) GASTROENTEROLOGY
(10) GENERAL PRACTICE
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(15) HOSPITAL RESIDENCE
(16) INTERNAL MEDICINE (INTERNIST)
(17) NEPHROLOGY (KIDNEYS)
(18) NEUROLOGY
(19) NUCLEAR MEDICINE
(20) ONCOLOGY (TUMORS, CANCER)
(21) OPHTHALMOLOGY (EYES)
(22) ORTHOPEDICS
(24) OSTEOPATHY (DO)
(25) OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT)
(26) PATHOLOGY
(27) PHYS MED/REHAB
(28) PLASTIC SURGERY
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
text
OTHER DR SPECIALTY (SPECIFY)
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC' SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY
AND THE GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE
SELECT 'OTHER DR SPECIALTY'.]
(01) CONTINUOUS ANSWER
(01)-(05) BOX US1
(07)-(35) BOX US1
(91) US6A - MDSPECOS
(-8) BOX US1
(-9) BOX US1
BOX US1
BOX US1
routing
IF US2 - PLACEKND = 10/AtHome, GO TO US15 - USHOWLNG.
ELSE GO TO US8 - GETUSHOW.
How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)]?
(01) WALKING
(02) DRIVING
(03) BEING DRIVEN
(04) AMBULANCE OR OTHER SPECIAL VEHICLE
(05) TAXI
(06) OTHER PUBLIC TRANSPORTATION
(07) DR. USUALLY COMES TO HOME
(91) SOME OTHER WAY
(-8) DON'T KNOW
(-9) REFUSED
GETUSHOW
US8
code one
GETUSOS
US8
verbatim text
SOME OTHER WAY (SPECIFY)
GETUSUNT
US9
code one
About how long does it usually take for [you/(SP)] to get there?
GETUSHRS
US9
numeric
(01) CONTINUOUS ANSWER
GETUSMIN
US9
numeric
(01) CONTINUOUS ANSWER
[EXPLAIN IF NEEDED: [Do you/Does (SP)] get there by walking, driving, being driven by someone else, by ambulance or other special vehicle for disabled people, by taxi, other public
transportation, or some other way?]
(01) continuous answer
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) DON'T KNOW
(-9) REFUSED
ACCOMPUS
US10
yes/no
[Do you/Does (SP)] usually have someone accompany [you/him/her] there?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
PERSON_USUALGO
US11
roster
Who usually goes with [you/(SP)]?
SELECT OR ADD ONLY ONE PERSON
(01) CONTINUOUS ANSWER
PERSWITH
US11A1
code one
How often (are you/is that person) with [you/(SP)] while [you/(SP)] (see/sees) the medical provider or other medical person? Would you say always, sometimes, or never?
What are the reasons [you accompany (SP)/this person accompanies you/this person accompanies (SP)] there? What (do you/does this person) do?
ACCREAS
ACCOTHOS
US11AA
US11AA
code all
verbatim text
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
(01) ALWAYS
(02) SOMETIMES
(03) NEVER
(-8) DON'T KNOW
(-9) REFUSED
(01) WRITES DOWN WHAT DOCTOR SAYS/RECORDS
INSTRUCTIONS/TAKES NOTES/REMEMBERS
(02) GIVES INFORMATION/EXPLAINS SP'S MEDICAL
CONDITION OR NEEDS TO THE DOCTOR
(03) EXPLAINS DOCTOR’S INSTRUCTIONS TO SP
(04) ASKS QUESTIONS
(05) TRANSLATES LANGUAGE
(06) SCHEDULES APPOINTMENTS
(07) NOTHING/KEEPS SP COMPANY/SITS WITH SP/MORAL
SUPPORT
(08) TRANSPORTATION
(09) SP NEEDS PHYSICAL ASSISTANCE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(01) US9 - GETUSUNT
(02) US9 - GETUSUNT
(03) US9 - GETUSUNT
(04) US9 - GETUSUNT
If (US2 - PLACEKND=1/DoctorsOffice) or (US4 - USUALDOC=1/Yes), Display "(US5A PROVIDER NAME)'S
(05) US9 - GETUSUNT
office". Display US5A - MDNAME provider name.
(06) US9 - GETUSUNT
Else Display "(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
(07) US15 - USHOWLNG
(91) US8 - GETUSOS
[Do you] respondent is SP
(-8) US15 - USHOWLNG
[Does (SP)] respondent is proxy
(-9) US15 - USHOWLNG
[do you] respondent is SP
[does (SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
US9 - GETUSUNT
(01) US9 - GETUSHRS
(02) US9 - GETUSMIN
(03) US9 - GETUSHRS
(-8) US10 - ACCOMPUS
(-9) US10 - ACCOMPUS
If US9 GETUSUNT=3/HoursAndMinutes go to US9 GETUSMIN.
Else go to US10 - ACCOMPUS.
US10 - ACCOMPUS
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[you] respondent is SP
[(SP)] respondent is proxy
(01) US11 - PERSON_USUALGO
(02) US15 - USHOWLNG
(-8) US15 - USHOWLNG
(-9) US15 - USHOWLNG
US11A1 - PERSWITH
[are you] respondent is proxy
[is that person] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
US11AA - ACCREAS
[see] respondent is SP
[sees] respondent is proxy
If proxy interview and person selected at US11 is proxy, display "you accompany (SP)".
Else if proxy interview and person selected at US11 is not the proxy, display "this person accompanies
(SP)".
Else display "this person accompanies you".
If proxy interview and person selected at US11 is proxy, display "do you".
Else display "does this person".
(01) US15 - USHOWLNG
(02) US15 - USHOWLNG
(03) US15 - USHOWLNG
(04) US15 - USHOWLNG
(05) US15 - USHOWLNG
(06) US15 - USHOWLNG
(07) US15 - USHOWLNG
(08) US15 - USHOWLNG
(09) US15 - USHOWLNG
(91) US11AA - ACCOTHOS
(-8) US15 - USHOWLNG
(-9) US15 - USHOWLNG
US15 - USHOWLNG
SHOW CARD US1
USHOWLNG
US15
code one
How long [have you/has (SP)] been [seeing (US5A PROVIDER NAME)/going to (US3A PROVIDER NAME)]?
(01) LESS THAN 1 YEAR
(02) 1 YEAR TO LESS THAN 3 YEARS
(03) 3 YEARS TO LESS THAN 5 YEARS
(04) 5 YEARS TO LESS THAN 10 YEARS
(05) 10 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
[have you] respondent is SP
[has SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "seeing
(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else Display "going to (US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
(01) US17 - PREVMEDC
(02) PP1- REMINDAPPT
(03) PP1- REMINDAPPT
(04) PP1- REMINDAPPT
(05) PP1- REMINDAPPT
(-8) PP1- REMINDAPPT
(-9) PP1- REMINDAPPT
[you] respondent is SP
[(SP)] respondent is proxy
PREVMEDC
US17
yes/no
Before [you/(SP)] started [seeing (US5A PROVIDER NAME)/going to (US3A PROVIDER NAME)], had [you/(SP)] usually been going to some other place or seeing some other medical
provider for medical care?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "seeing
(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
PP1- REMINDAPPT
Else Display "going to (US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
[you] respondent is SP
[(SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)’s office". Display US5A - MDNAME provider name.
Else Display "(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
REMINDAPPT
PP1
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
yes/no
[your] respondent is SP
[(SP)'s] respondent is proxy
PP2- PREPARE
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)’s office". Display US5A - MDNAME provider name.
Else Display "(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
The next questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)].
Some offices remind patients about appointments. Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME) ], did [you/he/she] get a reminder from
[(US5A PROVIDER NAME)'S office /(US3A PROVIDER NAME)] about the appointment?
[your] respondent is SP
[(SP)'s] respondent is proxy
PREPARE
PP2
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
yes/no
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
PP3- APPTCANCEL
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)], did [you/he/she] get instructions telling [you/him/her] what to expect or how to prepare?
APPTCANCEL
PP3
code one
Now I’m going to read you questions about the medical providers you have seen in the last six months, that is since {CurrentMonth – 6}.
In the last six months, how often has [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)] canceled or changed the date of an appointment?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
APPTMISS
PP4
code one
People have busy lives and miss appointments for many reasons. In the last six months, how often did [you/(SP)] miss an appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER
NAME)]?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER NAME)". PP4- APPTMISS
Display US3A - CLNAME provider name.
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP6- PPREPEAT
(02) PP5- APPTNEW
(03) PP5- APPTNEW
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
(04) PP5- APPTNEW
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER NAME)".
(-8) PP6- PPREPEAT
Display US3A - CLNAME provider name.
(-9) PP6- PPREPEAT
[you] respondent is SP
[(SP)] respondent is proxy
SHOW CARD US2
APPTNEW
PP5
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, when [ you/(SP)] missed an appointment with US5A PROVIDER NAME/US3A PROVIDER NAME), how often did someone from [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)] contact [you/him/her] to make a new appointment?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)’s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP6- PPREPEAT
SHOW CARD US2
PPREPEAT
PP6
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [you/(SP) have to repeat information that [you/(SP)] had already provided during the same visit?
SHOW CARD US2
PPINFO
PP7
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] seem to know the important information about [your/(SP)'s] medical
history?
SHOW CARD US2
DOCLIFE
PP8
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] ask about things in [your/(SP)'s] work or life at home that affect
[your/(SP)'s] life?
SHOW CARD US2
EXPLAINEASY
PP9
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] explain things in a way that was easy [for (SP)] to understand?
PPLISTEN
PP10
code one
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
PP7- PPINFO
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP8- DOCLIFE
[your] respondent is SP
[(SP)'s] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP9- EXPLAINEASY
[your] respondent is SP
[(SP)'s] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP10- PPLISTEN
[for (SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP11- PPRESPECT
[you] respondent is SP
[(SP)] respondent is proxy
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] listen carefully to [you/(SP)]?
SHOW CARD US2
PPRESPECT
PP11
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] show respect for what [you/(SP)] had to say?
SHOW CARD US2
ENOUGHTIME
PP12
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] spend enough time with [you/(SP)]?
SHOW CARD US2
PPIDEAS
PP13
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] ask whether [you/(SP)] had ideas about how to improve [your/his/her]
health?
PPVALUE
PP14
code one
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP12- ENOUGHTIME
[you] respondent is SP
[(SP)] respondent is proxy
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
(01) POOR
(02) FAIR
How would you rate [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] knowledge of [your/(SP)'s] values and beliefs that are important to [your/his/her] health (03) GOOD
care?
(04) EXCELLENT
(-8) Don't Know
(-9) Refused
PP13- PPIDEAS
[you] respondent is SP
[(SP)] respondent is proxy
PP14- PPVALUE
[you] respondent is SP
[(SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP15- SETGOAL
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
SETGOAL
PP15
code one
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] talk with [you/(SP)] about setting goals for [your/his/her] health?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
(01) PP16- MEETGOAL
(02) PP16- MEETGOAL
(03) PP17-OSTAFF
(-8) PP17-OSTAFF
(-9) PP17-OSTAFF
[you] respondent is SP
[(SP)] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
MEETGOAL
PP16
code one
In the last six months, did the care [you/(SP)] received from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] help [you/(SP)] meet [your/his/her] goals?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD U+D46S3
USCKEVRY
USCOMPET
USUNWRNG
USHURRY
US27
US27
list
Now I am going to read some statements people have made about their health care. Think about the care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER
NAME). For each statement, please tell me whether you strongly agree, agree, disagree, or strongly disagree.
[(US5A PROVIDER NAME) is/The medical providers at (US3A PROVIDER NAME) are] very careful to check everything when examining (you/him/her).
SHOW CARD US3
[(US5A PROVIDER NAME) is/The medical providers at (US3A PROVIDER NAME) are] competent and well-trained.
list
US27
list
US27
list
SHOW CARD US3
[(US5A PROVIDER NAME) has/The medical providers at (US3A PROVIDER NAME) have] a complete understanding of the things that are wrong with [you/him/her].
SHOW CARD US3
[(US5A PROVIDER NAME) often seems/The medical providers at (US3A PROVIDER NAME)]) often (seem/seems)] to be in a hurry.
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
US27-USCKEVRY
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[you receive] respondent is SP
[(SP) receives] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name.
Else Display "(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME) is".
Display US5A - MDNAME provider name.
US27 - USCOMPET
US27-USUNWRNG
Else Display "The medical providers at (US3A PROVIDER NAME) are". Display US3A - CLNAME provider
name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME) has".
Display US5A - MDNAME provider name.
Else Display "The medical providers at (US3A PROVIDER NAME) have". Display US3A - CLNAME provider
US27 - USHURRY
name.
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME) often seems".
Display US5A - MDNAME provider name.
US32 - USEXPPRB
Else Display "The medical providers at (US3A PROVIDER NAME) often seem". Display US3A - CLNAME
provider name.
[you] respondent is SP
[(SP)] respondent is proxy
[receive] respondent is SP
[receives] respondent is proxy
SHOW CARD US2 US3
USEXPPRB
US32
list
[Think about the care [you/(SP)] [receive/receives] from [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)].]
/[(US5A PROVIDER NAME) often does/The medical providers at (US3A PROVIDER NAME)]) often (does/do)] not explain (your/his/her) medical problems to (you/him/her).
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display “(US5A
PROVIDER NAME)”. Else Display “(US3A PROVIDER NAME)”. Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display “(US5A
PROVIDER NAME) often does”. Else Display “The medical providers at (US3A PROVIDER NAME) often
do”. Display US3A - CLNAME provider name.
US32 - USDISCUS
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
USDISCUS
US32
list
SHOW CARD US3
[You/(SP)] often (have/has) health problems that should be discussed but are not.
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
[You] respondent is SP
[(SP)] respondent is proxy
[have] respondent is SP
[has] respondent is proxy
US32 - USFAVOR
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display “(US5A
PROVIDER NAME) often acts”. Else Display “The medical providers at (US3A PROVIDER NAME) often
act”. Display US3A - CLNAME provider name.
USFAVOR
US32
list
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
SHOW CARD US3
(04) STRONGLY DISAGREE
[(US5A PROVIDER NAME) often acts/The medical providers at (US3A PROVIDER NAME) often act] as though [(he/she) was/they were] doing [you/(SP)] a favor by talking to (you/him/her).
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(he/she)
was".
Always display "(he/she)" in parenthesis.
Else display "they were".
US32 - USTELALL
[you] respondent is SP
[(SP)] respondent is proxy
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME) tells".
Else Display "The medical providers at (US3A PROVIDER NAME) tell". Display US3A - CLNAME provider
name.
USTELALL
US32
list
SHOW CARD US3
[(US5A PROVIDER NAME) tells/The medical providers at (US3A PROVIDER NAME) tell] (you/him/her) all (you want/he wants/she wants) to know about (your/his/her) condition and
treatment.
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
US32 - USANSQUX
[you want] respondent is SP
[he wants] respondent is proxy, SP male
[she wants] respondent is proxy, SP female
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
USANSQUX
US32
list
SHOW CARD US3
[(US5A PROVIDER NAME) answers/The medical providers at (US3A PROVIDER NAME) answer] all (your/his/her) questions.
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME) answers".
Else Display "The medical providers at (US3A PROVIDER NAME) answer". Display US3A - CLNAME
provider name.
US37 - USCONFID
[your] respondent is SP
[his] respondent is proxy
[her] respondent is SP
[you] respondent is SP
[(SP)] respondent is proxy
[receive] respondent is SP
[receives] respondent is proxy
SHOW CARD US3
USCONFID
US37
list
[Think about the care [you/(SP)] (receive/receives) from (US5A PROVIDER NAME/US3A PROVIDER NAME).]
[You have/(SP) has] great confidence in (US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)].
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name.
Else Display "(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
US37 - USDEPEND
[You have] respondent is SP
[(SP) has] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name.
Else Display "The medical providers at (US3A PROVIDER NAME)". Display US3A - CLNAME provider
name.
Always display brackets around question text.
USDEPEND
US37
list
SHOW CARD US3
[You depend/(SP) depends)] on [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] in order to feel better both physically and emotionally.
People often get instructions about their health from more than one person in the same office, such as other medical providers, nurses, nutritionists, and social workers.
OSTAFF
PP17
yes/no
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did [you/(SP)] get any instructions about your health from any other staff [in (US5A PROVIDER NAME)'s office/ at (US3A PROVIDER NAME)]?
SHOW CARD US2
OSAWARE
PP18
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did these other staff seem up-to-date about the care [you were/(SP) was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)]?
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[You depend] respondent is SP
[(SP) depends] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name.
Else Display "The medical providers at (US3A PROVIDER NAME)". Display US3A - CLNAME provider
name.
PP17-OSTAFF
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP18- OSAWARE
(02) PP21- OSTEST
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "in (US5A
(-8) PP21- OSTEST
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "at (US3A PROVIDER (-9) PP21- OSTEST
NAME)". Display US3A - CLNAME provider name.
[you were] respondent is SP
[(SP) was] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP19- OSCARE
[you] respondent is SP
[(SP) ] respondent is proxy
SHOW CARD US2
OSCARE
PP19
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did these other staff talk with [you/(SP)] about care [you/he/she] [were/was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)]?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP20- OSINFO
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
[were] respondent is SP
[was] respondent is proxy
SHOW CARD US2
OSINFO
PP20
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did these other staff seem to know the important information about [your/(SP)'s] medical history?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[your] respondent is SP
[(SP)'s ] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP21- OSTEST
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
The next set of questions ask about the care you received from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office.
OSTEST
PP21
yes/no
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office order a blood test, x-ray, or other test for
[you/(SP)]?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP22- OSFOLLOWUP
(02) PP25- PPHARD
(-8) PP25- PPHARD
(-9) PP25 - PPHARD
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
OSFOLLOWUP
PP22
code one
In the last six months, when [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone from [his/her/their] office ordered a blood test, x-ray, or other test
for [you/(SP)], how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone from [his/her/their] office follow up to give [you/(SP)] those
results?
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
PP23- REQUEST
[(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)]
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)’s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
REQUEST
PP23
code one
In the last six months, how often did [you/(SP)] have to request [your/his/her] test results before [you/he/she] got them?
SHOW CARD US2
TESTCLEAR
PP24
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often were [your/(SP)'s] test results presented in a way that was easy to understand?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP24- TESTCLEAR
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
[your] respondent is SP
[(SP)'s] respondent is proxy
PP25- PPHARD
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PPHARD
PP25
code one
In the last six months, were there things that made it hard for [you/(SP)] to take care of your health?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP26- ASKHARD
(02) PP26 - ASKHARD
(03) PP28- PPIDENTIFY
(-8) PP28- PPIDENTIFY
(-9) PP28- PPIDENTIFY
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
ASKHARD
PP26
yes/no
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office ask you about these things that made it hard
for [you/(SP)] to take care of [your/his/her] health?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP27- PLANHARD
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PLANHARD
PP27
code one
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
In the last six months, did you and [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office come up with a plan to help [you/(SP)]
(03) NO
deal with the things that make it hard for [you/(SP)] to take care of [your/his/her] health?
(-8) DON'T KNOW
(-9) REFUSED
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP28- PPIDENTIFY
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
PPIDENTIFY
PP28
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office help you identify the most
important things for [you/(SP)] to do for [your/his/her] health?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP29- PPSERVICES
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[you] respondent is SP
[(SP)] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PPSERVICES
PP29
yes/no
In the last six months, did [you/(SP)] need services at home to help [you/him/her] take care of [your/his/her] health?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
(01) PP30- HELPGET
(02) PP31- PPINSTRUCTIONS
(-8) PP31- PPINSTRUCTIONS
(-9) PP31- PPINSTRUCTIONS
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
HELPGET
PP30
code one
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office help [you/(SP)] get these services at (-8) Don't Know
home to take care of [your/his/her] health?
(-9) Refused
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP31- PPINSTRUCTIONS
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PPINSTRUCTIONS
PP31
yes/no
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office give [you/(SP)] instructions about how to take
care of [your/his/her] health?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
(01) PP32- PPFOLLOWUP
(02) PP34- KNOWASK
(-8) PP34- KNOWASK
(-9) PP34- KNOWASK
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
SHOW CARD US2
PPFOLLOWUP
PP32
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often [were you/was (SP)] able to follow these instructions about taking care of [your/his/her] health?
SHOW CARD US2
INSTUHELP
PP33
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
code one
In the last six months, how often did the instructions [you/(SP)] received help [you/him/her] take care of [your/his/her] health?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[were you] respondent is SP
[was (SP)] respondent is proxy
PP33- INSTUHELP
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP34- KNOWASK
[you] respondent is SP
[(SP)] respondent is proxy
KNOWASK
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP34
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, if [you /(SP)] had any trouble taking care of [your/his/her] health at home, would [you/he/she] know who to ask for help?
code one
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PPMED
PP35
yes/no
In the last six months, did [you/(SP)] take any prescription medicine?
[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK IF THE R HAD ANY PRESCRIPTIONS FILLED]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
PP35- PPMED
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP36- HOWMED
(02) PP39-CONTACTBW
(-8) PP39-CONTACTBW
(-9) PP39-CONTACTBW
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
HOWMED
PP36
code one
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about how [you (-8) Don't Know
were/he was/she was] supposed to take [your/his/her] medicine?
(-9) Refused
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
[you] respondent is SP
[(SP)] respondent is proxy
PP37- ASPRESCRIBED
[you were] respondent is SP
[he was] respondent is proxy, SP is male
[she was] respondent is proxy, SP is female
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
SHOW CARD US2
ASPRESCRIBED
PP37
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
There are many reasons why people may not always be able to take their medicines as prescribed. In the last six months, how often [were you/was (SP)] able to take [your/his/her]
medicine as prescribed?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[were you] respondent is SP
[was (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP38- REACTION
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
REACTION
PP38
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about what to
do if [you have/he has/she has] a bad reaction to [your/his/her] medicine?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
[you] respondent is SP
[(SP)] respondent is proxy
PP39- CONTACTBW
[you have] respondent is SP
[he has] respondent is proxy, SP is male
[she has] respondent is proxy, SP is female
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SHOW CARD US2
CONTACTBW
PP39
code one
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office contact [you/(SP)] between visits to (-8) Don't Know
see how [you were/he was/she was] doing?
(-9) Refused
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP40- MEDQAFTER
[you] respondent is SP
[(SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP is male
[she was] respondent is proxy, SP is female
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
MEDQAFTER
PP40
yes/no
In the last six months, did [you/(SP)] try to contact [(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)] with a medical question after regular office hours?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
(01) PP41- QTIMELY
(02) PP42- SPCLCARE
(-8) PP42- SPCLCARE
(-9) PP42- SPCLCARE
[you] respondent is SP
[(SP)] respondent is proxy
SHOW CARD US2
QTIMELY
PP41
code one
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, when [you/(SP)] tried to contact [(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)] after regular office hours, how often did [you/he/she] get an answer to (-8) Don't Know
[your/his/her] medical question in a timely manner?
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
PP42-SPCLCARE
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
SHOW CARD US5 AC1
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
Specialists are medical providers who specialize in one area of health care. This card lists some examples of specialists.
SPCLCARE
PP42
yes/no
In the last six months, did [you/(SP)] receive care from any specialists outside the office of [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)]?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
(01) PP43- DRINFORMED
(02) PP50- ADMITHOS
(-8) PP50 - ADMITHOS
(-9) PP50 - ADMITHOS
SHOW CARD US2
In general, how often (does/do) [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] seem informed and up-to-date about the care [you/(SP)] (get/gets) from
specialists?
DRINFORMED
PP43
[does] if (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes)
[do] if US3A-CLNAME is displayed below
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
code one
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP44- REMINDDR
[you] respondent is SP
[(SP)] respondent is proxy
[get] respondent is SP
[gets] respondent is proxy
SHOW CARD US2
In general, how often (do/does) [you/(SP)] have to remind [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] about care [you/(SP)] (receive/receives) from
specialists?
[does] respondent is proxy
[do] respondent is SP
[you] respondent is SP
[(SP)] respondent is proxy
REMINDDR
PP44
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
code one
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
PP45- SPCLSTPM
[you] respondent is SP
[(SP)] respondent is proxy
[receive] respondent is SP
[receives] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did any specialists outside the [office of (US5A PROVIDER NAME)/(US3A PROVIDER NAME)] prescribe medicine for [you/(SP)]?
SPCLSTPM
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
PP45
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "the office
of(US5A PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP46- TALKPMS
(02) PP47- SPLKNOW
(-8) PP47 -SPLKNOW
(-9) PP47- SPLKNOW
yes/no
SHOW CARD US2
In general, how often (does/do) [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] talk with [you/(SP)] about the medicines prescribed by these specialists?
TALKPMS
PP46
code one
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[does] if (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes)
[do] if US3A-CLNAME is displayed below
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NAME)". Display US3A - CLNAME provider name.
[you] respondent is SP
[(SP)] respondent is proxy
US37E1-SPCLNAME
The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the last six months outside the [office of (US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)].
[you] respondent is SP
[(SP)] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
First, what is the name of the specialist [you/(SP)] saw most often in the last six months?
SPCLNAME
US37E1
verbatim text
(01) continuous answer
(-8) DON’T KNOW
(-9) REFUSED
[you] respondent is SP
[he] respondent is proxy, SP is male
[she] respondent is proxy, SP is female
US37E2-SPCLSEX
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "office of
(US5A PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
SPCLSEX
US37E2
code one
Is [(US37E1 PROVIDER NAME)/the specialist you saw most often in the last six months] a male or female?
(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED
[US37E1 PROVIDER NAME)] US37E1 NE -8 or -9
[the specialist you saw most often in the last six months] US37E1 in(-8,-9)
PP47- SPLKNOW
[you see] respondent is SP
[(SP) sees] respondent is proxy
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
SPLKNOW
PP47
code one
[(US37E1-SPCLNAME)] US37E1 NE -8 or -9
[this specialist] US37E1 in(-8,-9)
The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the last six months outside the [office of (US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)].
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], does [he/she/he or she] seem to know enough information about [your/his/her] medical history?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[he] US37E2 = 01
[she] US37E2 = 02
[this specialist] US37E2 NE 1 or 2
PP48- SPLREPEAT
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[you see] ] respondent is SP
[(SP) sees] respondent is proxy
[(US37E1-SPCLNAME)] US37E1 NE -8 or -9
[this specialist] US37E1 in(-8,-9)
SPLREPEAT
PP48
code one
(01) NEVER
SHOW CARD US2
(02) SOMETIMES
(03) USUALLY
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do you/does he/does she] have to repeat information that [you have/he has/she has] already given to [(US5A (04) ALWAYS
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)]?
(-8) Don't Know
(-9) Refused
[do you] respondent is SP
[does he] respondent is proxy, SP is male
[does she] respondent is proxy, SP if female
PP49- SPLKNTEST
[you have] respondent is SP
[he has] respondent is proxy, SP is male
[she has] respondent is proxy, SP is female
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name. Else Display "the medical providers at
(US3A PROVIDER NA
[you see] ] respondent is SP
[(SP) sees] respondent is proxy
SPLKNTEST
PP49
SHOW CARD US2
code one
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does [he/she/he or she] seem to know [your/(SP)'s] important test results from other providers?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
ADMITHOS
PP50
yes/no
In the last six months, [were you/was (SP)] admitted to a hospital overnight or longer?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[(US37E1-SPCLNAME)] US37E1 NE -8 or -9
[this specialist] US37E1 in(-8,-9)
[your] respondent is SP
[(SP)'s] respondent is proxy
[were you] respondent is SP
[was (SP)] respondent is proxy
PP50-ADMITHOS
(01) PP51- HOSFLWUP
(02) PP57- RATECARE
(-8) PP57- RATECARE
(-9) PP57- RATECARE
[your] respondent is SP
[(SP)'s] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
HOSFLWUP
PP51
yes/no
After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office contact [you/him/her]
to see how [you were/he was/she was] doing?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP52- HOSMED
[you] respondent is SP
[him] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[you were] respondent is SP
[he was] respondent is proxy, SP is male
[she was] respondent is proxy, SP is female
HOSMED
PP52
yes/no
After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any medicines?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[your] respondent is SP
[(SP)'s] respondent is proxy
[were you] respondent is SP
[was (SP)] respondent is proxy
(01) PP53- HOSFOLLOWUP
(02) PP54- HOSINSTU
(-8) PP54- HOSINSTU
(-9) PP54- HOSINSTU
[your] respondent is SP
[(SP)'s] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
HOSFOLLOWUP
PP53
yes/no
After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office contact [you/SP] to
check if [you were/he was/she was ] able to follow instructions about any medicines [you were/he was/she was] prescribed?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[his] US5B-MDSEX = 01/MALE
[her] US5B-MDSEX = 02/FEMALE
[their] US5B-MDEX not in(01,02)
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [his]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [her]
else fill [their]
PP54- HOSINSTU
[you] respondent is SP
[SP] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP is male
[she was] respondent is proxy, SP is female
[you were] respondent is SP
[he was] respondent is proxy, SP is male
[she was] respondent is proxy, SP is female
[your] respondent is SP
[(SP)'s] respondent is proxy
HOSINSTU
PP54
yes/no
After (your/(SP)'s] most recent hospital stay, (were you/was he/was she] given instructions about caring for [yourself/himself/herself] at home?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[were you] respondent is SP
[was he] respondent is proxy, SP is male
[was she] respondent is proxy, SP is female
(01) PP55- INSTUEASY
(02) PP56- HOSINFO
(-8) PP56- HOSINFO
(-9) PP56- HOSINFO
[yourself] respondent is SP
[himself] respondent is proxy, SP is male
[herself] respondent is proxy, SP is female
After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP) was] given easy to understand?
INSTUEASY
PP55
code one
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
HOSINFO
PP56
code one
After (your/(SP)'s) most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] seem to know the important information about this
hospital stay?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD PP1
RATECARE
PP57
code one
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all [your/(SP)'s) health care in the
last six months?
SHOW CARD PP2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
RATEMANAGE
PP58
code one
People sometimes need to manage their medical care by making appointments with multiple providers, following their instructions, and taking medicines as prescribed.
Using any number from 0 to 10, where 0 is hard and 10 is easy, what number would you use to rate how easy it was for [you/(SP)] to manage [your/his/her] medical care in the last six
months?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
DOCKNOWALL
PP59
code one
In the last six months, was there one provider who knew about all [your/(SP)'s] medical care needs?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
KNOWMEDS
PP60
code one
In the last six months, was there one provider who knew about all the medicines [you were/(SP) was] taking?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
KNOWPERSON
PP61
code one
In the last six months, was there one provider who knew [you/(SP)] well as a person?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(00) 0 WORST HEALTH CARE POSSIBLE
(01) 1
(02) 2
(03) 3
(04) 4
(05) 5
(06) 6
(07) 7
(08) 8
(09) 9
(10) 10 BEST HEALTH CARE POSSIBLE
(00) 0 HARD TO MANAGE
(01) 1
(02) 2
(03) 3
(04) 4
(05) 5
(06) 6
(07) 7
(08) 8
(09) 9
(10) 10 EASY TO MANAGE
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[your] respondent is SP
[(SP)'s] respondent is proxy
PP56- HOSINFO
[you were] respondent is SP
[(SP) was] respondent is proxy
[your] respondent is SP
[(SP)'s] respondent is proxy
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)'s office". Display US5A - MDNAME provider name. Else Display "(US3A PROVIDER
NAME)". Display US3A - CLNAME provider name.
[your] respondent is SP
[(SP)'s] respondent is proxy
PP57- RATECARE
PP58- RATEMANAGE
[your] respondent is SP
[(SP)'s] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
PP59- DOCKNOWALL
[your] respondent is SP
[(SP)'s] respondent is proxy
PP60- KNOWMEDS
[you were] respondent is SP
[(SP) was] respondent is proxy
PP61- KNOWPERSON
[you] respondent is SP
[(SP)] respondent is proxy
PP62- PROB_INFO
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
The next questios are about problems you might have had with your health care.
PROB_INFO
PP62
code one
SHOWCARD PP3
In the last six months, how much of a problem was each of these to [you/(SP)]?
(01) NOT A PROBLEM AT ALL
(02) A SMALL PROBLEM
(03) A MODERATE PROBLEM
(04) A BIG PROBLEM
(05) A VERY BIG PROBLEM
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[(SP)'s] respondent is proxy
PP63- PROB_TRMT
Lack of information about [your/(SP)'s] medical conditions?
SHOWCARD PP3
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PROB_TRMT
PP63
code one
[IF NEEDED: In the last six months, how much of a problem was each of these to [you/(SP)]?]
Lack of information about treatment options?
SHOWCARD PP3
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PROB_CNCRNS
PP64
code one
[IF NEEDED: In the last six months, how much of a problem was each of these to [you/(SP)]?]
Bringing up concerns about [your/(SP]'S] health or health care with [your/his/her] providers?
(01) NOT A PROBLEM AT ALL
(02) A SMALL PROBLEM
(03) A MODERATE PROBLEM
(04) A BIG PROBLEM
(05) A VERY BIG PROBLEM
(-8) DON'T KNOW
(-9) REFUSED
(01) NOT A PROBLEM AT ALL
(02) A SMALL PROBLEM
(03) A MODERATE PROBLEM
(04) A BIG PROBLEM
(05) A VERY BIG PROBLEM
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
PP64- PROB_CNCRNS
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[(SP)'s] respondent is proxy
PP65- ASST_MED
[your] respondent is SP
[his] respondent is proxy, SP is male
[her] respondent is proxy, SP is female
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did [you/(SP)] ever need assistance with the following?
ASST_MED
PP65
code one
Taking medicines
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
(01) PP65A
(02) PP65A
(03) PP66-ASST_MNGE
(-8) PP66-ASST_MNGE
(-9) PP66-ASST_MNGE
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PP65A
code one
In the last six months, did one or more friends or relatives help [you/(SP)] with taking medicines?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
PP66-ASST_MNGE
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
[IF NEEDED: In the last six months, did [you/(SP)] ever need assistance with the following?]
ASST_MNGE
PP66
code one
Making medical-related appointments
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
Always display (In the last six months…) in parentheses
(01) PP66A
(02) PP66A
(03) PP67- ASST_TRANSPORT
(-8) PP67- ASST_TRANSPORT
(-9) PP67- ASST_TRANSPORT
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PP66A
code one
In the last six months, did one or more friends or relatives help [you/(SP)] with making medical-related appointments?
[IF NEEDED: In the last six months, did [you/(SP)] ever need assistance with the following?]
ASST_TRANSPORT
PP67
code one
Getting to or from a medical appointment
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PP67A
code one
In the last six months, did one or more friends or relatives help [you/(SP)] with getting to or from a medical appointment?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
Always display (In the last six months…) in parentheses
[you] respondent is SP
[(SP)] respondent is proxy
PP67- ASST_TRANSPORT
(01) PP67A
(02) PP67A
(03) PP68- ASST_UNDSTND
(-8) PP68- ASST_UNDSTND
(-9) PP68- ASST_UNDSTND
PP68- ASST_UNDSTND
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
[IF NEEDED: In the last six months, did [you/(SP)] ever need assistance with the following?]
ASST_UNDSTND
PP68
code one
Understanding information from a health care provider
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
Always display (In the last six months…) in parentheses
(01) PP68A
(02) PP68A
(03) PP70- AGREE_INTRO
(-8) PP70- AGREE_INTRO
(-9) PP70- AGREE_INTRO
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
PP68A
code one
In the last six months, did one or more friends or relatives help [you/(SP)] with understanding information from a health care provider?
Now I’m going to ask you two questions about all the doctors you have seen in the last two years.
RECORDNA
UNMEDTST
US37I
US37J
code one
code one
In the last two years, when getting care for a medical problem, was there ever a time when test results, medical records, or reasons for referrals were not available at the time of
[your/(SP)’s] scheduled doctor’s appointment?
In the last 2 years, when getting care for a medical problem, was there ever a time when medical providers ordered a medical test that [you/(SP)] felt was unnecessary because the test
had already been done?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
US37I-RECORDNA
(01) YES
(02) NO
(03) NOT APPLICABLE
(04) NOT SURE
(-9) Refused
[your] respondent is SP
[(SP)'s] respondent is proxy
US37J-UNMEDTST
(01) YES
(02) NO
(03) NOT APPLICABLE
(04) NOT SURE
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
US37K - EMEDREC
EMEDREC
US37K
yes/no
Many health care providers are beginning to use electronic or computer-based medical records instead of using paper-based records. When you visit [(US5A PROVIDER NAME)/the
medical providers at (US3A PROVIDER NAME)] [does he or she/do they] generally enter your health information into a computer while you are present?
[EXPLAIN IF NEEDED: An “electronic health record” is an electronic version of a patient’s medical history maintained by a provider over time. It automates the way in which doctors can
access patient health information. "Health Information" includes information such as symptoms, vital signs, test results, or prescribed medicines.]
BOX PP2
routing
IF US1-PLACEPAR = 2 (NO) GO TO US39-NUSNOTSK
OTHERWISE GO TO BOX PP70
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "(US5A
PROVIDER NAME)". Display US5A - MDNAME provider name.
Else Display "the medical providers at (US3A PROVIDER NAME)". Display US3A - CLNAME provider
name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4 - USUALDOC=1/Yes), Display "does he or
she".
Else Display "do they".
if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 01/MALE, FILL [does he]
else if (US2-PLACEKND IN (1,10) or US4-USUSALDOC=1) AND US5B-MDSEX = 02/FEMALE, FILL [does
she]
else fill [do they]
BOX PP2
[you do] respondent is SP
[(SP) does] respondent is proxy
NUSNOTSK
US39A
list
I am going to read some reasons that people have given for not having a usual source of health care. For each one, please tell me whether or not it is a reason [you do/(SP) does] not
have a usual place for health care.
There is no reason to have a usual source of health care because [you/(SP)] seldom or never (get/gets) sick. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
US39 - NUSMOVIN
[get] respondent is SP
[gets] respondent is proxy
Always display "[Is that a reason…]" in brackets.
NUSMOVIN
US39B
list
[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[You] respondent is SP
[(SP)] respondent is proxy
[you do] respondent is SP
[(SP) does] respondent is proxy
US39 - NUSAVAIL
Always display "[Is that a reason…]" in brackets.
NUSAVAIL
US39C
list
[Your/(SP’s)] usual source of health care in this area is no longer available. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Your] respondent is SP
[(SP)] respondent is proxy
[you do] respondent is SP
[(SP) does] respondent is proxy
(01) US42 - USWHYNAV
(02) US43 - NUSDIFFP
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
Always display "[Is that a reason…]" in brackets.
USWHYNAV
US42
code one
Why is [your/(SP’s)] usual source of health care no longer available?
(01) PREVIOUS DOCTOR RETIRED
(02) PREVIOUS DOCTOR DIED
(03) PREVIOUS DOCTOR MOVED
(04) SP MOVED
(05) PREVIOUS DR/PLACE TOO FAR AWAY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
USWHYNO1
US42
verbatim text
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
[your] respondent is SP
[(SP)'s] respondent is proxy
(01) US43 - NUSDIFFP
(02) US43 - NUSDIFFP
(03) US43 - NUSDIFFP
(04) US43 - NUSDIFFP
(05) US43 - NUSDIFFP
(91) US42 - USWHYNO1
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
US43 - NUSDIFFP
[you] respondent is SP
[(SP)] respondent is proxy
Thinking about other possible reasons that people have for not having a usual source of health, please tell me if this statement applies to [you/(SP)]:
NUSDIFFP
US43
list
[You like/(SP) likes] to go to different places for different health care needs. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you like] respondent is SP
[(SP) likes)] respondent is proxy
US43 - NUSTOOFR
[you do] respondent is respondent is SP
[(SP) does] respondent is proxy
Always display "[Is that a reason…]" in brackets.
NUSTOOFR
US43
list
The places where [you/(SP)] can receive health care are too far away. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
[you do] respondent is respondent is SP
[(SP) does] respondent is proxy
US43 - NUSTOOEX
Always display "[Is that a reason…]" in brackets.
NUSTOOEX
US43
BOX PP70
AGREE_INTRO
PP70
list
routing
The cost of health care is too expensive. [Is that a reason [you do/(SP) does] not have a usual source of health care?]
PP71
[you do] respondent is respondent is SP
[(SP) does] respondent is proxy
BOX PP70
Always display "[Is that a reason…]" in brackets.
If respondent = proxy, go to BOX USEND
else go to PP70-AGREE_INTRO
Please indicate how much you agree or disagree with each of the following statements. Please be as honest and as accurate as you can. Try not to let your response to one statement
influence your response to other statements. There are no "correct" or "Incorrect" answers. Answer according to your own feelings, rather than how you think "most people" would
answer.
SHOW CARD PPX4
AGREE_BEST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
In uncertain times, I usually expect the best.
(01) CONTINUE
PP71- AGREE_BEST
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP72- AGREE_RELAX
SHOW CARD PP4
AGREE_RELAX
PP72
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
It is easy for me to relax.
SHOW CARD PP4
AGREE_WRONG
PP73
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
If something can go wrong for me, it will.
SHOW CARD PP4
AGREE_OPTMSTC
PP74
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
I am always optimistic about my future.
SHOW CARD PP4
AGREE_WAY
PP75
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
I hardly ever expect things to go my way.
SHOW CARD PP4
AGREE_GOOD
PP76
[IF NEEDED: Please indicate how much you agree or disagree with each of the following statements.]
I rarely count on good things happening to me.
SHOW CARD PP4
AGREE_BAD
PP77
[IF NEEDED: Please indicate how much you agree or disagree with the following statement.]
Overall, I expect more good things to happen to me than bad.
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP73- AGREE_WRONG
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP74- AGREE_OPTMSTC
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP75- AGREE_WAY
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP76- AGREE_GOOD
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
PP77- AGREE_BAD
(01) AGREE A LOT
(02) AGREE A LITTLE
(03) NEITHER AGREE NOR DISAGREE
(04) DISAGREE A LITTLE
(05) DISAGREE A LOT
(-8) DON'T KNOW
(-9) REFUSED
BOX USEND
Patient Activation (PAQ): THIS SECTION HAS BEEN DELETED
MR Screen
Variable Name
Name
Question type Question text/description
Code list
BOX PA1 routing
GO TO PAINTRO - PAINTRO.
Now I have some questions about how you make health care decisions. Answers
to questions like these will help Medicare better understand how people use
medical services.
PAINTRO
PAINTRO
no entry
PANECESS
PA1
code 1
PASIDEFX
PA2
code 1
PAINSTRC
PA3
code 1
PAMEDREC
PA4
code 1
PACHGDRS
PA5
code 1
Please keep in mind that there are no right or wrong answers to these questions. (01) CONTINUE
Your opinions and experiences are important to us.
(-7) Empty
(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT
CONFIDENT
(04) NOT AT ALL
SHOW CARD PA1
CONFIDENT
Please tell me how confident you are that you can identify when it is necessary (-8) Don't Know
for you to get medical care.
(-9) Refused
(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT
CONFIDENT
SHOW CARD PA1
(04) NOT AT ALL
[How confident are you that you can...]
CONFIDENT
(-8) Don't Know
Identify when you are having side effects from your medications?
(-9) Refused
(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT
SHOW CARD PA1
CONFIDENT
Doctors often give instructions about how you should care for yourself at home, (04) NOT AT ALL
like changing a bandage, taking medicines on schedule, or applying ice packs.
CONFIDENT
How confident are you that you can follow instructions to care for yourself at
(-8) Don't Know
home?
(-9) Refused
(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT
SHOW CARD PA1
CONFIDENT
Doctors also often give instructions about changing your habits or lifestyle, such (04) NOT AT ALL
as changing your diet, stopping smoking, or getting regular exercise. How
CONFIDENT
confident are you that you can follow this kind of instruction, to change your
(-8) Don't Know
habits or lifestyle?
(-9) Refused
(01) VERY LIKELY
SHOW CARD PA2
(02) LIKELY
Please use this card to respond to the following statements.
(03) UNLIKELY
(04) VERY UNLIKELY
How likely are you to change doctors if you are dissatisfied with the way you and (-8) Don't Know
your doctor communicate?
(-9) Refused
Text Fill Input
Logic
mask Routing
PA1 - PANECESS
PA2 - PASIDEFX
PA3 - PAINSTRC
PA4 - PAMEDREC
PA5 - PACHGDRS
PA6 - PADISAGR
PADISAGR
PAHCONDS
PA6
PA9
code 1
code 1
SHOW CARD PA2
How likely are you to tell your doctor when you disagree with him or her?
SHOW CARD PA3
These next questions are about practices sometimes associated with receiving
medical care. Please tell me if you always, usually, sometimes, or never do the
following:
Do you always, usually, sometimes, or never read about health conditions in
newspapers, magazines, or on the Internet?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PARXINFO
PA10
code 1
Read information about a new prescription, such as side effects and
precautions?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PADRQUEX
PA11
code 1
Bring with you to your doctor visits a list of questions or concerns you want to
cover?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PAANSWR
PA12
code 1
Leave your doctor's office feeling that all of your concerns or questions have
been fully answered?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PALISTRX
PA13
code 1
Take a list of all of your prescribed medicines to your doctor visits?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PATRSLT
PA14
code 1
Make sure you understand the results of any medical test or procedure such as
an x-ray, blood test, or EKG for heart conditions?
SHOW CARD PA3
[Do you always, usually, sometimes, or never...]
PAOPTION
PA15
code 1
Talk with your doctor or other medical person about your options if you need
tests, follow-up care, or a referral for care by a medical specialist?
(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
PA9 - PAHCONDS
PA10 - PARXINFO
PA11 - PADRQUEX
PA12 - PAANSWR
PA13 - PALISTRX
PA14 - PATRSLT
PA15 - PAOPTION
PA16 - PADRLISN
SHOW CARD PA3
Now I am going to read some statements that may describe your relationship
with your doctor. Please tell me if the following statements always, usually,
sometimes, or never happen.
PADRLISN
PA16
code 1
PADREXPL
PA20
code 1
PADVICE
PA21
code 1
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
My doctor listens to what I have to say about my symptoms and concerns. [Does (-8) Don't Know
that always, usually, sometimes, or never happen?]
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
SHOW CARD PA3
(04) NEVER
My doctor explains things to me in terms that I can easily understand. Does that (-8) Don't Know
always, usually, sometimes, or never happen?
(-9) Refused
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
SHOW CARD PA3
(04) NEVER
I can call my doctor's office to get medical advice when I need it. Does that
(-8) Don't Know
always, usually, sometimes, or never happen?
(-9) Refused
PA20 - PADREXPL
PA21 - PADVICE
BOX PA2
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2015-06-15 |
| File Created | 2015-06-15 |