Cms-p-0015a Mcbs

Inpatient Utilization (IPQ)
Variable Name
MR Screen Name
BOX IP1

Question type
routing

Question text/description
IF THE SP WAS STILL IN A HOSPTIAL AT THE TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO IPS1 EVENDMM.
ELSE IF SP IS IN THE EXIT SAMPLE AND ROUND IS NOT 71 AND PREVIOUS ROUND INTERVIEW WAS NOT
SKIPPED, GO TO BOX IP6.
ELSE GO TO BOX IP1AB.

Code list

EVENDMM

IPS1

date

Last time [you/(SP)] had been admitted to (HOSPITAL NAME) on (ADMISSION DATE) and [were/was] still a
patient there on (REFERENCE DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for that
stay?

EVENDDD

IPS1

date

Last time [you/(SP)] had been admitted to (HOSPITAL NAME) on (ADMISSION DATE) and [were/was] still a
patient there on (REFERENCE DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for that
stay?

EVENDYY

IPS1

date

Last time [you/(SP)] had been admitted to (HOSPITAL NAME) on (ADMISSION DATE) and [were/was] still a
patient there on (REFERENCE DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for that
stay?

STILLHOSP

IPS1

date

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) SP IS STILL IN HOSPITAL
(-7) Empty

BOX IP1A

routing

BOX IP1AB

routing

BOX IP1AA

routing

EVENDMM

IP1A

date

You told me [you were/(SP) was] admitted to (HOSPITAL NAME) from the emergency room on (ADMISSION
DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for the stay that started on
(ADMISSION DATE)?

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused

EVENDDD

IP1A

date

You told me [you were/(SP) was] admitted to (HOSPITAL NAME) from the emergency room on (ADMISSION
DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for the stay that started on
(ADMISSION DATE)?

EVENDYY

IP1A

date

You told me [you were/(SP) was] admitted to (HOSPITAL NAME) from the emergency room on (ADMISSION
DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for the stay that started on
(ADMISSION DATE)?

STILLHOSP

IP1A

date

BOX IP1B

routing

You told me [you were/(SP) was] admitted to (HOSPITAL NAME) from the emergency room on (ADMISSION
DATE). When [were you/was (SP)] discharged from (HOSPITAL NAME) for the stay that started on
(ADMISSION DATE)?
IF SP WAS REPORTED AS STILL IN THE HOSPITAL AT IP1A, GO TO BOX IP5.
ELSE GO TO IP7 - ANYOPERS.

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) SP IS STILL IN HOSPITAL
(-7) Empty

IF SP WAS REPORTED AS STILL IN THE HOSPITAL AT IPS1, GO TO BOX IP6.
ELSE GO TO IP7 - ANYOPERS.
IF THE SP HAD AT LEAST ONE EMERGENCY ROOM VISIT IN THE CURRENT ROUND THAT RESULTED IN THE SP
BEING ADMITTED TO A HOSPITAL, GO TO BOX IP1AA.
ELSE GO TO IP1 - IPPROBE.
CREATE EVENT FOR FIRST/NEXT ER VISIT ADDED WHERE SP WAS ADMITTED TO HOSPITAL
GO TO IP1A - EVENDMM.

Inpatient Utilization (IPQ)
Variable Name
MR Screen Name
IPPROBE
IP1

PROVIDER_IP

PROVNAME

IP2

IP2

Question type
yes/no

roster

Question text/description
[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] [admitted to a
hospital/admitted any other time to this or any other hospital] as an inpatient -- either for an overnight stay
or for a "same day" procedure?
IF HAD SAME DAY PROCEDURE AND IS NOT SURE IF ADMITTED OR NOT, TREAT AS OUTPATIENT EVENT AND
ENTER WHEN YOU GET TO OP UTILIZATION.
[ENTER A STAY AT A DRUG AND REHABILITATION CENTER AS AN IP EVENT, NOT AN IU EVENT.]
Where [were you/was (SP)] admitted -- to which hospital?
SELECT OR ADD ONLY ONE HOSPITAL.
[PROBE TO OBTAIN THE COMPLETE AND FORMAL NAME OF THE HOSPITAL.]

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

[DISPLAY PROVIDER ROSTER AS RESPONSE OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
N+1. ADD ANOTHER
DISPLAY PROVIDER NAME, SPECIALITY, GROUP NAME
FOR ALL PROVIDERS WHERE PROVNUM>02.

verbatim
[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
ENTER THE NAME OF THE HOSPITAL BELOW
NAME:

GROUPNAM

IP2
BOX IP2

verbatim
routing

GROUP:
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 IP3 - VAPLACE.
ELSE GO TO BOX IP2AA.

VAPLACE

IP3

yes/no

Is (HOSPITAL NAME) a Department of Veterans Affairs, or V.A., facility?

BOX IP2AA

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 IP3A - 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 IP3B - HMOREFER.
ELSE GO TO IP4 - EVBEGMM.

HMOASSOC

IP3A

yes/no

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

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

HMOREFER

IP3B

yes/no

[Were you/Was (SP)] referred to (HOSPITAL NAME) by [READ MANAGED CARE PLAN NAME(S) BELOW]?

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

[INCLUDE REFERRALS BY THE RESPONDENT’S PRIMARY CARE PHYSICIAN (PCP).]

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

Inpatient Utilization (IPQ)
Variable Name
MR Screen Name
EVBEGMM
IP4

Question type
date

Question text/description
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?

Code list
MM:

EVBEGDD
EVBEGYY
EVENDMM

date
date
date

Admission Date:
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?

DD:
YY:
MM:

IP4
IP4
IP4

EVENDDD
EVENDYY

IP4
IP4

date
date

Dishcarge Date:
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?
When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?

STILLHOSP

IP4

date

When [were you/was (SP)] admitted to and discharged from (HOSPITAL NAME)?

BOX IP2A

routing

IF INPATIENT ADMISSION AND DISCHARGE DATE OVERLAP AN EXISTING IP STAY, GO TO IP4_ERR - IPOVERLP.
ELSE GO TO BOX IP3.

IPOVERLP

IP4_ERR

code 1

IPADD

IP5

INVALID DATE. THIS DATE OVERLAPS AN EXISTING IP STAY FROM (ADMISSION DATE) TO [(DISCHARGE
DATE)/SP STILL IN HOSPITAL].
HAVE ALL DATES BEEN ENTERED?

NAVIGATOR

IP5_IN

instance navigator

BOX IP3

routing

IP7

yes/no

BOX IP4A

routing

PRESMDCN

IP13

yes/no

At the time [you were /(SP) was] discharged, were any medicines prescribed for [you/(SP)]?

PRESFILL

IP14

yes/no

Were any of the prescriptions filled?

ANYOPERS

YY:
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) SP IS STILL IN HOSPITAL
(-7) Empty

(01) CORRECT DATES
(02) CONTINUE INTERVIEW
(01) ADD ANOTHER
(02) ALL DONE

[DISPLAY ALL EVENTS ASSOCIATED WITH THIS PROVIDER]
YOU HAVE ENTERED DATES FOR THE FOLLOWING EVENTS. SELECT AN EVENT TO DISCUSS WITH SP OR PRESS (01) EVENT1
[PREVIOUS] TO GO BACK AND ADD MORE EVENTS.
(02) EVENT2
…
[DISPLAY ALL EVENTS ADDED AT IP4]
(N) EVENT N
[EVENT DATE, PROVIDER]
(N+1) CONTINUE INTERVIEW
IF SP WAS REPORTED AS STILL IN THE HOSPITAL AT IP4, GO TO BOX IP5.
ELSE GO TO IP7 - ANYOPERS
Were any operations performed on [you/(SP)] during the hospital stay that was (ADMISSION DATE) to
(01) YES
(DISCHARGE DATE)?
(02) NO
(-8) Don't Know
[Operations include surgery and other surgical procedures like setting bones, stitching or removing growths, (-9) Refused
or any cutting of the skin.]
IF CURRENTLY ADMINISTERING ST, GO TO BOX ST23B.
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS23B.
ELSE IF SP IS IN THE EXIT SAMPLE AND ROUND IS NOT 71 AND PREVIOUS ROUND INTERVIEW NOT SKIPPED,
GO TO BOX IP6.
ELSE GO TO IP13 - PRESMDCN.

[COUNT A MEDICINE AS "FILLED" REGARDLESS OF WHO OBTAINED IT FOR THE RESPONDENT, WHEN IT WAS
OBTAINED, 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
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Inpatient Utilization (IPQ)
Variable Name
MR Screen Name
BOX IP4B

Question type
routing

Question text/description
Code list
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN ASKED IN THE CURRENT ROUND, GO TO
IP14A - IPPMMEDS.
ELSE GO TO IP15 - MEDICINE_IP.

IPPMMEDS

no entry

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.]

MEDICINE_IP

IP14A

IP15

roster

[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.
Please tell me the names of these medicines.
ENTER ALL MEDICINES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
[DISPLAY ROSTER WITH ALL MEDICINES FROM PRIOR ROUNDS (WHERE EVENT.EVNTTYPE='PM' AND
EVNTDFLG^=1)]
DISPLAY MEDICINE NAME (EVENT.PMEDNAME) AND STRENGTH (EVENT.PRMSTRUNI)

[DISPLAY MEDICINE ROSTER AS RESPONSE OPTIONS:
1. [MEDICINE 1]
2. [MEDICINE 2]
…
N. [MEDICINE N]
N+1. ADD ANOTHER
[DISPLAY MEDICINE NAME AND STRENGTH FOR EACH.
IF NO EXISTING MEDICINES DISPLAY "NO MEDICINES
LISTED"]

MED

IP15

verbatim

[AT TOP OF SCREEN DISPLAY LINK TO PRESCRIBED MEDICINE LOOKUP WITH LABEL "Search Medicine"]
Please tell me the names of these medicines.
ENTER ALL MEDICINES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.

PMEDNAME
PMSTRUNI
ADDP

IP15
IP15
IP15B

BOX IP5

verbatim
verbatim
roster

routing

[DISPLAY ROSTER WITH ALL MEDICINES FROM PRIOR ROUNDS (WHERE EVENT.EVNTTYPE='PM' AND
EVNTDFLG^=1)]
DISPLAY MEDICINE NAME (EVENT.PMEDNAME) AND STRENGTH (EVENT.PRMSTRUNI)
NAME:
STRENGTH:
MEDICATIONS FILLED DURING THIS VISIT
[DISPLAY ALL MEDICINES ADDED AT MED]
IF ASKING ABOUT ONGOING IP STAY FROM THE PREVIOUS ROUND, GO TO BOX IP1AB.
ELSE IF ASKING ABOUT AN EMERGENCY ROOM VISIT IN THE CURRENT ROUND THAT RESULTED IN AN IP STAY,
THEN
IF SP HAS ANOTHER EMERGENCY ROOM VISIT IN THE CURRENT ROUND THAT RESULTED IN AN IP STAY
THAT HAS NOT BEEN ASKED ABOUT, GO TO BOX IP1AA.
ELSE GO TO IP1 - IPPROBE.
ELSE GO TO IP16 - IPMORE.

(01) ADD ANOTHER
(02) ALL DONE

Inpatient Utilization (IPQ)
Variable Name
MR Screen Name
IPMORE
IP16

BOX IP6

Question type
yes/no

routing

Question text/description
IF RESPONDENT HAS ALREADY MENTIONED ANOTHER INPATIENT STAY, ENTER “YES” WITHOUT ASKING.
OTHERWISE, ASK:
[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you had/has (SP) had/did (SP) have] any other admissions to this
or any other hospital as an inpatient -- either for an overnight stay or for a "same day" procedure?
IF HAD SAME DAY PROCEDURE AND IS NOT SURE IF ADMITTED OR NOT, TREAT AS OUTPATIENT EVENT AND
ENTER WHEN YOU GET TO OP UTILIZATION.
[ENTER A STAY AT A DRUG AND REHABILITATION CENTER AS AN IP EVENT, NOT AN IU EVENT.]
GO TO NEXT SECTION (OPQ)

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