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CAHPS Hospice Survey
Quality Assurance
Guidelines
Version 1.0
August 2014
CAHPS® Hospice Survey
Quality Assurance Guidelines
ACKNOWLEDGMENTS
These Specifications were prepared under contract to the Centers for Medicare & Medicaid
Services (CMS) by the RAND Corporation in collaboration with the Health Services Advisory
Group and Brown University.
CMS is pleased to acknowledge the role of the Agency for Healthcare Research and Quality, its
CAHPS grantees, and Joan M. Teno, MD, MS of Brown University in developing and testing the
Consumer Assessment of Healthcare Providers and Systems (CAHPS®1) Hospice Survey.
1
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government agency.
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CAHPS Hospice Survey
Quality Assurance Guidelines
Table of Contents
I. Reader’s Guide
1
Purpose of Quality Assurance Guidelines
CAHPS Hospice Survey Quality Assurance Guidelines V1.0 Contents
II. Introduction and Overview
5
Background
CAHPS Hospice Survey Instrument
CAHPS Hospice Survey Data Collection and Submission Timeline
III. Program Requirements
9
Overview
Purpose of the CAHPS Hospice Survey
Roles and Responsibilities
CAHPS Hospice Survey Minimum Business Requirements
CAHPS Hospice Survey Rules of Participation
IV. Communications and Technical Support
21
Overview
CAHPS Hospice Survey Information and Technical Assistance
General Information, Announcements and Updates
To Communicate with CMS Regarding the CAHPS Hospice Survey
V. Sampling Protocol
23
Overview
Eligibility for the CAHPS Hospice Survey
Sample Frame Creation
Sampling Procedure
Method of Sampling
VI. Mail Only Survey Administration
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Overview
Production of Questionnaire and Related Materials
Mailing of Materials
Data Receipt and Retention
Personnel Training
Quality Control Guidelines
Monitoring and Quality Oversight
Safeguarding Decedent/Caregiver Confidentiality
Data Security
Data Retention and Storage
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VII.
Telephone Only Survey Administration
Overview
Telephone Interviewing Systems
Telephone Attempts
Obtaining and Updating Telephone Numbers
Data Receipt and Retention
Electronic Telephone Interviewing System
Quality Control Guidelines
Safeguarding Decedent/Caregiver Confidentiality
VIII. Mixed Mode Survey Administration
53
Overview
Mail Protocol
Data Receipt and Retention of Mailed Questionnaires
Quality Control Guidelines for Mail Data
Telephone Protocol
Telephone Interviewing Systems
Receipt and Retention of Telephone Data
Electronic Telephone Interviewing System
Quality Control Guidelines for Telephone Data Collection
Safeguarding Decedent/Caregiver Confidentiality
IX. Data Coding and Data File Preparation
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73
Overview
Random, Unique, De-Identified Tracking Number
File Specifications
Decision Rules and Coding Guidelines
Survey Skip Patterns
Header Record
Decedent/Caregiver Administrative Record
Survey Results Record
Disposition of Survey Codes
Definition of a Completed Survey
Survey Response Rate
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Table of Contents
X. Data Submission
89
Overview
Data Submission Process
Data File Submission Dates
Survey Vendor Authorization Process
Preparation for Data Submission
Survey File Submission Naming Convention
Password Authentication
Organization of the CAHPS Hospice Survey Data Warehouse
File Encryption
Instructions for Accessing the CAHPS Hospice Survey Data Warehouse
Data Auditing and Validation Checks
Data Submission Reports
XI. Oversight Activities
95
Overview
Oversight Activities
CAHPS Hospice Survey Model Quality Assurance Plan (QAP)
Analysis of Submitted Data
Site Visits/Conference Calls
Non-compliance and Sanctions
XII. Exception Request Process
99
Overview
Exception Request Process
XIII. Discrepancy Report Process
Overview
Discrepancy Report Process
XIV Data Quality Checks
Overview
Traceable Data File Trail
Review of Data Files
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XV. Appendices
A. Minimum Business Requirements
B. CAHPS Hospice Survey Vendor Authorization Form
C. CAHPS Hospice Survey Data Warehouse Access
D. Sample File Layout
E. XML File Layout Version 1
Sample XML File Layout
F. Interviewing Guidelines for Telephone Surveys
G. Frequently Asked Questions for Customer Support
H. CAHPS Hospice Survey Model Quality Assurance Plan
I. CAHPS Hospice Survey Exception Request Form
J. CAHPS Hospice Survey Discrepancy Report Form
K. CAHPS Hospice Survey Participation Exemption for Size Form
L. Examples of Additional Supplemental Questions for Survey Vendor Use
M. CAHPS Hospice Mail Survey (English)
N. CAHPS Hospice Mail Survey (Spanish)
O. Telephone Script (English)
P. Telephone Script (Spanish)
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Reader’s Guide
Purpose of Quality Assurance Guidelines
The CAHPS Hospice Survey Quality Assurance Guidelines V1.0 manual has been developed by
the Centers for Medicare & Medicaid Services (CMS) to standardize the survey data collection
process and to ensure comparability of data reported through the CAHPS Hospice Survey. This
Reader’s Guide provides survey vendors with a high-level overview and reference for essential
information presented in the CAHPS Hospice Survey Quality Assurance Guidelines V1.0.
Readers are directed to the related chapters of the CAHPS Hospice Survey Quality Assurance
Guidelines V1.0 for more detail.
CAHPS Hospice Survey Quality Assurance Guidelines V1.0 Contents
The CAHPS Hospice Survey Quality Assurance Guidelines V1.0 contains chapters that address
CAHPS Hospice Survey administration requirements. These include:
Introduction and Overview
This chapter includes a description of the CAHPS Hospice Survey initiative and the history of its
development.
Program Requirements
This chapter presents the Program Requirements, including the purpose of the CAHPS Hospice
Survey, the Roles and Responsibilities for participating organizations (i.e., CMS, hospices and
survey vendors), Minimum Business Requirements to administer the CAHPS Hospice Survey,
and Rules of Participation.
Communications and Technical Support
This chapter includes information about communications and technical support available to
survey vendors administering the CAHPS Hospice Survey and other interested parties.
Sampling Protocol
This chapter describes the process and requirements for selecting a random sample of decedents
whose primary informal caregiver (caregiver) will be selected to respond to the CAHPS Hospice
Survey.
Modes of Survey Administration
CAHPS Hospice Survey Quality Assurance Guidelines V1.0 chapters VI to VIII describe each of
the three allowed modes of survey administration: Mail Only, Telephone Only, and Mixed
methodology of mail with telephone follow-up. These chapters address the administration of the
CAHPS Hospice Survey, data receipt and retention, and quality control guidelines for each of the
three modes. Each mode of survey administration requires adherence to a standardized protocol
and timeline.
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Data Coding and Data File Preparation
The CAHPS Hospice Survey utilizes standardized protocols for file specifications, coding and
submission of data. Survey vendors will submit data files via the CAHPS Hospice Survey Data
Warehouse. This chapter contains information about preparing the CAHPS Hospice Survey data
files for submission, including information on the requirements for coding and interpreting
ambiguous or missing data elements in returned surveys.
Data Submission
This chapter contains information about preparing and submitting survey data files to the
CAHPS Hospice Survey Data Warehouse, including the survey vendor authorization process, the
survey vendor data submission registration process, and the data submission process.
Oversight Activities
This chapter provides information on the oversight activities that the CMS-sponsored CAHPS
Hospice Survey Project Team conducts to verify compliance with CAHPS Hospice Survey
protocols. These oversight activities include, but are not limited to: review of survey vendor’s
CAHPS Hospice Survey Quality Assurance Plan (QAP), analyses of submitted data, site
visits/teleconference calls, additional activities related to the administration of the CAHPS
Hospice Survey, and possible outcomes of non-compliance.
Exception Request Process
This chapter describes the process for reviewing methodologies that vary from standard CAHPS
Hospice Survey protocols. The exception request process is designed to allow for flexibility
while maintaining the integrity of the data.
Discrepancy Report Process
This chapter describes the process for notifying CMS of any discrepancies from standard
CAHPS Hospice Survey protocols during the survey administration process.
Data Quality Checks
This chapter provides an overview describing the importance of data quality checks and
examples of data quality check activities as recommended by the CAHPS Hospice Survey
Project Team.
Appendices
The Appendices include the CAHPS Hospice Surveys and mailing materials [English and
Spanish (Chinese to be provided under separate cover)]; telephone (English and Spanish) scripts;
suggested supplemental questions; supporting interviewing documents; data file layout
specifications; survey authorization form; form for accessing the CAHPS Hospice Survey Data
Warehouse; the survey vendor model QAP; and the forms for submitting requests for protocol
exceptions, submitting discrepancy reports and the exemption for size.
For More Information
For program information and to view important updates and announcements, visit the CAHPS
Hospice Survey Web site at: http://www.hospicecahpssurvey.org.
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Reader’s Guide
To Provide Comments or Ask Questions
For information and technical assistance, contact CAHPS Hospice Survey Information and
Technical Support via email at: [email protected] or call 1-844-472-4621.
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Introduction and Overview
Background
Before the development of the CAHPS Hospice Survey, there was no official national standard
survey to measure experience with hospice care. The CAHPS Hospice Survey will be
implemented using detailed standard survey administration protocols to allow for fair
comparisons across hospices.
Centers for Medicare & Medicaid Services (CMS) developed the CAHPS Hospice Survey with
input from many stakeholders, including other government agencies, industry stakeholders,
consumer groups, other key individuals, and organizations involved in hospice care. The survey
was designed to measure and assess the experiences of decedents who died while receiving
hospice care as well as the experiences of their caregivers. The survey aims to produce
comparable data on decedents’/caregivers’ perspectives of care that allow objective and
meaningful comparisons between hospices on domains that are important to consumers, and
create incentives for hospices to improve their quality of care.
Note: The term decedent/caregiver is used throughout this manual to identify the patient who
died while receiving hospice care (decedent) and the informal primary caregiver (i.e., family
member or friend) identified to receive and respond to the CAHPS Hospice Survey (caregiver).
CAHPS Hospice Survey Development, Data Collection and Reporting
The development process for the survey began in 2012 and included: a public request for
information about publically available measures and important topics to measure (78 FR 5458); a
review of the existing literature on tools that measure experiences with end-of-life care;
exploratory interviews with caregivers of hospice decedents; a technical expert panel attended by
survey development and hospice care quality experts; cognitive interviews to test draft survey
content; incorporation of public responses to Federal Register notices (78 FR 48234); and a field
test conducted by CMS in November and December 2013.
Thirty-three programs from 29 hospice organizations participated in the field test, which was
designed to assess survey administration procedures among hospices of varying size, geographic
region, chain status, ownership, and urbanicity. Respondents were caregivers of patients who
died while receiving hospice care in the prior two to five months. In all, 1,136 respondents,
representing the three main settings of hospice care (home, nursing home and inpatient;
including freestanding hospice inpatient unit and acute care hospitals), completed the field test
survey.
National Implementation of the CAHPS Hospice Survey will begin on January 1, 2015 and
hospices will be required to contract with an approved CAHPS Hospice Survey vendor to
conduct the survey in order for the hospice to meet the Hospice Quality Reporting Program
requirements.
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Introduction and Overview
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Office of Management and Budget (OMB) and Public Comment Process
The OMB’s Paperwork Reduction Act clearance process for the CAHPS Hospice Survey
requires two Federal Register Notices. The initial notice was published in May 2014 (CMS1609-P). A 30-day Federal Register Notice was published in August 2014.
Preparation for CAHPS Hospice Survey Data Collection
Survey vendors interested in administering the CAHPS Hospice Survey must apply to participate
and must attend Introduction to CAHPS Hospice Survey Training, as well as all subsequent
CAHPS Hospice Survey Update Training sessions. Training is offered via Webinar. At a
minimum, the survey vendor’s Project Manager must attend the CAHPS Hospice Survey training
sessions. In addition, subcontractors that are responsible for major functions of CAHPS Hospice
Survey administration must attend CAHPS Hospice training.
During the first quarter of calendar year (CY) 2015, hospices will be required to conduct a dry
run of the survey for at least one month of patient deaths (deaths which occurred in January
2015, February 2015, or March 2015). Beginning in April 2015, all hospices will be required to
participate in the survey on an ongoing basis. The one “dry run month,” plus the nine months of
April 2015 to December 2015 participation, will be required to meet the pay for reporting
requirement of the Hospice Quality Reporting Program for the fiscal year (FY) 2017 annual
payment update (APU).
The CAHPS Hospice Survey treats the patient who died while in hospice care and his or her
informal primary caregiver (i.e., family member or friend) as the unit of care. Each contracted
hospice must provide specified decedent/caregiver data to its survey vendor on a monthly basis.
CAHPS Hospice Survey Instrument
Components of the CAHPS Hospice Survey Instrument
The standardized 47 question CAHPS Hospice Survey instrument is composed of the following
measures:
Nine Quality Measures
Hospice Team Communication (comprised of five CAHPS Hospice Survey items)
Getting Timely Care (comprised of two CAHPS Hospice Survey items)
Treating Family Member with Respect (comprised of two CAHPS Hospice Survey
items)
Providing Emotional Support (comprised of two CAHPS Hospice Survey items)
Getting Help for Symptoms (comprised of four CAHPS Hospice Survey items)
Support for Religious and Spiritual Beliefs (comprised of one CAHPS Hospice
Survey item)
Information Continuity (comprised of one CAHPS Hospice Survey item)
Understanding the Side Effects of Pain Medication (comprised of one CAHPS
Hospice Survey item)
Getting Hospice Care Training (comprised of four CAHPS Hospice Survey items)
The CAHPS Hospice Survey will be available in English, Spanish and Chinese. The Chinese
mail survey is in traditional and simplified characters and targets both Mandarin and Cantonese
speakers.
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Introduction and Overview
The CAHPS Hospice Survey will be administered using the Mail Only Mode, Telephone Only
Mode, or Mixed Mode (mail with telephone follow-up).
CAHPS Hospice Survey Data Collection and Submission Timeline
Data collection for sampled decedents/caregivers must be initiated two months following the
month of patient death. The data collection process must be completed within 42 calendar days
after initial contact. Submission of the data to the CAHPS Hospice Survey Data Warehouse will
occur quarterly. Please see the schedule outlined in the table below.
Month of Death
Initial Contact with Sampled
Decedents/Caregivers
Data Submission to the
CAHPS Hospice Survey
Data Warehouse
January 2015
February 2015
March 2015
April 1, 2015
May 1, 2015
June 1, 2015
August 12, 2015
April 2015
May 2015
June 2015
July 1, 2015
August 1, 2015
September 1, 2015
November 1, 2015
July 2015
August 2015
September 2015
October 1, 2015
November 1, 2015
December 1, 2015
February 10, 2016
October 2015
November 2015
December 2015
January 1, 2016
February 1, 2016
March 1, 2016
May 11, 2016
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Program Requirements
Overview
This chapter describes the Program Requirements, which include the purpose of the CAHPS
Hospice Survey, roles and responsibilities for participating organizations, the Rules of
Participation, and Minimum Business Requirements to administer the CAHPS Hospice Survey.
Survey vendors administering the CAHPS Hospice Survey must meet all of the Minimum
Business Requirements.
Purpose of the CAHPS Hospice Survey
The CAHPS Hospice Survey and its administration protocols are designed to produce
standardized information about decedents’/caregivers’ perspectives of care that allows objective
and meaningful comparisons of hospices on topics that are important to consumers. In the future,
public reporting of CAHPS Hospice Survey results will create incentives for hospices to improve
the quality of care while enhancing accountability in healthcare by increasing transparency.
In order to fulfill these goals, it is essential that, to the fullest extent possible:
caregivers respond to the CAHPS Hospice Survey, and
caregivers’ responses are informed only by the care their family member’s or friend’s
received from the hospice named on the survey cover
CMS carefully developed the CAHPS Hospice Survey and its administration protocols to
achieve the following outcomes:
to increase the likelihood that caregivers will respond to the survey, the CAHPS Hospice
Survey should be the first survey a caregiver receives about their family member’s or
friend’s experience of hospice care
to ensure that the caregiver’s responses are unbiased and reflect only his or her family
member’s or friend’s experience of care, hospices and survey vendors (and anyone acting
on their behalf) must not attempt to influence how the caregiver responds to CAHPS
Hospice Survey items
Roles and Responsibilities
The following content clarifies the roles and responsibilities of participating organizations.
CMS Roles and Responsibilities
CMS supports the standardization of the survey administration and data collection
methodologies for measuring and reporting caregivers’ perspectives on their family members’ or
friends’ hospice care as follows:
Provide CAHPS Hospice Survey administration protocols through the CAHPS Hospice
Survey Quality Assurance Guidelines
Train survey vendors to administer the CAHPS Hospice Survey
Provide technical assistance via CAHPS Hospice Survey Information and Technical
Support and distribute information about survey administration procedures and policy
updates on the CAHPS Hospice Survey Web site at www.hospicecahpssurvey.org
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Provide quality oversight to ensure that the CAHPS Hospice Survey is credible, useful
and practical to allow for valid comparisons to be made across hospices
Hospice Roles and Responsibilities
It is the responsibility of the Medicare-certified hospice to participate every month in the CAHPS
Hospice Survey.
Some hospices may be exempted for size from participation for a given annual payment update
(APU) period. The only scenario under which a Medicare-certified hospice provider can be
exempted from participation in the CAHPS Hospice Survey is described below:
The Participation Exemption for Size process has been created to provide hospices
meeting the size criteria a means to request consideration for this exemption. For the
calendar year (CY) 2015 data collection period, Medicare-certified hospices that have
served fewer than 50 survey-eligible decedents/caregivers in the period from January 1,
2014 through December 31, 2014 can apply for an exemption from CAHPS Hospice
Survey CY 2015 data collection and reporting requirements. To qualify for the survey
exemption for CY 2015, hospices must submit a Participation Exemption for Size Form
online via the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org). For the
CY 2015 data collection period, this form must be submitted no later than August 12,
2015. The form must be completed in its entirety. Please see Appendix K for specific
information to be submitted on the Participation Exemption for Size Form.
The Participation Exemption for Size Form will be reviewed by the CAHPS Hospice
Survey Project Team. Hospices will need to include the number of survey-eligible
decedents/caregivers for CY 2014, the total number of patients discharged alive, and
the number of decedents who fall into each ineligibility category [i.e., under the age
of 18, died within 48 hours of admission to hospice care, decedent has no caregiver of
record (a patient for whom no caregiver is listed in the medical record or
administrative data), caregiver is a non-familial legal guardian, caregiver has a
foreign home address, decedent/caregiver requested not to be contacted].
Note: For multiple hospice programs sharing one CCN, the survey-eligible
decedent/caregiver count is the total from all programs.
If a hospice is eligible to participate, it must:
Contract with an approved CAHPS Hospice Survey vendor to administer their survey
Note: No organization, firm, or business that owns, operates, or provides staffing for a
hospice is permitted to administer its own CAHPS Hospice Survey or administer the
survey on behalf of any other hospice in the capacity as a CAHPS Hospice Survey
vendor. Such organizations will not be approved by CMS as CAHPS Hospice Survey
vendors.
Authorize the contracted survey vendor to collect and submit CAHPS Hospice Survey
data to the CAHPS Hospice Survey Data Warehouse on the hospice’s behalf (refer to
Appendix B)
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Program Requirements
Work with their approved survey vendor to determine a date each month by which to
provide their survey vendor with the monthly decedents/caregivers list
By the agreed-upon date each month, compile and deliver to the survey vendor a
complete and accurate decedents/caregivers list with the caregiver information that
will enable the survey vendor to administer the survey
Use a secure method to transmit monthly decedents/caregivers lists to the survey vendor
Review data submission reports to ensure that their survey vendor has submitted data on
time and without data problems
Avoid influencing caregivers in any way about whether or how to answer the CAHPS
Hospice Survey. For example, a hospice may not suggest that caregivers decline to be
contacted for the survey, or provide any information to caregivers about how to answer
the survey
Understand the hospices’ responsibilities regarding participation in the Hospice Quality
Reporting Program, including key date ranges and deadline dates
Survey Vendor Roles and Responsibilities
CAHPS Hospice Survey vendors are subject to the following requirements:
Survey vendors must have physical plant resources available to handle the volume of
surveys being administered, in addition to systematic processes that effectively track
sampled decedents’/caregivers’ progress through the data collection protocol and
caregivers’ responses to the survey. System resources are subject to oversight activities
including site visits to physical locations (including the physical locations of
subcontractors, if applicable).
Complete the Participation Form for Survey Vendors and become approved to administer
the CAHPS Hospice Survey. Participation Forms will be available on the CAHPS
Hospice Survey Web site prior to the scheduled Introduction to CAHPS Hospice Survey
Webinar training session.
Participate in and successfully complete the Introduction to CAHPS Hospice Survey
webinar training session and all update training sessions
The survey vendor’s designated CAHPS Hospice Survey project manager must also
complete a Training Quiz after participating in CAHPS Hospice Survey webinar
training sessions
Ensure that all survey vendor staff who work on the CAHPS Hospice Survey are trained
and follow the standard CAHPS Hospice Survey protocols and guidelines
Work with the client hospice’s staff to create monthly decedent/caregiver lists, including
data elements needed
Designate a date each month by which the hospice must provide each monthly
decedents/caregivers list
Receive and perform checks of the monthly decedents/caregivers lists provided by each
hospice to ensure that they include the entire eligible population and all required data
elements
Follow the Rules of Participation (see below) to administer the CAHPS Hospice Survey
Comply with all requirements of the Health Insurance Portability and Accountability Act
(HIPAA) Security and Privacy Rules during all survey administration and data collection
processes
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http://www.cms.gov/Regulations-and-Guidance/HIPAA-AdministrativeSimplification/HIPAAGenInfo/index.html
http://www.cms.gov/Regulations-and-Guidance/HIPAA-AdministrativeSimplification/HIPAAGenInfo/PrivacyandSecurityStandards.html
http://www.hhs.gov/ocr/privacy/
Meet all CAHPS Hospice Survey due dates (including submission of QAPs and survey
materials for review) or risk revocation of approval to administer the CAHPS Hospice
Survey
Receive and perform checks of the decedent/caregiver list to verify that it includes the
entire eligible population and all required data elements
When updated decedent/caregiver lists are received, prior to data submission, the survey
vendor should update all decedent/caregiver administrative information available. In
addition, the survey vendor must perform quality checks to track and verify changes from
the original decedent/caregiver lists.
Prepare sample frame
Draw sample of decedents/caregivers according to the sampling protocols contained in
the CAHPS Hospice Survey Quality Assurance Guidelines
Administer the CAHPS Hospice Survey and oversee the quality of work of staff and
subcontractors, if applicable, according to protocols contained in the CAHPS Hospice
Survey Quality Assurance Guidelines
Verify that each contracted hospice has authorized the survey vendor to submit data on
the hospice’s behalf
Submit data files to the CAHPS Hospice Survey Data Warehouse in accordance with the
survey file layouts by data submission deadlines
Review CAHPS Hospice Survey Data Submission Reports and confirm successful upload
of contracted hospices’ data files to the CAHPS Hospice Survey Data Warehouse
Perform quality checks of all survey administration processes and document the
performance of the quality check activities
Assign and train organizational staff with appropriate back-up responsibilities for
coverage of key staff
Maintain active contract(s) with hospice(s) in order to retain approval status (see
Minimum Business Requirements)
Survey vendors administering Telephone Only and Mixed Modes of survey
administration must use telephone interviewers who do not know decedents/caregivers
either professionally or personally
Note: If a survey vendor is non-compliant with program requirements for any of their
contracted hospices, the non-compliant action could affect the hospice’s APU for a given
fiscal year. In addition, approved survey vendors that are non-compliant with CAHPS
Hospice Survey protocols may lose their CAHPS Hospice Survey approval status.
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Program Requirements
CAHPS Hospice Survey Minimum Business Requirements
An entity must be approved by CMS in order to administer the CAHPS Hospice Survey and
submit CAHPS Hospice Survey data to the CAHPS Hospice Survey Data Warehouse. A survey
vendor must meet ALL of the CAHPS Hospice Survey Minimum Business Requirements. In
addition, subcontractors performing major CAHPS Hospice Survey administration functions
(e.g., mail/telephone operations) must also meet ALL of the CAHPS Hospice Survey Minimum
Business Requirements that pertain to that role.
Approved CAHPS Hospice Survey vendors must fully comply with the CAHPS Hospice
Survey oversight activities
Participate in CAHPS Hospice Survey oversight activities to ensure compliance with
CAHPS Hospice Survey technical specifications and survey requirements. The
purpose of the oversight activities is to ensure that approved survey vendors follow
ALL the CAHPS Hospice Survey administration protocols; and thereby, ensure the
comparability of CAHPS Hospice Survey data across hospices.
In order for the CAHPS Hospice Survey Project Team to perform the required
oversight activities, organizations that are approved to administer the CAHPS
Hospice Survey must conduct all of their business operations within the United
States. This requirement applies to all staff and subcontractors.
In order to ensure the confidentiality of data, survey vendors may not use home-based
or virtual interviewers to conduct the CAHPS Hospice Survey, nor may they conduct
any survey administration processes (e.g. mailings) from a residence
Approved survey vendors are expected to maintain active contract(s) for CAHPS Hospice
Survey administration with client hospice(s). An “active contract” is one in which the
CAHPS Hospice Survey vendor is authorized by hospice client(s) to submit CAHPS
Hospice Survey data to the CAHPS Hospice Survey Data Warehouse. If a CAHPS
Hospice Survey vendor does not have any contracted hospice client(s) for the CAHPS
Hospice Survey within two years (a consecutive 24 months) of the date the survey
vendor received approval to administer the CAHPS Hospice Survey, then that survey
vendor’s “Approved” status for CAHPS Hospice Survey administration will be
withdrawn. If approval status is withdrawn, the survey vendor must once again follow
the steps to apply for consideration of approval to administer the CAHPS Hospice
Survey. The first step is to complete a participation form and submit it to the CAHPS
Hospice Survey Project Team for consideration. Once conditionally approved, the survey
vendor must then participate in the Introduction to CAHPS Hospice Survey Training.
In reviewing Participation Forms from potential CAHPS Hospice Survey vendors, the
CAHPS Hospice Survey Project Team will take into consideration the applicant’s prior
experience administering CAHPS Surveys, if any
Note: If a survey vendor is non-compliant with program requirements, the non-compliant
action could affect a hospice’s APU for a given fiscal year.
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A survey vendor must meet ALL of the Survey Vendor Minimum Business Requirements. In
addition, subcontractors performing major CAHPS Hospice Survey administration functions
(e.g., mail/telephone operations) must also meet all of the CAHPS Hospice Survey Minimum
Business Requirements that pertain to that role. The minimum business requirements for an
organization to become approved to administer the CAHPS Hospice Survey are as follows:
Relevant Survey Experience:
Criteria
Survey Vendor
Minimum four years
Number of Years in
Business
Minimum three years in conducting surveys in the selected
Number of Years
mode(s) of administration
Conducting Surveys in
the Requested Mode
Minimum two years conducting patient-specific surveys as an
Number of Years
organization
Conducting PatientSpecific Surveys
Two years prior experience selecting random sample based on
Sampling Experience
specific eligibility criteria:
Work with contracted client(s) to obtain patient data for
sampling via HIPAA-compliant electronic data transfer
processes
Adequately document sampling process
Survey vendors are responsible for conducting the sampling
process and must not subcontract this activity
Survey Capability and Capacity:
Criteria
Survey Vendor
Designated CAHPS Hospice Survey personnel:
Personnel
Project Director with minimum two years prior experience
conducting patient-specific surveys in the requested mode
Staff with minimum one year prior experience in sample
frame development and sample selection
Programmer (subcontractor designee, if applicable) with
minimum one year prior experience receiving large encrypted
data files in different formats/software packages electronically
from an external organization; processing survey data needed
for survey administration and survey response data; preparing
data files for electronic submission; and submitting data files
to an external organization
Call Center/Mail Center Supervisor (subcontractor designee,
if applicable) with minimum one year prior experience in role
Have appropriate organizational back-up staff for coverage of key
staff
Volunteers are not permitted to be involved in any aspect of the
CAHPS Hospice Survey administration process
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Criteria
Physical Plant and
System Resources
Program Requirements
Sample Frame
Creation
Mail Administration
Survey Vendor
Physical plant resources available to handle the volume of surveys
being administered, including computer and technical equipment:
A secure commercial work environment
Home-based or virtual interviewers cannot be used to
administer the CAHPS Hospice Survey nor used to conduct
any survey administration processes
Physical facilities and electronic equipment and software to
collect, process and report data securely
If offering telephone surveys, must have the equipment,
software and facilities to conduct CATI interviews and to
monitor interviewers
Electronic or alternative survey management system to:
Track fielded surveys throughout the protocol, avoiding
respondent burden and losing respondents
Assign random, unique, de-identified identification number
(Tracking ID) to track each sampled patient/primary informal
caregiver (i.e., family member or friend of the hospice patient)
Organizations that are approved to administer the CAHPS
Hospice Survey must conduct all of their business operations
within the United States. This requirement applies to all staff and
subcontractors.
All System Resources are subject to oversight activities, including
site visits to physical locations
Two years prior experience selecting random sample based on
specific eligibility criteria:
Generate the sample frame data file that contains all
individuals who meet the eligible population criteria
Draw random sample of individuals for the survey, who meet
the eligible population criteria
Mail survey administration activities are not to be conducted from
a residence, nor from a virtual office
Obtain and update addresses of sampled patients/primary informal
caregivers
Produce and print professional quality survey instruments and
materials according to guidelines; a sample of all mailing
materials must be submitted for review
Merge and print sample name and address on personalized mail
survey cover letters, and print unique Tracking ID on the survey
questionnaire
Mail out of survey materials
Receive and process (key-entry or scanning) completed
questionnaires
Track and identify non-respondents for follow-up mailing
Assign final survey status codes to describe the final result of each
sampled case
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Program Requirements
Criteria
Telephone
Administration
August 2014
Mixed Mode
Administration (Mail
with Telephone
Follow-up)
Data Submission
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Survey Vendor
Telephone interviews are not to be conducted from a residence
nor from a virtual office
Obtain, verify and update telephone numbers
Develop computer programs for electronically administering the
survey (CATI)
Collect telephone interview data for the survey, using CATI
system; a sample of the telephone script and interviewer screen
shots must be submitted for review
Identify non-respondents for follow-up telephone calls
Schedule and conduct callbacks to non-respondents at varying
times of the day and different days of the week
Assign final status codes to reflect results of attempts to obtain
completed interview with sampled cases
Mail survey administration and telephone interviews are not to be
conducted from a residence nor from a virtual office
Adhere to all Mail Only and Telephone Only survey
administration requirements (described above).
Track cases from mail survey through telephone follow-up
activities
Survey vendors are responsible for conducting data submission
and must not subcontract this process
Scan or key data from completed mail surveys
Import (as necessary) data from CATI system into a data file
Develop data files, edit and clean data according to standard
protocols
Follow all data cleaning and data submission rules, including
verifying that data files are de-identified and contain no duplicate
cases
Export data from the electronic data collection system to the
required format for data submission, confirm that the data were
exported correctly, that the data submission files are formatted
correctly and contain the correct data headers and data records
Submit data electronically in the specified format to the CAHPS
Hospice Survey Data Warehouse
Work with CMS’ contractor to resolve data problems and data
submission problems
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Criteria
Technical Assistance/
Customer Support
Program Requirements
Survey Vendor
Two years prior experience providing telephone customer support
Provide toll-free customer support line:
Customer support must be offered in all languages that the
survey vendor administers the survey in
Respond to calls within 24-48 hours
Participation in Quality Control Activities and Documentation Requirements:
Criteria
Survey Vendor
Demonstrated Quality
Control Procedures
Documentation
Requirements
Incorporate well-documented quality control procedures (as
applicable) for:
In-house training of staff and subcontractors involved in
survey operations
Printing, mailing and recording receipt of survey
questionnaires, if applicable
Telephone administration of survey, if applicable
Coding and verifying of survey data and survey-related
materials
Scanning or keying in survey data
Preparation of final person-level data files for submission
All other functions and processes that affect the
administration of the CAHPS Hospice Survey
Participate in any conference calls and site visits as part of overall
quality monitoring activities:
Provide documentation as requested for site visits and
conference calls, including but not limited to: staff training
records, telephone interviewer monitoring records and file
construction documentation
Keep electronic or hard copy files of staff training and training
dates
Maintain electronic documentation of telephone monitoring, if
applicable
Maintain documentation of mail production quality checks, if
applicable
Maintain documentation of all survey administration activities
and related quality checks for review during site visits
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Adhere to all Protocols, Specifications and Agree to Participate in Training Sessions:
Attend all CMS Introduction and Vendor Update training sessions
Survey Training
(subcontractors assigned key roles must attend training)
Administer the Survey Review and follow all procedures described in the CAHPS
Hospice Survey Quality Assurance Guidelines that are applicable
According to all
to the selected survey data collection mode
Survey Specifications
Fully comply with the CAHPS Hospice Survey oversight
activities
Approved survey vendors are expected to maintain active
contract(s) for CAHPS Hospice Survey administration with client
hospice(s). An “active contract” is one in which the CAHPS
Hospice Survey vendor is authorized by hospice client(s) to
collect and submit CAHPS Hospice data to the CAHPS Hospice
Survey Data Warehouse. If a CAHPS Hospice Survey vendor
does not have any contracted hospice clients within two years (a
consecutive 24 months) of the date they received approval to
administer the CAHPS Hospice Survey, then that survey vendor’s
“Approved” status for CAHPS Hospice Survey administration
will be withdrawn. If approval status is withdrawn, the
organization must once again follow the steps to apply for
reconsideration for approval to administer the CAHPS Hospice
Survey.
CAHPS Hospice Survey Rules of Participation
Survey vendors agree to the following Rules of Participation as found in the CAHPS Hospice
Survey Participation Forms:
Submit Participation Form
Before attending the Introduction to CAHPS Hospice Survey Training, new survey
vendors must complete and submit a Participation Form online. Participation Forms are
available on the CAHPS Hospice Survey Web site at www.hospicecahpssurvey.org.
Note: Approval of the survey vendors’ participation status to administer the CAHPS
Hospice Survey is contingent upon successful completion of teleconference call(s) with
the CAHPS Hospice Survey Project Team, if requested, to discuss relevant survey
experience, organizational survey capability and capacity and quality control
procedures.
Attend CAHPS Hospice Survey Training
Survey vendors that intend to administer the survey must attend the Introduction to
CAHPS Hospice Survey Training and subsequent CAHPS Hospice Survey Update
Training sessions sponsored by CMS. At a minimum, the survey vendor’s Project
Manager must participate in the CAHPS Hospice Survey training sessions.
Subcontractors who are responsible for major functions of CAHPS Hospice Survey
administration (e.g., mail/telephone) must attend CAHPS Hospice Survey training.
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Program Requirements
Change in key personnel
A survey vendor must immediately notify the CAHPS Hospice Survey Project Team
of changes in its contact person or key staff and organizational structure (i.e., changes
in ownership, name, and address) via email ([email protected])
Participation in a CAHPS Hospice Survey Dry Run
During the first quarter of CY 2015, hospices will be required to conduct a dry run of the
survey for at least one month of patient deaths (deaths which occurred in January 2015,
February 2015, or March 2015). The one “dry run month,” plus the nine months of April
2015 to December 2015 participation, will be required to meet the requirement of the
Hospice Quality Reporting Program for the FY 2017 APU.
Review and Follow the CAHPS Hospice Survey Quality Assurance Guidelines and
Policy Protocols
The CAHPS Hospice Survey Quality Assurance Guidelines manual has been developed to
assure the standardization of the survey data collection process and the comparability of
reported data. Survey vendors must review and follow the CAHPS Hospice Quality
Assurance Guidelines. In addition, survey vendors must follow all policy protocols,
including CAHPS Hospice Survey Bulletins, posted on the CAHPS Hospice Survey Web
site at www.hospicecahpssurvey.org.
Attest to the Accuracy of the Organization’s Data Collection Process
The survey vendor must review and attest (as determined by CMS) to the accuracy of the
organization’s data collection process and conformance with the CAHPS Hospice Survey
Quality Assurance Guidelines
Survey vendors are responsible for sampling and data submission and these
processes cannot be subcontracted
Any variations from the survey administration protocols must be reported to CMS
immediately upon discovery (except those that have been pre-approved by CMS through
the Exception Request process). CMS may determine that data collected in a nonapproved manner may not be reported.
Develop Survey Vendor CAHPS Hospice Survey QAP
Survey vendors must develop a QAP for survey administration in accordance with the
CAHPS Hospice Survey Quality Assurance Guidelines and update the QAP as part of
their participation status. The Model QAP document (see Appendix H) must be used for
developing the QAP. The QAP must be updated, as necessary, to reflect changes in key
personnel, resources and processes (see Oversight Activities chapter for more
information).
Upon request, each survey vendor must submit their QAP and materials relevant to that
year’s CAHPS Hospice Survey administration (as determined by CMS), including
mailing materials (e.g., cover letters and questionnaires) and/or telephone scripts
(including screen shots and skip pattern logic, if applicable) to
[email protected] for review by the CAHPS Hospice Survey Project
Team.
Note: The CAHPS Hospice Survey Project Team’s acceptance of a submitted QAP and
corresponding survey materials does not constitute or imply approval or endorsement of
the survey vendor’s CAHPS Hospice Survey administration processes. Additionally, any
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materials submitted with the QAP (e.g., questionnaires, cover letters, tracking forms,
etc.) must be templates and must not contain any decedent/caregiver protected health
information (PHI) or personal identifying information (PII).
Participate in Oversight Activities Conducted by the CAHPS Hospice Survey
Project Team
Survey vendors, including subcontractors, must be prepared to participate in all oversight
activities, such as site visits and/or teleconference calls, as requested by the CAHPS
Hospice Survey Project Team, to confirm that correct survey protocols are followed.
Failure to comply with oversight activities may result in the revocation of approval to
administer the CAHPS Hospice Survey. All materials relevant to survey administration
are subject to review. Non-compliance with CAHPS Hospice Survey program
requirements (including, but not limited to, participation and cooperation in oversight
activities), may result in the contracted hospice’s CAHPS Hospice Survey scores not
being reported, which could affect the hospice’s APU, and/or other sanctions (see the
Oversight Activities chapter for more information on non-compliance and sanctions).
Review and Acknowledge Agreement with the Rules of Participation
By signing the CAHPS Hospice Survey Participation Form, survey vendors signify
agreement with all of the Rules of Participation, including all CAHPS Hospice Survey
oversight activities and survey administration due dates.
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Communications and Technical Support
Overview
Organizations and individuals have access to a number of sources of information regarding the
CAHPS Hospice Survey. Several of these sources are listed below.
CAHPS Hospice Survey Information and Technical Assistance
For information and technical assistance, contact CAHPS Hospice Survey Information and
Technical Support.
Via email at [email protected]
Via telephone 1-844-472-4621
When contacting the CAHPS Hospice Survey Project Team regarding a specific hospice, be sure
to provide the following information in your email or telephone voice mail:
Survey vendor name
Hospice six-digit CMS Certification Number (CCN)
Hospice name
For additional information and technical assistance related to the use of the CAHPS Hospice
Survey Data Warehouse or data submission issues, contact the CAHPS Hospice Survey Data
Coordination Team via email only at:
[email protected]
General Information, Announcements and Updates
To learn more about the CAHPS Hospice Survey and to view important new updates and
announcements, please visit the CAHPS Hospice Survey Web site at:
www.hospicecahpssurvey.org.
To Communicate with CMS Regarding the CAHPS Hospice Survey
Via email at [email protected]
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Sampling Protocol
Overview
This chapter describes the procedures survey vendors should use to request the
decedent/caregiver list from their hospices, identify decedents/caregivers eligible for the survey,
construct a sampling frame, and select a sample each month. The sampling procedures described
in this chapter were developed to ensure standardized administration of the CAHPS Hospice
Survey by all approved survey vendors and to ensure the comparability of the data and survey
results that are reported.
Eligibility for the CAHPS Hospice Survey
The following groups of decedents/caregivers are eligible for inclusion in the sample frame:
Decedents age 18 and over
Decedents with death at least 48 hours following last admission to hospice care
Decedents for whom there is a caregiver of record
Decedents whose caregiver is someone other than a non-familial legal guardian
Decedents for whom the caregiver has a U.S. or U.S. Territory home address
Decedents/caregivers who request that they not be contacted (those who sign “no publicity”
requests while under the care of hospice or otherwise directly request not to be contacted) will be
excluded from the sample frame. Patients whose last admission to hospice resulted in a live
discharge will be excluded.
Note: Decedents/caregivers must be included in the CAHPS Hospice Survey sample frame unless
the survey vendor has positive evidence that a decedent/caregiver is ineligible. If information is
missing on any variable that affects survey eligibility when the sample frame is constructed, the
decedent/caregiver must be included in the sample frame.
Monthly Decedents/Caregivers List
Data collection on the CAHPS Hospice Survey is conducted on a monthly basis. Survey vendors
select monthly samples of all decedents/caregivers who meet survey eligibility criteria for each
contracted hospice. For each monthly sample, the survey administration must be initiated two
calendar months after the patient’s death. Submission to the CAHPS Hospice Survey Data
Warehouse is done on a quarterly basis.
Month of Death
Initial Contact with Sampled
Decedents/Caregivers
Data Submission to the
CAHPS Hospice Survey
Data Warehouse
January 2015
February 2015
March 2015
April 1, 2015
May 1, 2015
June 1, 2015
August 12, 2015
April 2015
May 2015
June 2015
July 1, 2015
August 1, 2015
September 1, 2015
November 1, 2015
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Sampling Protocol
Month of Death
August 2014
July 2015
August 2015
September 2015
Initial Contact with Sampled Data Submission to the
Decedents/Caregivers
CAHPS Hospice Survey
Data Warehouse
October 1, 2015
November 1, 2015
February 10, 2016
December 1, 2015
October 2015
November 2015
December 2015
January 1, 2016
February 1, 2016
March 1, 2016
May 11, 2016
Hospice Information Submission Requirements
Each hospice must submit monthly:
The decedent/caregiver list
Counts of cases ineligible due to:
Live discharge
Requests for no contact (i.e., decedent or caregiver signed “no publicity” requests or
otherwise directly requested not to be contacted) to the survey vendor in time for the
survey vendor to initiate the survey data collection protocols
Decedent/Caregiver List
Hospices are required to supply monthly decedent/caregiver lists to their survey vendors
containing the following data elements for each decedent who died within a calendar month
while under the care of the hospice program (first day of month through last day of month).
Decedent name (first, middle [if available], last) and prefix/suffix
Decedent date of birth
Decedent date of death
Decedent sex
Decedent race/ethnicity
Decedent primary diagnosis
Decedent admission date for final episode of hospice care
Decedent payers (primary, secondary, other)
Decedent last location/setting of care (i.e., home, assisted living facility, nursing home,
acute care hospital, freestanding hospice inpatient unit)
Caregiver name (first, middle [if available], last) and prefix/suffix
Caregiver contact information, including mailing address, telephone number(s), email
address (if available)
Caregiver relationship to decedent (i.e., spouse/partner, child, sibling, other, etc.)
The information that the hospice provides will be used by the survey vendor to identify surveyeligible decedents/caregivers and survey the sampled decedents/caregivers.
Note: Each contracted hospice is required to submit its entire decedent/caregiver list to its
survey vendor, excluding no-publicity decedents/caregivers.
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Sampling Protocol
Counts of Ineligibles
The hospice must submit to its survey vendor a count for each of the following ineligibility
categories:
Patient(s) discharged alive. This includes patients who have the following Patient Status
codes (FL17):
01 Discharged to home, revoked, or decertified
50 Discharged/transferred to hospice – home (routine or CHC)
51 Discharged/transferred to hospice – medical facility (respite or GIP)
Decedents or caregivers who requested not to be contacted (i.e., signed “no publicity”
requests or otherwise directly requested not to be contacted)
Note: With the exception of no-publicity decedents/caregivers, hospices are required to
document the complete list of all decedents/caregivers for whom information has been withheld
from the survey vendor for any reason.
Sample Frame Creation
Survey vendors participating in the CAHPS Hospice Survey are responsible for generating
complete, accurate and valid sample frame data files each month that contain all administrative
information on all decedents/caregivers who meet the eligible population criteria.
Prior to generating the CAHPS Hospice Survey sample frame, survey vendors must apply
the eligibility criteria and remove ineligible decedents/caregivers. The following steps must
be followed when creating the sample frame:
Decedents/Caregivers whose eligibility status is uncertain must be included in the sample
frame
The sample frame for a particular month must include all survey-eligible
decedents/caregivers from the first through the last day of the month (e.g., for January,
any qualifying patient deaths from the 1st through 31st)
Decedents with missing or incomplete caregiver addresses and/or telephone numbers
must not be removed from the sample frame. Instead, every attempt must be made to find
the correct address and/or telephone number. If the necessary contact information is not
found, the “Final Survey Status” must be coded as “10 – Non-response: Bad address” or
as “11 – Non-response: Bad/No Phone Number.” (For more information, see the Data
Coding and Data File Preparation chapter.)
Survey vendors are required to provide counts of (a) patients discharged alive (provided by the
hospice), (b) no publicity patients (provided by the hospice), and (c) total number of ineligible
decedents/caregivers as determined by the survey vendor applying the following criteria:
Decedent was under the age of 18
Decedent’s death was less than 48 hours following last admission to hospice care
Decedent has no caregiver of record
Decedent’s caregiver is a non-familial legal guardian
Decedent’s caregiver has an address outside the U.S. or U.S. Territories
Note: Survey vendors must retain counts of the number of ineligible decedents/caregivers in each
of the above categories. This documentation is subject to review.
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Sampling Protocol
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The survey vendor must retain the original decedent/caregiver lists, the sample frames (the entire
list of eligible CAHPS Hospice Survey decedents/caregivers from which each hospice’s sample
is drawn) and ineligibility counts for three years.
Sampling Procedure
Hospices with fewer than 50 survey-eligible decedents/caregivers during the prior calendar year
are exempt from the survey data collection and reporting requirements. Hospices with 50 to 699
survey-eligible decedents/caregivers in the prior year are required to survey all cases (conduct a
census) and attempt to obtain as many completes as possible. Hospices with 700 or more surveyeligible decedents/caregivers in the prior year are required to survey a minimum sample of 700
using an equal-probability design. While there is no requirement for census administration,
hospices with 700 or more survey-eligible decedents/caregivers may conduct a census, if desired.
Survey-eligible decedents/caregivers are defined as that group of decedent and caregiver pairs
that meet all the criteria for inclusion in the survey sample.
For national implementation, the CAHPS Hospice Survey Project Team has assumed an
eligibility rate of 85% and a response rate of 50%, based on the experience in the 2013 field test
of the CAHPS Hospice Survey instrument. These rates will result in an estimated 300 completed
surveys for each hospice with 700 or more survey-eligible decedents/caregivers in the calendar
year and between 21 and 300 completed surveys for hospices with between 50 and 699 surveyeligible decedents/caregivers during the calendar year.
Note: Hospices that share a common CCN (formerly known as the Medicare Provider Number
[MPN]) must calculate the total number of survey-eligible decedents/caregivers per CCN, not
per individual hospice program.
Consistent Monthly Sampling
For ease of sampling within hospices large enough to conduct non-census sampling, CMS
recommends that survey vendors sample an approximately equal number of decedents/caregivers
each month, unless adjustments are required. Adjustments should take place between quarters
only. Survey vendors have the option to allocate the yearly sample proportionately to each month
according to the expected proportional distribution of total survey-eligible decedents/caregivers
over the 4 rolling quarters (12-month reporting period). Survey vendors must sample from every
month in the reporting period, even if they have already achieved the required number of
sampled decedents/caregivers.
Final Survey Sample
The final sample drawn each month must reflect a random sample of decedents/caregivers from
the survey sample frame, or for those hospices conducting a census, all decedents/caregivers
from the survey sample frame.
Note: When a census is conducted, the “Type of Sampling” field in the Header Record must be
coded “2 Census Sample.”
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Sampling Protocol
Method of Sampling
Sampling for the CAHPS Hospice Survey is based on the survey-eligible decedents/caregivers
(CAHPS Hospice Survey sample frame) for a calendar month. If every survey-eligible
decedent/caregiver for a given month has the same probability of being sampled, then an
equiprobable approach is being used.
Simple Random Sampling (SRS)
SRS is the most basic sampling technique. Here, a group of decedents/caregivers (a sample) is
randomly selected from a larger group of survey-eligible decedents/caregivers. Each
decedent/caregiver is chosen entirely by chance, and each survey-eligible decedent/caregiver has
an equal chance of being included in the sample. For the CAHPS Hospice Survey, a census
sample is also considered to be a simple random sample.
SRS Example 1: End of month % random sample selection
Sampling for Hospice C is conducted only once for a given month at the end of the
month
Suppose Hospice C has 150 survey-eligible decedents/caregivers for a given month
and wishes to use a 50% sampling rate
o Randomly sort all 150 survey-eligible decedents/caregivers prior to sampling
o Then select 50% of the 150 survey-eligible decedents/caregivers for a monthly
sample size of 75 decedents/caregivers. Since the survey-eligible
decedents/caregivers list is already randomly sorted, the first 75 decedents may be
selected to form the monthly random sample.
SRS Example 2: Census sampling
Hospice D is required, or if a hospice with more than 700 survey-eligible
decedents/caregivers per year chooses to sample all survey-eligible decedents/caregivers
A census sample is SRS because each decedent/caregiver has an equal chance (100%)
of being included in the sample and the decedents/caregivers are not stratified in any
manner
Suppose Hospice D has 40 survey-eligible decedents/caregivers for a given month.
Since this hospice is using census sampling, each of the 40 survey-eligible
decedents/caregivers is included in the hospice’s CAHPS Hospice Survey sample.
Note: Other sampling scenarios may exist and the survey vendor should contact CAHPS Hospice
Survey Information and Technical Support with questions at: [email protected]
or call 1-844-472-4621.
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Mail Only Survey Administration
Overview
This chapter describes guidelines for the Mail Only Mode of the CAHPS Hospice Survey
administration.
Data collection for sampled decedents/caregivers must be initiated two months following the
month of patient death. Survey vendors will send sampled caregivers a first questionnaire with a
cover letter within the first seven days of the field period. A second questionnaire with a followup cover letter must be sent to all sampled caregivers who did not respond to the first
questionnaire, approximately 21 calendar days after the first questionnaire mailing.
Note: If after the first mailing the survey vendor learns that a sampled decedent/caregiver is
ineligible for the CAHPS Hospice Survey, the survey vendor must not send the caregiver the
second questionnaire. After the sample has been drawn, any decedents/caregivers who are
found to be ineligible must not be removed or replaced in the sample. Instead, these
decedents/caregivers are assigned a “Final Survey Status” code of ineligible (2, 3, 4, 5, or 6 as
applicable). An administrative record must be submitted for these decedents/caregivers.
Data collection must be closed out for a sampled caregiver by six weeks (42 calendar days)
following the mailing of the first questionnaire (initial contact). Caregivers who receive the
CAHPS Hospice Survey must not be offered incentives of any kind. Caregivers who do not
respond to the survey are assigned a “Final Survey Status” code of non-response.
Survey vendors must include the “Number Survey Attempts – Mail” field in the
Decedent/Caregiver Administrative Data Record. This field is required when “Survey Mode” in
the Header Record is “1 – Mail Only.” This field captures the mail wave attempt in which the
final disposition of the survey is determined. More information regarding the coding of the
survey attempts field is presented in the Data Coding and Data File Preparation chapter.
Survey vendors must make every reasonable effort to achieve optimal survey response rates and
to pursue contacts with potential respondents until the data collection protocol is completed.
The basic tasks and timing for conducting the CAHPS Hospice Survey using the Mail Only
Mode of survey administration are summarized below.
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Mail Only Survey Administration
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Activity
Timing
Mail initial questionnaire with cover letter to Two months after the month of patient
sampled caregivers
death within the first seven days of the field
period
Mail second questionnaire with cover letter to Approximately 21 calendar days after the
all sampled caregivers who do not respond to first survey mailing
the first survey mailing
Complete data collection
Within six weeks (42 calendar days) of the
first survey mailing
Submit data files to the CAHPS Hospice See the quarterly data submission deadlines
Survey Data Warehouse by the data in the Sampling Protocol chapter
submission deadline. No files will be accepted
after the submission deadline date.
To reiterate, the first mail attempt must occur two months after the month of patient death within
the first seven days of the field period. Data collection must then be completed no later than six
weeks (42 calendar days) after the initial mail-out. To illustrate the timing of the survey mail-out,
the example below is provided of a patient who died on April 18 while in hospice care.
Example:
The first survey is mailed out on July 1 (two months after month of patient’s death)
If the caregiver has not returned the survey by July 22 (21 days after the initial
mailing on July 1), a second survey is mailed out
Data collection must be closed out on August 12 for this caregiver, which is six
weeks (42 days) from the July 1 initial mail-out date:
If the survey is returned on or before August 12, which is the last day of the
survey administration time period for this caregiver, then the survey is included
in the final survey data file and assigned a “Final Survey Status” code of either
“1 – Completed survey” or “7 – Non-response: Break off” based on the
calculation of percent complete as described in the Data Coding and Data File
Preparation chapter
o If the survey is returned after August 12 (August 13, for example), which is
beyond the six weeks (42 days) survey administration time period for this
caregiver, then the survey data are not included in the final survey data file
(however, an administrative data record is submitted for this caregiver)
and a “Final Survey Status” code of “9 Non-response: Non-response after
maximum attempts” is assigned
Production of Questionnaire and Related Materials
The Mail Only Mode of survey administration may be conducted in English, Spanish and
Chinese. Survey vendors are provided with the CAHPS Hospice Survey questionnaires in
English, Spanish and Chinese and initial and follow-up cover letters in English, Spanish and
Chinese. Survey vendors are not permitted to make or use any other translations of the CAHPS
Hospice Survey cover letters or questionnaires. We strongly encourage hospices with a
significant caregiver population that speaks Spanish or Chinese to offer the CAHPS Hospice
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Survey in that language(s). We encourage hospices that serve patient populations that speak
languages other than those noted to request CMS to create an official translation of the CAHPS
Hospice Survey in those languages.
Mailings must include a personalized cover letter, a questionnaire, and a business reply envelope.
The cover letters may be sent in both English and Spanish or both English and Chinese, and may
be two-sided (English on one side and Spanish on the other or English on one side and Chinese
on the other). Cover letters sent to respondents must be personalized with the decedent’s name,
the caregiver’s name and the hospice’s name. The letter must also provide a toll-free number for
respondents to call if they have questions. The cover of the questionnaire must include a label
indicating the name of the hospice, and if applicable, may include the specific hospice inpatient
unit, acute care hospital or nursing home facility in which their family member or friend resided.
For CAHPS Hospice Survey administration, the OMB Paperwork Reduction Act language must
appear in the mailing, either on the cover letter or on the front or back of the questionnaire. In
addition, the OMB control number must appear on the front page of the questionnaire.
To increase the likelihood that the respondent is the person within the sampled caregiver’s
household who is most knowledgeable about the decedent’s hospice care, language must be
included in the questionnaire, and optionally in the cover letter, clearly stating that the survey
should be given to the person in the household who knows the most about the hospice care
received by the decedent.
Each survey vendor must submit a sample of their CAHPS Hospice Survey mailing materials
(e.g., questionnaires and cover letters) by the specified due date for review by the CAHPS
Hospice Survey Project Team.
Required for the Mail Questionnaire
The CAHPS Hospice Survey Core questions (Q1 – Q40) must be placed at the beginning of the
survey. The order of the Core questions must not be altered and all the Core questions must
remain together. The “About Your Family Member” and “About You” questions must be placed
after the Core questions and cannot be eliminated from the questionnaire. The “About You”
questions must follow the “About Your Family Member” questions.
Survey vendors must adhere to the following specifications for questionnaire formatting and the
production of mail materials:
Question and answer category wording must not be changed
No changes are permitted in the order of the Core questions
No changes are permitted in the order of the “About Your Family Member” questions
No changes are permitted in the order of the “About You” questions
No changes are permitted in the order of the response categories for the Core, “About
Your Family Member” or “About You” questions
The Core questions must remain together
The “About Your Family Member” and “About You” questions must remain together
Each question and answer categories must remain together in the same column and on the
same page
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Response options must be listed vertically (see examples in Appendix M and N).
Response options that are listed horizontally or in a combined vertical and horizontal
format are not allowed.
Formatting
Wording that is bolded or underlined in the questionnaire provided in the CAHPS
Hospice Survey Quality Assurance Guidelines must be emphasized in the same manner in
the survey vendor’s questionnaire
Arrow (i.e., ) placement in the questionnaire instructions and answer categories that
specifies skip patterns must not be changed
Section headings (e.g., “Your Family Member’s Hospice Care,” etc.) must be included on
the questionnaire and must be capitalized
Survey materials must be in a readable font (i.e. Arial) with a font size of 10 point at a
minimum
Other Requirements
All survey instructions written at the top of the questionnaire must be printed verbatim
Randomly generated, unique identifiers must be placed on the first or last page of the
questionnaire, at a minimum. Survey vendors may add other identifiers on the
questionnaire for tracking purposes (e.g., unit identifiers, etc.). Neither the decedent’s nor
the caregiver’s name may be printed on the questionnaire.
The text indicating the purpose of the unique identifier [“You may notice a number on
the survey. This number is used to let us know if you returned your survey so we do not
have to send you reminders.”] must be printed either immediately after the survey
instructions on the questionnaire or on the cover letter, and may appear on both.
The survey vendor’s return address must be printed on the last page of the questionnaire
to make sure that the questionnaire is returned to the correct address in the event that the
enclosed return envelope is misplaced by the caregiver
If the survey vendor’s name is included in the return address, then the survey vendor’s
business name must be used, not an alias or tag line
A mail wave indicator must be included on the survey
Optional for the Mail Questionnaire
Survey vendors have some flexibility in formatting the CAHPS Hospice Survey questionnaire by
following the guidelines described below.
Small coding numbers, preferably in superscript, may be included next to the response
choices on the questionnaire
Hospice logos may be included on the questionnaire; however, other images and tag lines
are not permitted
The phrase “Use only blue or black ink” may be printed on the questionnaire
The name of the hospice may be printed on the questionnaire in Questions 2, 4 and 39, as
indicated below
Question 2 – “In what locations did your family member receive care from [ABC
Hospice]?”
Question 4 – “As you answer the rest of the questions in this survey, please think only
about your family member’s experience with [ABC Hospice].”
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Question 39 – “Please answer the following questions about your family member’s
care from [ABC Hospice]. Do not include care from other hospices in your answers.”
Page numbers may be included on the questionnaire
Color may be incorporated in the questionnaire
Survey vendors should consider incorporating the following recommendations in formatting the
CAHPS Hospice Survey questionnaire to increase the likelihood of receiving a returned survey:
Two-column format that is used in Appendices M and N
Wide margins (at least 3/4 inch) so that the survey has sufficient white space to enhance
its readability
Supplemental Questions
Survey vendors may add up to 15 hospice-specific supplemental questions to the CAHPS
Hospice Survey, following the guidelines described below:
Hospice-specific supplemental questions are added immediately after the Core questions
(Questions 1 – 40) or at the end of all the CAHPS Hospice Survey questions (Questions 1
– 47)
When supplemental questions are placed in between the Core questions and the
“About Your Family Member” questions, the “ABOUT YOUR FAMILY MEMBER”
heading must still be placed prior to the “About Your Family Member” questions
When adding supplemental questions after the “About You” questions, a transition
phrase must be placed before the supplemental questions
Phrases must be added to indicate a transition from the CAHPS Hospice Survey
questions to the hospice-specific supplemental questions regardless of whether the
supplemental questions are placed between the Core questions and the “About Your
Family Member” questions and/or after the “About You” questions. Examples of
transitional phrases are as follows:
“Now we would like to gather some additional detail on topics we have asked you
about before. These items use a somewhat different way of asking for your response
since they are getting at a slightly different way of thinking about the topics.”
“The following questions focus on additional care your family member may have
received from Hospice X.”
“This next set of questions is to provide the hospice additional feedback about your
family member’s hospice care.”
In addition, one supplemental question must be included in the mail questionnaire if the hospice
wishes to view the survey responses linked to respondents’ name and other identifying information.
The survey question, referred to as the Consent to Share Responses, must be printed in the mail
questionnaire, and the respondent must check the “Yes” response option for the vendor to provide the
hospice with the respondent’s answers linked to the respondent’s name and identifying information.
The question is typically placed at the end of the questionnaire, as the last question.
Survey vendors must avoid hospice-specific supplemental questions that:
pose a burden to the caregiver (e.g., length and complexity of supplemental questions,
etc.)
are worded very similarly to the Core CAHPS Hospice Survey questions
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may cause the caregiver to terminate the survey (e.g., items that ask about sensitive
medical, health or personal topics, etc.)
jeopardize decedent/caregiver confidentiality (other than the “Consent to Share
Responses” item above)
ask the caregiver to explain why he or she chose a specific response; for example, it is not
acceptable to ask caregivers why they indicated that they would not recommend the
hospice to friends and family
Cover Letters
Survey vendors may adapt the sample cover letters provided (see Appendices M and N). Survey
vendors must follow the guidelines described below when altering the cover letter templates
provided in this manual.
Required for the Cover Letter
The cover letter must be printed on the hospice’s or survey vendor’s letterhead and must
include the signature of the hospice administrator or survey vendor project director
The language indicating the purpose of the unique identifier (“You may notice a number
on the survey. This number is used to let us know if you returned your survey so we don’t
have to send you reminders.”) must be printed immediately after the survey instructions
on the questionnaire or on the cover letter, and may appear on both.
The following items must be included in the body of the cover letter:
name and address of the sampled caregiver. “To Whom It May Concern” is not an
acceptable salutation.
name of the decedent
Note: There may be instances in which a decedent and caregiver have the same
name. Quality control activities must be implemented to ensure the names on the
cover letter for the decedent and caregiver are correct.
language indicating that answers will be shared, if the survey responses will be shared
with the hospice for the purpose of quality improvement
an explanation that participation in the survey is voluntary
the hospice name to make certain that the caregiver completes the survey based on the
care received from that hospice only
a toll-free customer support telephone number for survey vendors
o Customer support must be offered in all languages in which the survey vendor
administers the survey
o Vendors must be ready to support calls from deaf or the hearing impaired,
including, but not limited to TTY
The OMB language must appear on either the questionnaire or cover letter, and may
appear on both, in a readable font at a minimum of 10 point
Cover letters must NOT:
be attached to the survey; doing so could compromise confidentiality
attempt to bias, influence or encourage caregivers to answer CAHPS Hospice Survey
questions in a particular way
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imply that the hospice, its personnel or its agents will be rewarded or gain benefits if
caregivers answer CAHPS Hospice Survey questions in a particular way
ask or imply that caregivers should choose certain responses; indicate that the hospice
is hoping for a given response, such as a “10,” “Definitely yes,” or an “Always”
indicate that the hospice’s goal is for all caregivers to rate them as a “10,” “Definitely
yes” or an “Always”
offer incentives of any kind for participation in the survey
include any content that attempts to advertise or market the hospice’s mission or
services
offer caregivers the opportunity to complete the survey over the telephone
include extraneous titles for caregiver (e.g., Aunt, Uncle)
Optional for the Cover Letter
Cover letters may be double sided (English/Spanish or English/Chinese)
Use of the Spanish or Chinese cover letters is allowed if the survey vendor is sending a
Spanish or Chinese questionnaire to the caregiver
Information may be added to the English cover letters (in English, Spanish or Chinese)
that indicates that the caregiver may request a mail survey in Spanish or Chinese
English should be the default language in the continental United States and Spanish
should be the default language in Puerto Rico
Survey vendor’s return address may be included on the cover letter to make sure the
questionnaire is returned to the correct address in the event that the enclosed return
envelope is misplaced by the caregiver. If the survey vendor’s name is included in the
return address, then the survey vendor’s business name must be used, not an alias or tag
line.
Any instructions that appear on the survey may be repeated in the cover letter
Note: Any variations to the questionnaire and/or cover letters, other than the optional items
listed above, will require an approved Exception Request prior to survey administration (see the
Exception Request Process and the Discrepancy Report Process chapters).
Mailing of Materials
Survey vendors must mail materials following the guidelines described below:
Attempts must be made to contact every survey-eligible decedent/caregiver drawn into
the sample, whether or not they have a complete mailing address. Survey vendors must
use commercial software or other means to update addresses provided by the hospice for
sampled decedents/caregivers. (Mailings returned as undeliverable and for which no
updated address is available must be coded “10 Non-response: Bad address.”) Survey
vendors must retain a record of attempts made to acquire missing addresses. All materials
relevant to survey administration are subject to review.
Survey vendors must first make every reasonable attempt to obtain a caregiver’s
address including re-contacting the hospice client to inquire about an address update
for caregivers with no mailing address. Attempts to obtain the caregivers address
must be documented.
Self-addressed, stamped business return envelopes must be enclosed in the survey
envelope along with the cover letter and questionnaire. The CAHPS Hospice Survey
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cannot be administered without both a cover letter and self-addressed, stamped business
return envelope.
All mailings must be sent to each caregiver by name, and to the caregiver’s most current
address listed in the hospice record or retrieved by other means
For caregivers who request to be sent an additional questionnaire (either after the first or
second mailing) survey vendors must follow the guidelines below:
It is acceptable to mail a replacement survey at the caregiver’s request within the 42
calendar day survey administration period; however, the survey administration
timeline does not restart
After 42 calendar days from the first mailing, a replacement CAHPS Hospice Survey
must NOT be mailed-out, as the data collection timeframe of 42 calendar days after
the first mailing has expired
Hospices and survey vendors are not allowed to:
show or provide the CAHPS Hospice Survey or cover letters to caregivers prior to the
administration of the survey, including while the patient is still under hospice care
mail any pre-notification letters or postcards after patient death to inform caregivers
about the CAHPS Hospice Survey
Notes:
In instances where returned mail surveys have all missing responses (i.e., without any
questions answered – blank questionnaires), send a second survey to the caregiver if the
data collection time period has not expired. If the second mailing is returned with all
missing responses, then code the Final Survey Status as “8 – Non-response: Refusal.” If
the second mailing is not returned, then code the Final Survey Status as “9 – Nonresponse: Non-response after maximum attempts.”
When the first survey is not returned, the second survey is mailed and subsequently the
second mailed survey is returned with all missing responses, then code the Final Survey
Status as “8 – Non-response: Refusal.”
It is strongly recommended that all mailings be sent with first class postage or indicia to ensure
delivery in a timely manner and to maximize response rates, as first class mail is more likely to
be opened.
Data Receipt and Retention
Survey vendors may use key-entry or scanning to record returned survey data in their data
collection systems. Returned questionnaires must be tracked by date of receipt as well as keyentered or scanned in a timely manner. If a caregiver returns two survey questionnaires, the
survey vendor must use only the first CAHPS Hospice Survey received.
Survey vendors must maintain a crosswalk of their interim disposition codes to the CAHPS
Hospice Survey Final Survey Status codes and include the crosswalk in the survey vendor’s
QAP.
Survey vendors must follow the data entry decision rules and data storage requirements
described below.
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Key-entry
Survey vendors’ key-entry processes must incorporate the following features:
Unique record verification system: The survey management system performs a check to
verify that the caregiver response data have not already been entered in the survey
management system
Valid range checks: The data entry system identifies responses/entries that are invalid or
out-of-range
Validation: Survey vendors must have a plan and process in place to verify the accuracy
of key-entered data. Survey vendors must confirm that key-entered data accurately
capture the responses on the original survey. A different staff member (preferably the
data entry supervisor) must reconcile any discrepancies.
Scanning
Survey vendors’ scanning software must accommodate the following:
Unique record verification system: The survey management system performs a check to
confirm that the caregiver’s survey responses have not already been entered in the survey
management system
Valid range checks: The software identifies invalid or out-of-range responses
Validation: Survey vendors must have a plan and process in place to confirm the
accuracy of scanned data. Survey vendors must make certain that scanned data accurately
capture the responses on the original survey. A staff member must reconcile any
responses not recognized by the scanning software.
Decision Rules
Whether employing scanning or key-entry of mail questionnaires, survey vendors must use the
following decision rules to resolve common ambiguous situations. Survey vendors must follow
these guidelines to ensure standardization of data entry across hospices.
If a mark falls between two response options but is obviously closer to one than the other,
then select the choice to which the mark is closest
If a mark falls equidistant between two response options, then code the value for the item
as “M – Missing/Don't know”
If a mark is missing, code the value for the item as “M – Missing/Don't know.” Survey
vendors must not impute a response (see Data Coding and Data File Preparation chapter
for information on coding skip pattern questions)
For other than multi-mark questions, when more than one response option is marked,
code the value as “M – Missing/Don't know”
Note: In instances where there are multiple marks but the caregiver’s intent is clear,
survey vendors should code the survey with the caregiver’s clearly identified intended
response.
Personnel Training
Training of personnel in the CAHPS Hospice Survey data collection protocols is key to
successful survey administration. The following section addresses training provided to:
Project staff
Customer support personnel
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Mail data entry personnel
Subcontractors
Training of Project Staff
At a minimum, the survey vendor’s Project Manager and any subcontractor(s) with responsibility
for major survey administration functions must participate in the CAHPS Hospice Survey
Training sponsored by CMS. Individuals who are involved and work on any aspect of CAHPS
Hospice Survey operations (e.g., account managers, sampling specialists, quality assurance
managers, programmers and information technology staff, etc.), must be thoroughly trained by
the survey vendor on CAHPS Hospice Survey protocols and methodology to guarantee
standardization of survey administration. Survey vendors must also provide training to their
hospice clients on preparation of the decedents/caregivers lists.
Survey vendors must establish a process for training new project team members on CAHPS
Hospice Survey administration in a timely fashion. It is strongly recommended that staff
members are cross-trained in all aspects of the CAHPS Hospice Survey administration process in
case of unforeseen staffing turnover or absence. Back-up staff for CAHPS Hospice Survey
administration responsibilities must be assigned to staff employed by the survey vendor.
Note: Volunteers are not permitted to be involved in any aspect of the CAHPS Hospice Survey
administration process.
Training of Customer Support Personnel
Survey vendors train customer support personnel in CAHPS Hospice Survey protocols and
methodology to answer questions appropriately. Survey vendors must periodically (at a
minimum on a quarterly basis) assess the reliability and consistency of customer support
personnel responses. In addition, questions posed by surveyed caregivers should be reviewed
regularly to determine if there is a need to develop additional FAQs. All inquiries received and
responses provided through customer support must be documented. This documentation must be
available for review upon request by the CAHPS Hospice Survey Project Team.
Distressed Respondent Procedures:
Of critical importance is the need for survey vendors to develop a “distressed respondent
protocol,” to be incorporated into all interviewer and help desk training. Handling
distressed respondent situations requires balancing keeping personally identifying
information (PII) and private health information (PHI) confidential and helping a person
who needs assistance. For survey research organizations, best interviewing practices
recommend having a distressed respondent protocol in place for handling distressed
respondents, which balances the respondent’s right to confidentiality and privacy and
providing assistance, if the situation indicates that the respondent’s health and safety are
in jeopardy.
If a respondent experiences distress significant enough for him or her to request
additional support, CMS and the CAHPS Hospice Survey Project Team recommend that
survey vendors’ telephone staff put the respondent in contact with the appropriate local
resource (generally a bereavement counselor or social worker on the hospice team that
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provided care to their family member or friend). This visit and support groups for
bereavement are part of the services covered under the Medicare Hospice Benefit.
Training of Mail Data Entry Personnel
Survey vendors will address the following items when training data entry personnel:
Use of data entry equipment and programs
Survey specifications and protocols
Survey instrument, question flow, and skip patterns
Data key-entry procedures
Validation programs
Decision rules/ambiguous responses
Training of survey vendor staff must be documented. This documentation must be available for
review upon request by the CAHPS Hospice Survey Project Team.
Quality Control Guidelines
Survey vendors are responsible for the quality of work performed by any staff members and
subcontractor(s). Survey vendors must conduct site verification of printing and mailing
processes, regardless of whether they are using internal staff or subcontractor(s) to perform this
work.
To avoid mail administration errors and to make certain that questionnaires are delivered as
required, survey vendors must:
perform interval checking of printed mailing pieces for:
fading, smearing, and misalignment of printed materials
appropriate survey contents, accurate address information, and proper postage on the
survey sample packet
assurance that all printed materials in a mailing envelope have the same unique
identifier
inclusion of all eligible sampled decedents in the sample mailing for that month
include seeded mailings in mail-outs at a minimum on a quarterly basis
Seeded mailings are sent to designated survey vendor CAHPS Hospice Survey
project staff (other than the staff producing the materials) to check for timeliness of
delivery, accuracy of addresses, content of the mailing, and the quality of the printed
materials
Seeded mailings must be integrated into the hospice’s batched survey mailings, not
sent as a stand-alone mailing to CAHPS Hospice Survey project staff
perform address updates for missing or incorrect information
Attempts must be made to update address information to confirm accuracy and
correct formatting
In addition to working with client hospices to obtain the most current caregiver
contact information, survey vendors must employ other options, such as the National
Change of Address (NCOA) and the United States Postal Service (USPS) CASS
Certified Zip+4 software. Other means are also available to update addresses for
accurate mailings, such as:
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o Commercial software
o Internet search engines
Survey vendors must retain a record of all quality control activities and document these activities
in the survey vendor’s QAP. All materials relevant to survey administration are subject to
review.
Monitoring and Quality Oversight
Survey vendors must establish a system for providing and documenting quality oversight and
monitoring of their CAHPS Hospice Survey administration and CAHPS Hospice Survey project
staff, including subcontractors. Quality checking activities must be performed by a different staff
member than the individual who originally performed the specific project task(s). In addition,
survey vendors must:
perform and document quality checks of all key events in survey administration
including, but not limited to: sample frame creation; sampling procedures; data receipt;
data entry; data submission; backup systems; etc.
monitor the performance of all staff involved with any aspect of programming, sample
frame creation, sampling, processing of response data (from receipt and handling of
returned surveys, through data entry, validation and edit checking) on an ongoing basis,
and verify that staff and subcontractors are compliant with HIPAA regulations
monitor the performance of all subcontractor(s)
provide performance feedback to all staff and subcontractor(s), through regular
assessments, to include special emphasis placed on the detection and correction of
identified performance problems
The CAHPS Hospice Survey Project Team will conduct site visits to survey vendors and to their
subcontractors, if applicable, to review survey vendors’ operations, monitoring, quality oversight
practices, and documentation. As noted earlier, if a survey vendor is non-compliant with program
requirements for any of their contracted hospices, the hospice survey data may not be reported.
Safeguarding Decedent/Caregiver Confidentiality
Survey vendors must take the following actions to further protect the confidentiality of
decedent/caregivers:
Prevent unauthorized access to confidential electronic and hard copy information by
restricting physical access to confidential data (use locks or password-protected entry
systems on rooms, file cabinets and areas where confidential data are stored)
Develop CAHPS Hospice Survey or survey specific confidentiality agreements and
obtain signatures from all personnel with access to survey information, including staff
and all subcontractors involved in survey administration and data collection
Confirm that staff and subcontractors are compliant with HIPAA regulations in regard to
decedent/caregiver protected health information (PHI)
Establish protocols for secure file transmission. Emailing of PHI via unsecure email is
prohibited.
Establish protocols for identifying security breaches and instituting corrective actions
Store returned mail paper questionnaires and/or electronically scanned questionnaires in a
secure and environmentally safe location for a minimum of three years
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Note: It is strongly recommended that the method used by contracted hospices to transmit
information (e.g., decedents/caregivers lists) to the survey vendor be reviewed by the hospice’s
HIPAA/privacy officer to confirm compliance with HIPAA regulations. Any materials (e.g., QAP,
questionnaires, cover letters, tracking forms) submitted by the survey vendor to the CAHPS
Hospice Survey Project Team must be blank templates and must not contain any
decedent/caregiver PHI.
Survey vendors must have physical plant resources available to handle the volume of surveys
being administered, in addition to systematic processes that effectively track sampled decedents’
progress through the data collection protocol and caregivers’ responses to the survey. System
resources are subject to oversight activities including site visits to physical locations.
Data Security
Survey vendors must securely store caregiver identifying electronic data and responses to the
survey. Survey vendors must take the following actions to secure the data:
Use a firewall and/or other mechanisms for preventing unauthorized access to the
electronic files
Implement access levels and security passwords so that only authorized users have access
to sensitive data
Implement daily data backup procedures that adequately safeguard system data
Test backup files at a minimum on a quarterly basis to make sure the files are easily
retrievable and working
Perform frequent saves to media to minimize data losses in the event of power
interruption
Data Retention and Storage
Survey vendors must store all CAHPS Hospice Survey administration lists and data in a secure
and environmentally controlled location for a minimum of three years.
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Telephone Only Survey Administration
Overview
This chapter describes guidelines for the Telephone Only Mode of the CAHPS Hospice Survey
administration.
Data collection for sampled decedents/caregivers must be initiated two months following the
month of patient death.
Note: If the survey vendor learns that a sampled decedent/caregiver is ineligible for the CAHPS
Hospice Survey, the survey vendor must not make further attempts to contact that caregiver.
After the sample has been drawn, any decedents/caregivers who are found to be ineligible
must not be removed or replaced in the sample. Instead, these decedents/caregivers are
assigned the “Final Survey Status” code of ineligible (2, 3, 4, 5, and 6, as applicable). An
administrative record must be submitted for these decedents/caregivers.
Data collection may be completed by telephone only. Outbound calling must be scheduled in a
manner to ensure all cases have a first attempt within 7 days of the start of the field period (initial
contact). Data collection must be closed out for a sampled caregiver by six weeks (42 calendar
days) following the first call attempt. If it is known that the caregiver may be available in the
latter part of the 42 calendar day data collection time period (e.g., caregiver is on vacation the
first 2 or 3 weeks of the 42 calendar day field period and there would be an opportunity to reach
the caregiver closer to the end of the field period), then survey vendors must use the entire field
time period to schedule telephone calls. Telephone call attempts are to be made between the
hours of 9 AM and 9 PM respondent time. Caregivers who receive the CAHPS Hospice Survey
must not be offered incentives of any kind. Caregivers who do not respond to the survey are
assigned a “Final Survey Status” code of non-response.
Survey vendors must include the “Number Survey Attempts – Telephone” field in the
Decedent/Caregiver Administrative Data Record. This field is required when “Survey Mode” in
the Header Record is “2 – Telephone Only.” This field captures the telephone attempt in which
the final disposition of the survey is determined. More information regarding the coding of the
survey attempts field is presented in the Data Coding and Data File Preparation chapter.
Survey vendors must make every reasonable effort to achieve optimal survey response rates and
to pursue contact with potential respondents until the data collection protocol is completed.
The basic tasks and timing for conducting the CAHPS Hospice Survey using the Telephone Only
Mode of survey administration are summarized below.
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Activity
Timing
Initiate systematic telephone contact with Two months after the month of patient death
sampled caregivers
within the first seven days of the field period
Complete telephone data collection
Within six weeks (42 calendar days) after the
first attempt
Submit data files to the CAHPS Hospice See the quarterly data submission deadlines
Survey Data Warehouse by the data in the Sampling Protocol chapter
submission deadline. No files will be accepted
after the submission deadline date.
To reiterate, the first telephone attempt must occur two months after the month of patient death
within the first seven days of the field period. Data collection must then be completed no later
than six weeks (42 calendar days) after the initial telephone attempt. To illustrate the timing of
the attempts, the following example is provided of a patient who died on April 1 while in hospice
care.
Example:
The first telephone attempt is made on July 1 (two months after the month of patient’s
death)
Data collection must be closed out by August 12 for this caregiver, which is six weeks
(42 days) from the July 1 first telephone attempt date:
If a telephone interview is completed on or before August 12, which is the last
day of the survey administration time period for this caregiver, then the survey
data are included in the final survey data file and assigned a “Final Survey Status”
code of either “1 – Completed survey” or “7 – Non-response: Break off” based on
the calculation of percent complete as described in the Data Coding and Data File
Preparation chapter
o If the survey is mistakenly completed after August 12 (August 13, for
example), which is beyond the six weeks (42 days) survey administration time
period for this caregiver, then the survey data are not included in the final
survey data file (however, an administrative data record is submitted for
this caregiver) and a “Final Survey Status” code of “9 Non-response: Nonresponse after maximum attempts” is assigned
Survey vendors must make every reasonable effort to achieve optimal telephone response rates
by thoroughly familiarizing interviewers with the study purpose; carefully supervising
interviewers; retraining those interviewers having difficulty enlisting cooperation; and recontacting reluctant respondents with different interviewers at different times until the final data
collection protocol is completed.
Telephone Interviewing Systems
Telephone Script
Telephone data collection must be available in both English and Spanish. English should be the
default language in the continental United States and Spanish should be the default language in
Puerto Rico. Survey vendors are provided standardized telephone scripts in both English and
Spanish (Appendices O and P) for CAHPS Hospice Survey administration. These telephone
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scripts must be read verbatim without adding any other scripting or tag questions, such as “How
are you?” Survey vendors are not permitted to make or use any other language translations of the
CAHPS Hospice Survey telephone scripts. We strongly encourage hospices with a significant
caregiver population that speaks Spanish to offer the CAHPS Hospice Survey in this language.
We encourage hospices that serve patient populations that speak languages other than those
noted to request CMS to create an official translation of the CAHPS Hospice Survey in those
languages.
Each survey vendor must submit a copy of its CAHPS Hospice Survey telephone script and
interviewer CATI screen shots (including skip pattern logic) by the specified due date for review
by the CAHPS Hospice Survey Project Team.
Required for the Telephone Script
The CAHPS Hospice Survey Core questions (Q1 – Q40) must be placed at the beginning of the
survey. The order of the Core questions must not be altered and all the Core questions must
remain together. The “About Your Family Member” and “About You” questions must be placed
after the Core questions and cannot be eliminated from the questionnaire. The “About You”
questions must follow the “About Your Family Member” questions.
Programming of the telephone scripts must follow the guidelines described below:
Question and answer category wording must not be changed
No changes are permitted in the order of the Core questions
No changes are permitted in the order of the “About Your Family Member” CAHPS
Hospice Survey questions
No changes are permitted in the order of the “About You” questions
No changes are permitted in the order of the answer categories for the Core, “About Your
Family Member” or “About You” questions
The Core questions must remain together
The “About Your Family Member” and “About You” questions must remain together
All underlined content must be emphasized
No other script content is to be emphasized; in particular, response options must be
read at the same even pace without any additional emphasis on any particular
response category
Only one language (English or Spanish) may appear on the electronic interviewing
system screen
The survey vendor is responsible for programming the scripts and specifications into their
electronic telephone interviewing system software or an alternative system
The transitional statements found throughout the telephone script are part of the
structured script and must be read. An example of a transitional phrase that must be
read can be found before Question 39 (Q 39 Intro): “Please answer the following
questions about your family member’s care from [ABC Hospice]. Do not include care
from other hospices in your answers.”
Do not program a specific response category as the default option
Survey vendors must have a process in place to address caregivers’ requests to verify the survey
legitimacy or to answer questions about the survey.
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Supplemental Questions
Survey vendors may add up to 15 hospice-specific supplemental questions to the CAHPS
Hospice Survey, following the guidelines described below:
Hospice-specific supplemental questions are added immediately after the Core CAHPS
Hospice Survey questions (Questions 1 – 40) or at the end of all the CAHPS Hospice
Survey questions (Questions 1 – 47).
When supplemental questions are placed in between the Core questions and the
“About Your Family Member” questions, the “ABOUT YOUR FAMILY MEMBER”
heading must still be placed prior to the “About Your Family Member” questions
When adding supplemental questions after the “About You” questions, a transition
phrase must be placed before the supplemental questions
Phrases must be added to indicate a transition from the CAHPS Hospice Survey
questions to the hospice-specific supplemental questions regardless of whether the
supplemental questions are placed between the Core questions and the “About Your
Family Member” questions and/or after the “About You” questions. Examples of
transitional phrases are as follows:
“Now we would like to gather some additional detail on topics we have asked you
about before. These items use a somewhat different way of asking for your response
since they are getting at a slightly different way of thinking about the topics.”
“The following questions focus on additional care your family member may have
received from Hospice X.”
“This next set of questions is to provide the hospice additional feedback about your
family member’s hospice care.”
In addition, one supplemental question must be included in the telephone questionnaire if the hospice
wishes to view the survey responses linked to respondents’ name and other identifying information.
The survey question, referred to as the Consent to Share Responses, must be included in the
telephone questionnaire, and the respondent must answer “Yes” for the vendor to provide the hospice
with the respondent’s answers linked to the respondent’s name and identifying information. The
question is typically placed at the end of the interview as the last question.
Survey vendors must avoid hospice-specific supplemental questions that:
pose a burden to the respondent (e.g., number, length, and complexity of supplemental
questions, etc.)
are worded very similarly to the Core CAHPS Hospice Survey questions
may cause the respondent to terminate the survey (e.g., items that ask about sensitive
medical, health or personal topics, etc.)
jeopardize decedent/caregiver confidentiality (other than the “Consent to Share
Reponses” item above)
ask the caregiver to explain why he or she chose a specific response; for example, it is not
acceptable to ask caregivers why they indicated that they would not recommend the
hospice to friends and family
Interviewing Systems
Telephone data collection must be computer-assisted using live interviewers. Paper surveys
administered by phone and the use of Touch-tone or Speech-enabled IVR are not acceptable.
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Therefore, an electronic telephone interviewing system is required for survey vendors. An
electronic telephone interviewing system uses standardized scripts and design specifications. The
survey vendor is responsible for programming the scripts and specifications into their electronic
telephone interviewing software. Regardless of caregiver response, the interviewer must record
all responses in the telephone interview. Predictive dialing may be used as long as there is a live
interviewer to interact with the caregiver, and the system is compliant with Federal Trade
Commission (FTC) and Federal Communications Commission (FCC) regulations.
Survey vendors may program the caller ID to display “on behalf of [HOSPICE NAME],”
with the permission and compliance of the hospice’s HIPAA/Privacy Officer. Survey
vendors must not program the caller ID to display only [HOSPICE NAME].
Monitoring/Recording Telephone Calls
When calling caregivers who reside in California, Connecticut, Delaware, Florida, Illinois,
Maryland, Massachusetts, Michigan, Montana, New Hampshire, Pennsylvania, and Washington,
survey vendors may begin the monitoring/recording of telephone calls after the interviewer
states, “This call may be monitored [recorded] for quality improvement purposes.” This
statement is found at the end of the INTRO section of the CAHPS Hospice Survey Telephone
Script located in Appendices O and P.
Telephone Attempts
Survey vendors must attempt to reach each and every caregiver in the sample. Telephone call
attempts are to be made between the hours of 9 AM and 9 PM respondent time. Repeated
attempts must be made until the caregiver is contacted, found ineligible or five attempts have
been made. After five attempts to contact the caregiver have been made, no further attempts are
to be made. A telephone attempt is defined as one of the following:
The telephone rings six times with no answer
The interviewer reaches a wrong number
An answering machine/voicemail is reached. In this case the interviewer must not leave a
message.
The interviewer reaches a household member and is told that the caregiver is not
available to come to the telephone or has a new telephone number. The interviewer must
not leave a message.
The interviewer reaches the caregiver but is asked to call back at a more convenient time
The call back should be scheduled at the caregiver’s convenience, if at all possible
The interviewer gets a busy signal on each of three consecutive telephone attempts
When systems permit, the three consecutive telephone attempts are to be made at
approximately 20-minute intervals
The interviewer reaches a disconnected number
If, during a telephone attempt, the sampled caregiver indicates that someone within the
household is more knowledgeable about the hospice care that the decedent received, the more
knowledgeable person may be a proxy respondent. If a sampled caregiver indicates that he or she
never oversaw, was not involved in, or is unknowledgeable about the hospice care provided to
the decedent, interviewers may ask if someone else in the household is knowledgeable about the
decedent’s hospice care. If such a person exists, he or she may be a proxy respondent.
Interviewers must not accept individuals outside of the sampled caregiver’s household as proxy
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respondents. Should no knowledgeable individual be identified within the household, the case
should be coded as ineligible using code “6 – Ineligible: Never involved in decedent care.”
Sampled caregivers are to be called up to five times unless the sampled caregiver (or an eligible
proxy caregiver) completes the survey, is found to be ineligible or explicitly refuses to complete
the survey (or if someone refuses on behalf of the caregiver).
If the survey vendor learns that a decedent/caregiver is ineligible for the CAHPS Hospice
Survey, the caregiver must not receive any further telephone attempts
Survey vendors must adhere to the following guidelines in their attempts to contact caregivers:
Telephone attempts are made at various times of the day, on different days of the week,
and in different weeks to maximize the probability that the survey vendor will contact the
caregiver
Note: More than one telephone attempt may be made in a week (7 calendar days).
However, the five telephone attempts cannot be made in just one week (7 calendar days).
The five call attempts must span more than one week (eight or more days) to account for
caregivers who are temporarily unavailable.
Caregivers who call back after an initial contact can be scheduled for interviews or
forwarded to an available CAHPS Hospice Survey interviewer
Interviewers must not leave messages on answering machines or with household
members, since this could violate a caregiver’s privacy. Survey vendors must instead
attempt to re-contact the caregiver to complete the CAHPS Hospice Survey.
When a caregiver requests to complete at a later date a telephone survey already in
progress, a call back should be scheduled. At the time of the call back, the interview
should resume with the next question where the caregiver left off from the previous call.
If on the fifth attempt, the caregiver requests to schedule an appointment to complete the
survey, it is permissible to schedule that appointment and call the caregiver back
provided that the appointment is within the 42 calendar day data collection time period. If
on the call back at the scheduled time, no connection is made with the caregiver, then no
further contact may be attempted. This additional (sixth) call attempt would be coded as
“5 – Fifth Telephone attempt” in the “Number Survey Attempts – Telephone” for data
file submission.
Note: The CAHPS Hospice Survey Project Team strongly recommends that, when
requested, telephone call back scheduling accommodates a caregiver’s request for a
specific day and time in order to ensure a reasonable response rate for the hospice.
Survey vendors must take the following steps to contact difficult-to-reach caregivers:
If the caregiver’s telephone number is incorrect, make every effort to find the correct
telephone number. If the person answering the telephone knows how to reach the
caregiver, the new information must be used.
If the caregiver is away temporarily, he or she must be contacted upon return, provided
that it is within the data collection time period. If it is known that the caregiver may be
available in the latter part of the 42 calendar day data collection time period (e.g.,
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caregiver is on vacation the first 2 or 3 weeks of the 42 calendar day data collection time
period and there would be an opportunity to reach the caregiver closer to the end of the
data collection time period), then survey vendors must use the entire data collection time
period to schedule telephone calls.
If the caregiver does not speak the language in which the survey is being administered,
the interviewer must thank the caregiver for his or her time and terminate the interview
If the call is inadvertently dropped and the interview is interrupted, the caregiver should
be re-contacted immediately to complete the remainder of the survey. This re-contact
does not constitute an additional call attempt.
Obtaining and Updating Telephone Numbers
Survey vendors normally obtain telephone numbers from the hospice’s records. Survey vendors
must use commercial software or other means to update telephone numbers provided by the
hospice for sampled caregivers. Requisite attempts must be made to contact every eligible
caregiver in the sample, whether or not there is a complete and correct telephone number for the
caregiver when the sample is created. Survey vendors must retain a record of attempts to acquire
missing telephone numbers. All materials relevant to survey administration are subject to review.
Hospices/Survey vendors should attempt to obtain updated telephone numbers prior to the start
of telephone attempts through commercial locating services, Internet or other means. To obtain
the most current caregiver contact information, survey vendors must employ various options for
updating telephone numbers:
Running update program software against the sample file just before or after uploading
data to survey management systems
Utilizing commercial software, Internet directories, and/or directory assistance
Data Receipt and Retention
Survey vendors must record the date of the telephone interview and must link survey responses
from the telephone interview to their survey management system, regardless of the interviewing
system employed. Survey vendors must maintain a crosswalk of their interim disposition codes
to the CAHPS Hospice Survey Final Survey Status codes and include the crosswalk in the survey
vendor’s QAP.
Electronic Telephone Interviewing System
The electronic telephone interviewing system employed by survey vendors must be
electronically linked to their survey management system to enable responses obtained from the
electronic telephone interviewing system to be automatically added to the survey management
system.
Data Storage
Survey vendors must retain all CAHPS Hospice Survey data collected through an electronic
telephone interviewing system in a secure and environmentally controlled location for a
minimum of three years.
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Quality Control Guidelines
Survey vendors are responsible for the quality of work performed by any staff members and
subcontractor(s). Survey vendors must employ the following guidelines for proper interviewer
training, monitoring and oversight regardless of whether they are using internal staff or
subcontractor(s) to perform this work.
Interviewer Training
Consistent monitoring of interviewers’ work is essential to achieve standardized and accurate
results. Properly trained and supervised interviewers ensure that standardized, non-directive
interviews are conducted. Interviewers conducting the telephone survey must be trained prior to
interviewing (see Appendix F for more information on interviewing guidelines).
Training must direct interviewers to read questions exactly as worded in the script, use
non-directive probes and maintain a neutral and professional relationship with the
respondent
Interviewers must be trained to read response options exactly as worded and at an even
pace without emphasis on any particular response category
Interviewers must be trained to record responses to survey questions only after the
caregiver has responded to the questions; that is, interviewers must not pre-code response
choices
In organizations where interviewers assign interim or final call disposition codes, they
must be trained in the definition of each disposition code
Interviewers must be trained in a process for redirecting calls to another interviewer when
the respondent is personally known to the initial interviewer
Distressed Respondent Procedures:
Of critical importance is the need for survey vendors to develop a “distressed respondent
protocol,” to be incorporated into all interviewer and help desk training. Handling
distressed respondent situations requires balancing keeping personally identifying
information (PII) and private health information (PHI) confidential and helping a person
who needs assistance. For survey research organizations, best interviewing practices
recommend having a distressed respondent protocol in place for handling distressed
respondents, which balances the respondent’s right to confidentiality and privacy and
providing assistance, if the situation indicates that the respondent’s health and safety are
in jeopardy.
If a respondent experiences distress significant enough for him or her to request
additional support, CMS and the CAHPS Hospice Survey Project Team recommend that
survey vendors’ telephone staff put the respondent in contact with the appropriate local
resource (generally a bereavement counselor or social worker on the hospice team that
provided care to their family member or friend). This visit and support groups for
bereavement are part of the services covered under the Medicare Hospice Benefit.
Note: If a survey vendor uses a subcontractor to conduct telephone interviewing, then the
survey vendor is responsible for attending/participating in the subcontractor’s telephone
interviewer training to confirm compliance with CAHPS Hospice Survey protocols and
guidelines.
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Telephone Monitoring and Oversight
Each survey vendor employing the Telephone Only Mode of survey administration must institute
a telephone monitoring and evaluation program. The telephone monitoring and evaluation
program must include, but is not limited to, the following oversight activities:
Survey vendors must monitor at least 10 percent of all CAHPS Hospice Survey
interviews, dispositions and call attempts in their entirety (both English and Spanish)
through silent monitoring of interviewers using the electronic telephone interviewing
system software or an alternative system. Silent monitoring capability must include the
ability to monitor calls onsite and from remote locations. All staff conducting CAHPS
Hospice Survey interviews must be included in the monitoring. Additionally, it is
strongly encouraged that survey vendors provide “floor rounding” in their call-center(s)
to visually observe and ensure the professionalism of the telephone interviewers.
Survey vendors using a subcontractor must monitor at least 10 percent of the
subcontractor’s CAHPS Hospice Survey telephone interviews and call attempts in
their entirety, provide feedback to the subcontractor’s interviewers about their
performance and confirm that the subcontractor’s interviewers correct any areas
that need improvement. Feedback must be provided to interviewers as soon as
possible following a monitoring session.
Note: CAHPS Hospice Survey protocols currently require that approved CAHPS Hospice
Survey vendors who subcontract the task of CAHPS Hospice Survey telephone
interviewing monitor at least 10% of all CAHPS Hospice Survey
calls/attempts/completed surveys. The CAHPS Hospice Survey Project Team also expects
that a survey vendor’s subcontractor will conduct internal monitoring of their telephone
interviewers as a matter of good business practice that incorporates quality checks.
While it is preferred that each organization continue to monitor 10% of CAHPS Hospice
Survey interviews (for an overall total of 20%), it is permissible for the survey vendor
and its subcontractor to conduct a combined total of at least 10% monitoring, as long as
each organization conducts a portion of the monitoring. Therefore, the survey vendor and
its subcontractor can determine the ratio of monitoring that each organization conducts,
as long as the combined total meets or exceeds 10%. Please note that CAHPS Hospice
Survey interviews monitored concurrently by the survey vendor and its subcontractor do
not contribute separately to each organization’s monitoring time.
Staff who are found to be consistently unable to follow the script verbatim, employ
proper probes, remain objective and courteous, be clearly understood, or operate the
electronic telephone interviewing system competently, must be identified and retrained
or, if necessary, replaced
In organizations where interviewers assign interim or final disposition codes, the
assignment of codes must be reviewed by a supervisor
Organizations must monitor interviewer survey response coding by, at a minimum,
reviewing the frequency of missing responses in the surveys administered by interviewers
Survey vendors must retain a record of all quality control activities and document these activities
in the survey vendor’s QAP. All materials relevant to survey administration are subject to
review.
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Safeguarding Decedent/Caregiver Confidentiality
Survey vendors must take the following actions to further protect the confidentiality of
decedents/caregivers:
Prevent unauthorized access to confidential electronic and hard copy information by
restricting physical access to confidential data (use locks or password-protected entry
systems on rooms, file cabinets and areas where confidential data are stored)
Develop CAHPS Hospice Survey or survey specific confidentiality agreements and
obtain signatures from all personnel with access to survey information, including staff
and all subcontractors involved in survey administration and data collection
Confirm that staff and subcontractors are compliant with HIPAA regulations in regard to
decedent/caregiver protected health information (PHI)
Establish protocols for secure file transmission. Emailing of PHI via unsecure email is
prohibited.
Establish protocols for identifying security breaches and instituting corrective actions
Note: It is strongly recommended that the method used by contracted hospices to transmit
information (e.g., decedents/caregivers lists) to the survey vendor be reviewed by the hospice’s
HIPAA/privacy officer to confirm compliance with HIPAA regulations. Any materials (e.g., QAP,
questionnaires, cover letters, tracking forms) submitted by the survey vendor to the CAHPS
Hospice Survey Project Team must be blank templates and must not contain any
decedent/caregiver PHI.
Survey vendors must have physical plant resources available to handle the volume of surveys
being administered, in addition to systematic processes that effectively track sampled caregivers’
progress through the data collection protocol and caregivers’ responses to the survey. System
resources are subject to oversight activities including site visits to physical locations.
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Mixed Mode Survey Administration
Overview
This chapter describes guidelines for the Mixed Mode of the CAHPS Hospice Survey
administration, which is a combination of an initial mailing of the questionnaire with telephone
follow-up.
Data collection for sampled decedents/caregivers must be initiated two months following the
month of patient death within the first seven days of the field period. Survey vendors must send
sampled caregivers a questionnaire with a cover letter within the first seven days of the field
period, then beginning approximately 21 calendar days after mailing the questionnaire conduct a
maximum of five telephone attempts to non-respondents.
Notes:
Reversing the protocol (telephone attempts followed by mail attempt) is not allowed
If the survey vendor learns that a sampled decedent/caregiver is ineligible for the
CAHPS Hospice Survey, no further attempts should be made to contact that caregiver.
After the sample has been drawn, any decedents/caregivers who are found to be
ineligible must not be removed or replaced in the sample. Instead, these
decedents/caregivers are assigned the “Final Survey Status” code of ineligible (2, 3, 4,
5, or 6, as applicable). An administrative record must be submitted for these
decedents/caregivers.
Data collection must be closed out for a sampled caregiver by six weeks (42 calendar days)
following the mailing of the questionnaire (initial contact). If the caregiver did not return a mail
survey and it is known that the caregiver may be available in the latter part of the 21 calendar
day telephone component of the field period, and there would be an opportunity to reach the
caregiver closer to the end of the telephone component of the field period, then survey vendors
must use the entire 21 calendar day telephone component field period to schedule telephone
calls. Telephone call attempts are to be made between the hours of 9 AM and 9 PM, respondent
time. Caregivers who receive the CAHPS Hospice Survey must not be offered incentives of any
kind. Caregivers who do not respond to the survey are assigned a “Final Survey Status” code of
non-response.
Note: Should a caregiver call the toll-free number to do the interview by phone, they cannot
complete the interview prior to the start of the telephone follow-up window and should be
scheduled for a callback during the telephone data collection time period.
Survey vendors must include the “Number Survey Attempts – Telephone” field in the Decedent
Administrative Data Record. This field is required when “Survey Mode” in the Header Record is
“3 – Mixed Mode” and “Survey Completion Mode” is “2 – Mixed Mode-phone.” If the survey is
completed/dispositioned during the telephone phase of the Mixed Mode, the “Number Survey
Attempts – Telephone” captures the telephone attempt in which the final disposition of the
survey is determined. More information regarding the survey attempts field is presented in the
Data Coding and Data File Preparation chapter.
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Survey vendors must make every reasonable effort to achieve optimal survey response rates and
to pursue contact with potential respondents until the data collection protocol is completed.
The basic tasks and timing for conducting the CAHPS Hospice Survey, using the Mixed Mode of
survey administration, are summarized below.
Activity
Send mail questionnaire with cover letter to
sampled caregiver
Initiate systematic telephone contact for all
non-respondents
Complete data collection activities
Submit data files to the CAHPS Hospice
Survey Data Warehouse by the data
submission deadline. No files will be accepted
after the submission deadline date.
Timing
Two months after the month of patient death
within the first seven days of the field period
Approximately 21 calendar days after
mailing of the questionnaire
Over the next 21 calendar days
See the quarterly data submission deadlines
in the Sampling Protocol chapter
To reiterate, the mail-out of the survey must occur two months after the month of patient death
within the first seven days of the field period. Data collection then must be completed no later
than six weeks (42 calendar days) after the mailing of the questionnaire. To illustrate the timing
of survey mail-out and telephone follow-up the following example is provided of a patient who
died on April 30 while in hospice care.
Example:
The survey is mailed out on July 1 (two months after patients death)
If the caregiver has not returned the survey by July 22 (21 days after the initial mailing
on July 1) telephone contact must be initiated
Data collection must be closed out on August 12 for this caregiver, which is six weeks
(42 days) from the July 1 initial mail-out date:
If a telephone interview is completed on or before August 12, which is the last
day of the survey administration time period for this caregiver, then the survey
data are included in the final survey data file and assigned a “Final Survey Status”
code of either “1 – Completed survey” or “7 – Non-response: Break off” based on
the calculation of percent complete as described in the Data Coding and Data File
Preparation chapter
If the survey is mistakenly completed after August 12 (August 13, for example),
which is beyond the six weeks (42 days) survey administration time period for this
caregiver, then the survey data are not included in the final survey data file
(however, an administrative data record is submitted for this caregiver) and a
“Final Survey Status” code of “9 Non-response: Non-response after maximum
attempts” is assigned
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Mixed Mode Survey Administration
Mail Protocol
This section describes guidelines for the mail phase of the Mixed Mode of survey administration.
Production of Questionnaire and Related Materials
The mail phase of the Mixed Mode of survey administration can be conducted in English and
Spanish. Survey vendors are provided with the CAHPS Hospice Survey questionnaires in
English and Spanish, and cover letters in English and Spanish (Appendices M and N). Survey
vendors are not permitted to make or use any other translations of the CAHPS Hospice Survey
cover letter or questionnaire. We strongly encourage hospices with a significant caregiver
population that speaks Spanish to offer the CAHPS Hospice Survey in this language. We
encourage hospices that serve patient populations that speak languages other than those noted to
request CMS to create an official translation of the CAHPS Hospice Survey in those languages.
Mailings must include a personalized cover letter, a questionnaire, and a business reply envelope.
The cover letters may be sent in both English and Spanish and may be two-sided, English on one
side and Spanish on the other. Cover letters sent to respondents must be personalized with the
decedent’s name, the caregiver’s name and the hospice’s name. The letter must also provide a
toll-free number for respondents to call if they have questions. The cover of the questionnaire
must include a label indicating the name of the hospice, and if applicable, may include the
specific hospice inpatient unit, acute care hospital or nursing home facility in which their family
member or friend resided.
For CAHPS Hospice Survey administration, the OMB Paperwork Reduction Act language must
appear in the mailing, either on the cover letter or on the front or back of the questionnaire. In
addition, the OMB control number must appear on the front page of the questionnaire.
To increase the likelihood that the respondent is the person within the sampled caregiver’s
household who is most knowledgeable about the decedent’s hospice care, language must be
included in the questionnaire, and optionally in the cover letter, clearly stating that the survey
should be given to the person in the household who knows the most about the hospice care
received by the decedent.
Each survey vendor must submit a sample of their CAHPS Hospice Survey mailing materials
(e.g., questionnaire and cover letter) by the specified due date for review by the CAHPS Hospice
Survey Project Team.
Required for the Mail Questionnaire
The CAHPS Hospice Survey Core questions (Q1 – Q40) must be placed at the beginning of the
survey. The order of the Core questions must not be altered and all the Core questions must
remain together. The “About Your Family Member” and “About You” questions must be placed
after the Core questions and cannot be eliminated from the questionnaire. The “About You”
questions must follow the “About Your Family Member,” or “About You” questions.
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Survey vendors must adhere to the following specifications for questionnaire formatting and the
production of mailing materials.
Question and answer category wording must not be changed
No changes are permitted in the order of the Core questions
No changes are permitted in the order of the “About Your Family Member” questions
No changes are permitted in the order of the “About You” questions
No changes are permitted in the order of the response categories for the Core, “About
Your Family Member” or “About You” questions
The Core questions must remain together
The “About Your Family Member” and “About You” questions must remain together
Each question and answer categories must remain together in the same column and on the
same page
Response options must be listed vertically (see examples in Appendix M and N).
Response options that are listed horizontally or in a combined vertical and horizontal
format are not allowed.
Formatting
Wording that is bolded or underlined in the questionnaire provided in the CAHPS
Hospice Survey Quality Assurance Guidelines must be emphasized in the same manner in
the survey vendor’s questionnaire
Arrow (i.e., ) placement in the questionnaire instructions and answer categories that
specifies skip patterns must not be changed
Section headings (e.g., “Your Family Member’s Hospice Care,” etc.) must be included on
the questionnaire and must be capitalized
Survey materials must be in a readable font (i.e. Arial) with a font size of 10 point at a
minimum
Other Requirements
All survey instructions written at the top of the questionnaire must be printed verbatim
Randomly generated, unique identifiers must be placed on the first or last page of the
questionnaire, at a minimum. Survey vendors may add other identifiers on the
questionnaire for tracking purposes (e.g., unit identifiers, etc.). Neither the decedent nor
the caregiver’s name may be printed on the questionnaire.
The text indicating the purpose of the unique identifier [“You may notice a number on
the survey. This number is used to let us know if you returned your survey so we do not
have to send you reminders.”] must be printed immediately after the survey instructions
or on the cover letter, and may appear on both.
The survey vendor’s return address must be printed on the last page of the questionnaire
in order to verify that the questionnaire is returned to the correct address in the event that
the enclosed return envelope is misplaced by the caregiver
If the survey vendor’s name is included in the return address, then the survey vendor’s
business name must be used, not an alias or tag line
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Optional for the Mail Questionnaire
Survey vendors have some flexibility in formatting the CAHPS Hospice Survey questionnaire by
following the guidelines described below:
Small coding numbers, preferably in superscript, may be included next to the response
choices on the questionnaire
Hospice logos may be included on the questionnaire; however, other images and tag lines
are not permitted
The phrase “Use only blue or black ink” may be printed on the questionnaire
The name of the hospice may be printed on the questionnaire in Questions 2, 4 and 39, as
indicated below
Question 2 – “In what locations did your family member receive care from [ABC
Hospice]?”
Question 4 – “As you answer the rest of the questions in this survey, please think only
about your family member’s experience with [ABC Hospice].”
Question 39 – “Please answer the following questions about your family member’s
care from [ABC Hospice]. Do not include care from other hospices in your answers.”
Page numbers may be included on the questionnaire
Color may be incorporated in the questionnaire
Survey vendors should consider incorporating the following recommendations in formatting the
CAHPS Hospice Survey questionnaire to increase the likelihood of receiving a returned survey:
Two-column format that is used in Appendices M and N
Wide margins (at least 3/4 inch) so that the survey has sufficient white space to enhance
its readability
Supplemental Questions
Survey vendors may add up to 15 hospice-specific supplemental questions to the CAHPS
Hospice Survey following the guidelines described below:
For Mixed Mode, the same survey questions added to the mail survey for a given hospice
must be added to the telephone CATI script
Hospice-specific supplemental questions are added immediately after the Core questions
(Questions 1 – 40) or at the end of all the CAHPS Hospice Survey questions (Questions 1
– 47)
When supplemental questions are placed in between the Core questions and the
“About Your Family Member” questions, the “ABOUT YOUR FAMILY MEMBER”
heading must still be placed prior to the “About Your Family Member” questions
When adding supplemental questions after the “About You” questions, a transition
phrase must be placed before the supplemental questions
Phrases must be added to indicate a transition from the CAHPS Hospice Survey
questions to the hospice-specific supplemental questions regardless of whether the
supplemental questions are placed between the Core questions and the “About Your
Family Member” questions and/or after the “About You” questions. Example of
transitional phrases are as follows:
“Now we would like to gather some additional detail on topics we have asked you
about before. These items use a somewhat different way of asking for your response
since they are getting at a slightly different way of thinking about the topics.”
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“The following questions focus on additional care your family member may have
received from Hospice X.”
“This next set of questions is to provide the hospice additional feedback about your
family member’s hospice care.”
In addition, one supplemental question must be included in the mail if the hospice wishes to view
the survey responses linked to respondents’ name and other identifying information. The survey
question, referred to as the Consent to Share Responses, must be printed on the mail
questionnaire. The respondent must check the “Yes” response option in the mail questionnaire
for the vendor to provide the hospice with the respondent’s answers linked to the respondent’s
name and identifying information. The question is typically placed at the end of the
questionnaire or interview, as the last question.
Survey vendors must avoid hospice-specific supplemental questions that:
pose a burden to the caregiver (e.g., number, length, and complexity of supplemental
questions, etc.)
are worded very similarly to the Core CAHPS Hospice Survey questions
may cause the respondent to terminate the survey (e.g., items that ask about sensitive
medical, health or personal topics, etc.)
jeopardize decedent/caregiver confidentiality (other than the “Consent to Share
Responses” item above)
ask the caregiver to explain why he or she chose a specific response; for example, it is not
acceptable to ask respondents why they indicated that they would not recommend the
hospice to friends and family
Cover Letter
Survey vendors may adapt the sample cover letters provided (see Appendices M and N). Survey
vendors must follow the guidelines described below when altering the cover letter templates
provided in this manual.
Required for the Cover Letter
The cover letter must be printed on the hospice’s or survey vendor’s letterhead and must
include the signature of the hospice administrator or survey vendor project director
The language indicating the purpose of the unique identifier (“You may notice a number
on the survey. This number is used to let us know if you returned your survey so we don’t
have to send you reminders.”) must be printed immediately after the survey instructions
on the questionnaire or on the cover letter, and may appear on both.
The following items must be included in the body of the cover letter:
name and address of the sampled caregiver. “To Whom It May Concern” is not an
acceptable salutation.
name of decedent
Note: There may be instances in which a decedent and caregiver have the same
name. Quality control activities must be implemented to ensure the names on the
cover letter for the decedent and caregiver are correct.
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language indicating that answers will be shared, if the survey responses will be shared
with the hospice for the purpose of quality improvement
an explanation that participation in the survey is voluntary
the hospice name to make certain that the caregiver completes the survey based on the
care received from that hospice only
a toll-free customer support telephone number for survey vendors
o Customer support must be offered in all languages in which the survey vendor
administers the survey
o Vendors must be ready to support calls from deaf or the hearing impaired,
including but not limited to TTY
The OMB language must appear on either the questionnaire or cover letter, and may
appear on both, in a readable font at a minimum of 10 point.
Cover letter must NOT:
be attached to the survey; doing so could compromise confidentiality
attempt to bias, influence or encourage caregivers to answer CAHPS Hospice Survey
questions in a particular way
imply that the hospice, its personnel or its agents will be rewarded or gain benefits if
caregivers answer CAHPS Hospice Survey questions in a particular way
ask or imply that caregivers should choose certain responses; indicate that the hospice
is hoping for a given response, such as a “10,” “Definitely yes,” or an “Always”
indicate that the hospice’s goal is for all caregivers to rate them as a “10,” “Definitely
yes” or an “Always”
offer incentives of any kind for participation in the survey
include any content that attempts to advertise or market the hospice’s mission or
services
offer caregivers the opportunity to complete the survey over the telephone
include extraneous titles for caregiver (e.g., Aunt, Uncle)
Optional for the Cover Letter
Cover letters may be double sided (English on one side and Spanish on the other)
Use of the Spanish cover letter is allowed if the survey vendor is sending a Spanish
questionnaire to the caregiver
Information may be added to the English cover letter (in English or Spanish) that
indicates that the caregiver may request a mail survey in Spanish
English should be the default language in the continental United States and Spanish
should be the default language in Puerto Rico
Survey vendor’s return address may be included on the cover letter to make sure that the
questionnaire is returned to the correct address in the event that the enclosed return
envelope is misplaced by the caregiver. If the survey vendor’s name is included in the
return address, then the survey vendor’s business name must be used, not an alias or tag
line.
Any instructions that appear on the survey may be repeated in the cover letter
Note: Any variations to the questionnaire and/or cover letter, other than the optional items listed
above, will require an approved Exception Request prior to survey administration (see the
Exception Request Process and Discrepancy Report Process chapters).
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Mailing of Materials
Survey vendors must mail materials following the guidelines described below:
Attempts must be made to contact every survey-eligible decedent/caregiver drawn into
the sample, whether or not they have a complete mailing address. Survey vendors must
use commercial software or other means to update addresses provided by the hospice for
sampled decedents/caregivers. (Mailings returned as undeliverable and for which no
updated address is available must be coded as “10 Non-response: Bad address.”)
Survey vendors must retain a record of attempts made to acquire missing addresses. All
materials relevant to survey administration are subject to review.
Survey vendors must first make every reasonable attempt to obtain a caregiver’s
address including re-contacting the hospice client to inquire about an address update
for caregivers with no mailing address. Attempts to obtain the caregivers address
must be documented.
Self-addressed, stamped business return envelopes must be enclosed in the survey
envelope along with the cover letter and questionnaire. The CAHPS Hospice Survey
cannot be administered without both a cover letter and self-addressed, stamped business
return envelope.
All mailings must be sent to each caregiver by name, and to the caregiver’s most current
address listed in the hospice record or retrieved by other means
For caregivers who request to be sent an additional questionnaire (either after the first or
second mailing) survey vendors must follow the guidelines below:
It is acceptable to mail a replacement survey at the caregiver’s request within the first
21 calendar days of the 42 calendar day survey administration period; however, the
survey administration timeline does not restart
After 21 calendar days from the mailing, a replacement CAHPS Hospice Survey must
NOT be mailed-out, as the telephone portion of the Mixed Mode protocol must be
initiated
Hospices and survey vendors are not allowed to:
show or provide the CAHPS Hospice Survey or cover letters to patients or caregivers
prior to the administration of the survey, including while the patient is still under hospice
care
mail any pre-notification letters or postcards after patient death to inform caregivers
about the CAHPS Hospice Survey
Note: In instances where returned mail surveys have all missing responses (i.e., without any
questions answered – blank questionnaire), initiate telephone contact after 21 days of mailing
the questionnaire.
It is strongly recommended that the mailing be sent with first class postage or indicia to ensure
delivery in a timely manner and to maximize response rates, as first class mail is more likely to
be opened.
Data Receipt and Retention of Mailed Questionnaires
Survey vendors utilizing the Mixed Mode of survey administration must keep track of the mode
in which each survey was completed (i.e., mail or telephone). If a caregiver returned the CAHPS
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Hospice Survey mail questionnaire with enough of the questions applicable to all caregivers
answered for the survey to be considered a completed survey (based on the calculation of percent
complete; for more information see the Data Coding and Data File Preparation chapter), then
the survey vendor must: 1. retain documentation in their survey management system that the
caregiver completed the survey in the mail phase of the Mixed Mode of survey administration;
and, 2. assign the appropriate “Survey Completion Mode” in the administrative record for this
decedent/caregiver (see the Data Coding and Data File Preparation chapter on “Survey
Completion Mode” for more information).
Survey vendors may use key-entry or scanning to record returned survey data in their data
collection systems. Returned questionnaires must be tracked by date of receipt and key-entered
or scanned in a timely manner. If a caregiver completes the CAHPS Hospice Survey via the
telephone and a questionnaire is subsequently returned by the caregiver, the survey vendor must
use the telephone CAHPS Hospice Survey responses since they were received first.
Survey vendors must maintain a crosswalk of their interim disposition codes to the CAHPS
Hospice Survey Final Survey Status codes and include the crosswalk in the survey vendor’s
QAP.
Survey vendors must follow the data entry decision rules and data storage requirements
described below.
Key-entry
Survey vendors’ key-entry processes must incorporate the following features:
Unique record verification system: The survey management system performs a check to
verify that the caregiver response data have not already been entered in the survey
management system
Valid range checks: The data entry system identifies responses/entries that are invalid or
out-of-range
Validation: Survey vendors must have a plan and process in place to verify the accuracy
of the key-entered data. Survey vendors must confirm that key-entered data accurately
capture the responses on the original survey. A different staff member (preferably the
data entry supervisor) must reconcile any discrepancies.
Scanning
Survey vendors’ scanning software should accommodate the following:
Unique record verification system: The survey management system performs a check to
confirm that the caregiver’s survey responses have not already been entered in the survey
management system
Valid range checks: The software identifies invalid or out-of-range responses
Validation: Survey vendors must have a plan and process in place to confirm the
accuracy of scanned data. Survey vendors must make certain that scanned data accurately
capture the responses on the original survey. A staff member must reconcile any
responses not recognized by the scanning software.
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Decision Rules for Mail Data
Whether employing scanning or key-entry of mail questionnaires, survey vendors must use the
following decision rules to resolve common ambiguous situations. Survey vendors must follow
these guidelines to ensure standardization of data entry across hospices.
If a mark falls between two response options but is obviously closer to one than the other,
then select the choice to which the mark is closest
If a mark falls equidistant between two response options, then code the value for the item
as “M – Missing/Don’t know”
If a mark is missing, code the value for the item as “M – Missing/Don’t know.” Survey
vendors must not impute a response. (see Data Coding and Data File Preparation
chapter for information on coding skip pattern questions)
For other than multi-mark questions, when more than one response option is marked,
code the value as “M – Missing/Don’t know”
Note: In instances where there are multiple marks but the caregiver’s intent is clear,
survey vendors should code the survey with the caregiver’s clearly identified intended
response.
Storage of Mail Data
Survey vendors must store returned paper questionnaires or scanned images of paper
questionnaires in a secure and environmentally controlled location for a minimum of three years.
Paper questionnaires or scanned images must be easily retrievable.
Quality Control Guidelines for Mail Data
Survey vendors are responsible for the quality of work performed by any staff members and
subcontractor(s). Survey vendors must conduct site verification of printing and mailing
processes, regardless of whether they are using internal staff or subcontractor(s) to perform this
work.
To avoid mail administration errors and to make certain the questionnaires are delivered as
required, survey vendors must:
perform interval checking of printed mailing pieces for:
fading, smearing, and misalignment of printed materials
appropriate survey contents, accurate address information, and proper postage on the
survey sample packet
assurance that all printed materials in a mailing envelope have the same unique
identifier
inclusion of all eligible sampled caregivers in the sample mailing for that month
include seeded mailings in mail-outs at a minimum on a quarterly basis
seeded mailings are sent to designated survey vendor CAHPS Hospice Survey project
staff (other than the staff producing the materials) to check for timeliness of delivery,
accuracy of addresses, content of the mailing, and quality of the printed materials
seeded mailings must be integrated into the hospice’s batched survey mailings, not
sent as a stand-alone mailing to CAHPS Hospice Survey project staff
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perform address updates for missing or incorrect information
Attempts must be made to update address information to confirm accuracy and
correct formatting
In addition to working with client hospices to obtain the most current caregiver
contact information, survey vendors must employ other options, such as the National
Change of Address (NCOA) and the United States Postal Service (USPS) CASS
Certified Zip+4 software. Other means are also available to update addresses for
accurate mailings, such as:
o Commercial software
o Internet search engines
Survey vendors must retain a record of all quality control activities and document these activities
in the survey vendor’s QAP. All materials relevant to survey administration are subject to
review.
Telephone Protocol
If the mail questionnaire has not been returned within 21 calendar days following the mail-out to
sampled caregivers, survey vendors must follow the CAHPS Hospice Survey telephone survey
protocol. This section describes guidelines for the telephone phase of the Mixed Mode of survey
administration. Survey vendors must conduct a maximum of five telephone attempts to nonrespondents from the questionnaire mailing.
Survey vendors should make every reasonable effort to achieve optimal telephone response rates,
such as thoroughly familiarizing interviewers with the study purpose, carefully supervising
interviewers, retraining those interviewers having difficulty enlisting cooperation, and recontacting reluctant respondents with different interviewers at different times, until the data
collection protocol is completed.
Telephone Interviewing Systems
Telephone Script
Telephone data collection must be available in both English and Spanish. English should be the
default language in the continental United States and Spanish should be the default language in
Puerto Rico. Survey vendors are provided standardized telephone scripts in both English and
Spanish (Appendices O and P) for CAHPS Hospice Survey administration. These telephone
scripts must be read verbatim without adding any other scripting, or tag questions such as “How
are you?” Survey vendors are not permitted to make or use any other language translations of the
CAHPS Hospice Survey telephone scripts. We strongly encourage hospices with a significant
caregiver population that speaks Spanish to offer the CAHPS Hospice Survey in this language.
We encourage hospices that serve patient populations that speak languages other than those
noted to request CMS to create an official translation of the CAHPS Hospice Survey in those
languages.
Each survey vendor must submit a copy of its CAHPS Hospice Survey telephone script and
interviewer screen shots (including skip pattern logic) by the specified due date for review by the
CAHPS Hospice Survey Project Team.
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Required for the Telephone Script
The CAHPS Hospice Survey Core questions (Q1 – Q40) must be placed at the beginning of the
survey. The order of the Core questions must not be altered and all the Core questions must
remain together. The “About Your Family Member” and “About You” questions must be placed
after the Core questions and cannot be eliminated from the questionnaire. The “About You”
questions must follow the “About Your Family Member” questions.
Programming of the telephone scripts must follow the guidelines described below:
Question and answer category wording must not be changed
No changes are permitted in the order of the Core questions
No changes are permitted in the order of the “About Your Family Member” questions
No changes are permitted in the order of the “About You” questions
No changes are permitted in the order of the answer category for the Core, “About Your
Family Member” or “About You” questions
The Core questions must remain together
The “About Your Family Member” and “About You” questions must remain together
All underlined content must be emphasized
No other script content is to be emphasized; in particular, response options must be
read at the same even pace without any additional emphasis on any particular
response category
Only one language (English or Spanish) may appear on the electronic interviewing
system screen
The survey vendor is responsible for programming the scripts and specifications into their
electronic telephone interviewing system software or an alternative system
The transitional statements found throughout the telephone script are part of the
structured script and must be read. An example of a transitional phrase that must be
read can be found before Question 39 (Q39 Intro): “Please answer the following
questions about your family member’s care from [ABC Hospice]. Do not include care
from other hospices in your answers.”
Do not program a specific response category as the default option
Survey vendors must have a process in place to address caregivers’ requests to verify the survey
legitimacy or to answer questions about the survey.
Supplemental Questions
Survey vendors may add up to 15 hospice-specific supplemental questions to the CAHPS
Hospice Survey following the guidelines described below:
For Mixed Mode, the same survey questions added to the mail survey for a given hospice
must be added to the telephone CATI script
Hospice-specific supplemental questions are added immediately after the Core CAHPS
Hospice Survey questions (Questions 1 – 40) or at the end of all the CAHPS Hospice
Survey questions (Questions 1 – 47)
When supplemental questions are placed in between the Core questions and the
“About Your Family Member” questions, the “ABOUT YOUR FAMILY MEMBER”
heading must still be placed prior to the “About Your Family Member” questions
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When adding supplemental questions after the “About You” questions a transition
phrase must be placed before the supplemental questions
Phrases must be added to indicate a transition from the CAHPS Hospice Survey
questions to the hospice-specific supplemental questions, regardless of whether the
supplemental questions are placed between the Core questions and the “About Your
Family Member” questions and/or after the “About You” questions. Examples of
transitional phrases are as follows:
“Now we would like to gather some additional detail on topics we have asked you
about before. These items use a somewhat different way of asking for your response
since they are getting at a slightly different way of thinking about the topics.”
“The following questions focus on additional care your family member may have
received from Hospice X.”
“This next set of questions is to provide the hospice additional feedback about your
family member’s hospice care.”
In addition, one supplemental question must be included in the telephone questionnaire if the hospice
wishes to view the survey responses linked to respondents’ name and other identifying information.
The survey question, referred to as the Consent to Share Responses, must be included in the
telephone script. The respondent must answer “Yes” for the vendor to provide the hospice with the
respondent’s answers linked to the respondent’s name and identifying information. The question is
typically placed at the end of the interview.
Survey vendors must avoid the following types of hospice-specific supplemental questions that:
pose a burden to the respondent (e.g., number, length, and complexity of supplemental
questions, etc.)
may affect responses to the CAHPS Hospice Survey
may cause the caregiver to terminate the survey (e.g., items that ask about sensitive
medical, health or personal topics, etc.)
jeopardize decedent/caregiver confidentiality (other than the “Consent to Share
Responses” item above)
ask the caregiver to explain why he or she chose a specific response; for example, it is not
acceptable to ask caregivers why they indicated that they would not recommend the
hospice to friends and family
Interviewing Systems
Telephone data collection must be computer-assisted using live interviewers. Paper survey
administered by phone and the use of Touch-tone or Speech-enabled IVR are not acceptable.
Therefore, an electronic telephone interviewing system is required for survey vendors. An
electronic telephone interviewing system uses standardized scripts and design specifications. The
survey vendor is responsible for programming the scripts and specifications into their electronic
telephone interviewing software. Regardless of caregiver response, the interviewer must record
all responses in the telephone interview. Predictive dialing may be used as long as there is a live
interviewer to interact with the caregiver, and the system is compliant with Federal Trade
Commission (FTC) and Federal Communications Commission (FCC) regulations.
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Survey vendors may program the caller ID to display “on behalf of [HOSPICE NAME],”
with the permission and compliance of the hospice’s HIPAA/Privacy Officer. Survey
vendors must not program the caller ID to display only [HOSPICE NAME].
Monitoring/Recording Telephone Calls
When calling caregivers who reside in California, Connecticut, Delaware, Florida, Illinois,
Maryland, Massachusetts, Michigan, Montana, New Hampshire, Pennsylvania, and Washington,
survey vendors may begin the monitoring/recording of telephone calls after the interviewer
states, “This call may be monitored [recorded] for quality improvement purposes.” This
statement is found at the end of the INTRO section of the CAHPS Hospice Survey Telephone
Script located in Appendices O and P.
Telephone Attempts
Survey vendors must attempt to reach each and every non-respondent to the mail survey.
Telephone call attempts are to be made between the hours of 9 AM and 9 PM respondent time.
Repeated attempts must be made until the caregiver is contacted, found ineligible or five
attempts have been made. After five attempts to contact the caregiver have been made, no further
attempts are to be made. A telephone attempt is defined as one of the following:
The telephone rings six times with no answer
The operator reaches a wrong number
An answering machine/voice mail is reached. In this case the interviewer must not leave
a message.
The interviewer reaches a household member and is told that the caregiver is not
available to come to the telephone or has a new telephone number. The interviewer must
not leave a message.
The interviewer reaches the caregiver but is asked to call back at a more convenient time
The call back should be scheduled at the caregiver’s convenience, if at all possible
The interviewer gets a busy signal during each of three consecutive telephone attempts
When systems permit, the three consecutive telephone attempts are to be made at
approximately 20-minute intervals
The interviewer reaches a disconnected number
If, during a telephone attempt, the sampled caregiver indicates that someone within the
household is more knowledgeable about the hospice care that the decedent received, the more
knowledgeable person may be a proxy respondent. If a sampled caregiver indicates that he or she
never oversaw, was not involved in, or is unknowledgeable about the hospice care provided to
the decedent, interviewers may ask if someone else in the household is knowledgeable about the
decedent’s hospice care. If such a person exists, he or she may be a proxy respondent.
Interviewers must not accept individuals outside of the sampled caregiver’s household as proxy
respondents. Should no knowledgeable individual be identified within the household, the case
should be coded as ineligible using code “6 – Ineligible: Never involved in decedent care.”
Sampled caregivers are to be called up to five times unless the sampled caregiver (or an eligible
proxy caregiver) completes the survey, is found to be ineligible or explicitly refuses to complete
the survey (or is someone refuses on behalf of the caregiver).
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If the survey vendor learns that a decedent/caregiver is ineligible for the CAHPS Hospice
Survey, that caregiver must not receive any further telephone attempts
Survey vendors must adhere to the following guidelines in their attempts to contact caregivers:
Telephone attempts are made at various times of the day, on different days of the week,
and in different weeks to maximize the probability that the survey vendor will contact the
caregivers
Note: More than one telephone attempt may be made in a week (7 calendar days).
However, the five telephone attempts cannot be made in just one week (7 calendar days).
The five call attempts must span more than one week to account for caregiver who are
temporarily unavailable.
Caregivers who call back after an initial contact can be scheduled for an interview or
forwarded to an available interviewer
Interviewers must not leave messages on answering machines or with household
members, since this could violate a caregiver’s privacy. Survey vendors must instead
attempt to re-contact the caregiver to complete the CAHPS Hospice Survey.
When a caregiver requests to complete at a later date a telephone survey already in
progress, a call back should be scheduled. At the time of the call back, the interview
should resume with the next question where the caregiver left off from the previous call.
If on the fifth attempt, the caregiver requests to schedule an appointment to complete the
survey, it is permissible to schedule that appointment and call the caregiver back
provided that the appointment is within the 42 calendar day data collection time period. If
on the call back at the scheduled time, no connection is made with the caregiver, then no
further contact may be attempted. This additional (sixth) call attempt would be coded as
“5 – Fifth Telephone attempt” in “Number Survey Attempts – Telephone” for data file
submission.
Note: The CAHPS Hospice Survey Project Team strongly recommends that, when
requested, telephone call back scheduling accommodate a caregiver’s request for a
specific day and time in order to ensure a reasonable response rate for the hospice.
Survey vendors take the following steps to contact difficult-to-reach caregivers:
If the caregiver’s telephone number is incorrect, make every effort to find the correct
telephone number. If the person answering the telephone knows how to reach the
caregiver, the new information must be used.
If the caregiver is away temporarily, he or she must be contacted upon return, provided
that it is within the data collection time period. If it is known that the caregiver may be
available in the latter part of the 42 calendar day data collection time period (e.g.,
caregiver is on vacation the first 2 or 3 weeks of the 42 calendar day data collection time
period and there would be an opportunity to reach the caregiver closer to the end of the
data collection time period), then survey vendors must use the entire data collection time
period to schedule telephone calls.
If the caregiver does not speak the language in which the survey is being administered,
the interviewer must thank the caregiver for his or her time and terminate the interview
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If the call is inadvertently dropped and the interview is interrupted, the caregiver should
be re-contacted immediately to complete the remainder of the survey. This re-contact
does not constitute an additional call attempt.
Obtaining and Updating Telephone Numbers
Survey vendors normally obtain telephone numbers from the hospice’s records. Survey vendors
must use commercial software or other means to update telephone numbers provided by the
hospice for the sampled caregivers. Requisite attempts must be made to contact every nonrespondent to the mail survey, whether or not there is a complete and correct telephone number
for the caregiver when the sample is created. Survey vendors must retain a record of attempts to
acquire missing telephone numbers. All materials relevant to survey administration are subject to
review.
Hospices/Survey vendors should attempt to obtain updated telephone numbers prior to the start
of telephone attempts through commercial locating services, Internet or other means. To obtain
the most current caregiver contact information, survey vendors must employ various options for
updating telephone numbers:
Running update program software against the sample file just before or after uploading
data to survey management systems
Utilizing commercial software, Internet directories, and directory assistance
Receipt and Retention of Telephone Data
Survey vendors utilizing the Mixed Mode of survey administration must keep track of the Mode
in which the survey was completed (i.e., mail or telephone). If a caregiver completed the CAHPS
Hospice Survey by telephone with enough of the questions applicable to all caregivers answered
for the survey to be considered a completed survey (based on the calculation of percent
complete; for more information see the Data Coding and Data File Preparation chapter), then
the survey vendor must:
retain documentation in their survey management system that the caregiver completed the
survey in the telephone phase of the Mixed Mode of survey administration
assign the appropriate “Survey Completion Mode” in the administrative record for this
decedent/caregiver (see the Data Coding and Data File Preparation chapter on “Survey
Completion Mode” for more information)
survey vendors must also document the telephone attempt “Number Survey Attempts –
Telephone” in which the Final Survey Status is determined. For example, if the interview
was conducted and finished with the caregiver on the fourth telephone attempt then the
survey vendor must document the “Number Survey Attempts – Telephone” as “4 –
Fourth Telephone attempt.” Please see the Data Coding and Data File Preparation
chapter for more information on coding the “Number Survey Attempts – Telephone”
field.
Survey vendors must record the date of the telephone interview and must link survey responses
from the telephone interview to their survey management system, regardless of the interviewing
system employed. Survey vendors must maintain a crosswalk of their interim disposition codes
to the CAHPS Hospice Survey Final Survey Status codes and include the crosswalk in the survey
vendor’s QAP.
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Mixed Mode Survey Administration
Electronic Telephone Interviewing System
The electronic telephone interviewing systems employed by survey vendors must be
electronically linked to their survey management system to enable responses obtained from the
electronic telephone interviewing system to be automatically added to the survey management
system.
Storage of Telephone Data
Survey vendors must retain all CAHPS Hospice Survey data collected through an electronic
telephone interviewing system in a secure and environmentally controlled location for a
minimum of three years.
Quality Control Guidelines for Telephone Data Collection
Survey vendors are responsible for the quality of work performed by any staff members and
subcontractor(s). Survey vendors must employ the following guidelines for proper interviewer
training, monitoring, and oversight regardless of whether they are using internal staff or
subcontractor(s) to perform this work.
Interviewer Training
Consistent monitoring of interviewers’ work is essential to achieve standardized and accurate
results. Properly trained and supervised interviewers ensure that standardized, non-directive
interviews are conducted. Interviewers conducting the telephone survey must be trained prior to
interviewing (see Appendix G for more information on interviewing guidelines).
Training must direct interviewers to read questions exactly as worded in the script, use
non-directive probes and maintain a neutral and professional relationship with the
respondent
Interviewers must be trained to read response options exactly as worded and at an even
pace without emphasis on any particular response category
Interviewers must be trained to record responses to survey questions only after the
caregiver has responded to the questions; that is, interviewers must not pre-code response
choices
In organizations where interviewers assign interim or final call disposition codes, they
must be trained in the definition of each disposition code
Interviewers must be trained in a process for redirecting calls to another interviewer when
the respondent is personally known to the initial interviewer
Distressed Respondent Procedures:
Of critical importance is the need for survey vendors to develop a “distressed respondent
protocol,” to be incorporated into all interviewer and help desk training. Handling
distressed respondent situations requires balancing keeping personally identifying
information (PII) and private health information (PHI) confidential and helping a person
who needs assistance. For survey research organizations, best interviewing practices
recommend having a distressed respondent protocol in place for handling distressed
respondents, which balances the respondent’s right to confidentiality and privacy and
providing assistance, if the situation indicates that the respondent’s health and safety are
in jeopardy.
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If a respondent experiences distress significant enough for him or her to request
additional support, CMS and the CAHPS Hospice Survey Project Team recommend that
survey vendors’ telephone staff put the respondent in contact with the appropriate local
resource (generally a bereavement counselor or social worker on the hospice team that
provided care to their family member or friend). This visit and support groups for
bereavement are part of the services covered under the Medicare Hospice Benefit.
Note: If the survey vendor uses a subcontractor to conduct telephone interviewing, then the
survey vendor is responsible for attending/participating in the subcontractor’s telephone
interviewer training to confirm compliance with CAHPS Hospice Survey protocols and
guidelines.
Telephone Monitoring and Oversight
Each survey vendor employing the Mixed Mode of survey administration must institute a
telephone monitoring and evaluation program, during the telephone phase of the protocol. The
telephone monitoring and evaluation program must include, but is not limited to, the following
oversight activities:
Survey vendors must monitor at least 10 percent of all CAHPS Hospice Survey
interviews, dispositions and call attempts in their entirety (both English and Spanish)
through silent monitoring of interviewers using the electronic telephone interviewing
system software or an alternative system. Silent monitoring capability must include the
ability to monitor calls onsite and from remote locations. All staff conducting CAHPS
Hospice Survey interviews must be included in the monitoring. Additionally, it is
strongly encouraged that survey vendors provide “floor rounding” in their call-center(s)
to visually observe and ensure the professionalism of the telephone interviewers.
Survey vendors using a subcontractor must monitor at least 10 percent of the
subcontractor’s CAHPS Hospice Survey telephone interviews and call attempts in
their entirety, provide feedback to the subcontractor’s interviewers about their
performance, and confirm that the subcontractor’s interviewers correct any areas
that need improvement. Feedback must be provided to interviewers as soon as
possible following a monitoring session.
Note: CAHPS Hospice Survey protocols currently require that approved CAHPS Hospice
Survey vendors who subcontract the task of CAHPS Hospice Survey telephone
interviewing monitor at least 10% of all CAHPS Hospice Survey
calls/attempts/completed surveys. The CAHPS Hospice Survey Project Team also expects
that a survey vendor’s subcontractor will conduct internal monitoring of their telephone
interviewers as a matter of good business practice that incorporates quality checks.
While it is preferred that each organization continue to monitor 10% of CAHPS Hospice
Survey interviews (for an overall total of 20%), it is permissible for the survey vendor
and its subcontractor to conduct a combined total of at least 10% monitoring, as long as
each organization conducts a portion of the monitoring. Therefore, the survey vendor and
its subcontractor can determine the ratio of monitoring that each organization conducts,
as long as the combined total meets or exceeds 10%. Please note that CAHPS Hospice
Survey interviews monitored concurrently by the survey vendor and its subcontractor do
not contribute separately to each organization’s monitoring time.
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Staff who are found to be consistently unable to follow the script verbatim, employ
proper probes, remain objective and courteous, be clearly understood, or operate the
electronic telephone interviewing system competently must be identified and retrained or,
if necessary, replaced
In organizations where interviewers assign interim or final disposition codes, the
assignment of codes must be reviewed by a supervisor
Organizations must monitor interviewer survey response coding by, at a minimum,
reviewing the frequency of missing responses in the surveys administered by interviewers
Survey vendors must retain a record of all quality control activities and document these activities
in the survey vendor’s QAP. All materials relevant to survey administration are subject to
review.
Safeguarding Decedent/Caregiver Confidentiality
Survey vendors must take the following actions to further protect the confidentiality of
decedents/caregivers:
Prevent unauthorized access to confidential electronic and hard copy information by
restricting physical access to confidential data (use locks or password-protected entry
systems on rooms, file cabinets and areas where confidential data are stored)
Develop CAHPS Hospice Survey or survey specific confidentiality agreements and
obtain signatures from all personnel with access to survey information, including staff
and all subcontractors involved in survey administration and data collection
Confirm that staff and subcontractors are compliant with HIPAA regulations in regard to
decedent/caregiver protected health information (PHI)
Establish protocols for secure file transmission. Emailing of PHI via unsecure email is
prohibited.
Establish protocols for identifying security breaches and instituting corrective actions
Store returned mail paper questionnaires and/or electronically scanned questionnaires in a
secure and environmentally safe location for a minimum of three years
Note: It is strongly recommended that the method used by contracted hospices to transmit
information (e.g., decedents/caregivers lists) to the survey vendor be reviewed by the hospice’s
HIPAA/privacy officer to confirm compliance with HIPAA regulations. Any materials (e.g., QAP,
questionnaires, cover letters, tracking forms) submitted by the survey vendor to the CAHPS
Hospice Survey Project Team must be blank templates and must not contain any
decedent/caregiver PHI.
Survey vendors must have physical plant resources available to handle the volume of surveys
being administered, in addition to systematic processes that effectively track sampled decedents’
progress through the data collection protocol and caregivers’ responses to the survey. System
resources are subject to oversight activities including site visits to physical locations.
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Data Coding and Data File Preparation
Overview
The CAHPS Hospice Survey uses standardized protocols for file specifications, coding and
submission of data. This chapter provides information about preparing data files for submission
to the CAHPS Hospice Survey Data Warehouse including requirements for assigning the
random, unique, de-identified decedent/caregiver identification number; XML file specifications;
coding and interpreting ambiguous or missing data elements in returned surveys; survey
disposition codes; and determining the rate of response.
Random, Unique, De-identified Tracking Number
The survey vendor must assign each decedent/caregiver in the sample a random, unique, deidentified number (Decedent ID). This Decedent ID is used to follow cases through the data
collection process and report whether the survey for each decedent/caregiver has been returned,
or needs a repeat mailing or telephone follow-up. Any de-identified combination of up to 16
letters and numbers may be used. The Decedent ID must not include any combination of letters
or numbers that can otherwise identify the decedent or caregiver. For example, the date of death
(month, date and/or year), the birth date (month, date and/or year) and hospice ID number (e.g.,
decedent hospice record number, etc.) must not be combined in any manner to generate the
Decedent ID. Each month, sampled decedents/caregivers must be assigned a new Decedent ID;
numbers must not be repeated from month to month, or used in a sequential numbering order
unless the decedent/caregiver list is randomized prior to the assignment of the Decedent ID.
File Specifications
The survey vendor must organize survey data into monthly files and then submit the files to the
CAHPS Hospice Survey Data Warehouse either monthly or quarterly. Survey vendors are
required to submit their data files to the CAHPS Hospice Survey Data Warehouse in the XML
file format.
Hospices with zero survey-eligible decedents/caregivers (zero cases) in a month must still
submit a CAHPS Hospice Survey Header Record.
Note: “Zero cases” submissions must not be used when hospices or survey vendors missed
surveying eligible decedents/caregivers, such as when hospices do not submit their
decedents/caregiver lists for the month to their survey vendor in a timely manner. In situations
such as these, a Discrepancy Report must be completed and submitted.
XML File Specifications
The XML format allows a hospice’s sampled decedent/caregiver records to be submitted in one
file. If a hospice’s data file contains a decedent/caregiver record that has been submitted more
than once, the most recently submitted record will completely overwrite any previous record for
that decedent/caregiver, and only the most recently submitted file will be stored in the data
warehouse. No substitutions for valid data element values are acceptable. For the full listing of
valid values, details on the XML file specifications, and for a sample XML file layout, see
Appendix E.
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Each XML file consists of three parts:
1. Header Record
2. Decedent/Caregiver Administrative Record
3. Survey Results Record
1. Header Record
Each monthly data file submitted by a survey vendor begins with the Header Record. The Header
Record contains identification and sampling information that is applicable to every survey record
in that month. The Header Record includes such variables as: hospice name; CMS Certification
Number (CCN), formerly known as the Medicare Provider Number; National Provider Identifier
(NPI), which is an optional field; survey mode; the total number of decedent/caregiver cases
received from the hospice in the month; the number of live discharge patients reported by the
hospice in the month; the number of no-publicity decedents/caregivers reported by the hospice in
the month; the number of decedents/caregivers determined by the vendor to be ineligible for all
other reasons in the month; the number of sampled decedents/caregivers; and sample type.
A critical component in the Header Sub-Record is the “Type of Sampling” used. See the
Sampling Protocol chapter for information on sampling options.
Each field of the Header Record requires an entry for a valid data submission, with the
exceptions of the optional “NPI;” field.
2. Decedent/Caregiver Administrative Record
The second part of the data submission file is the Decedent/Caregiver Administrative Record.
This contains de-identified information on each sampled decedent/caregiver in the file including
the Decedent ID; final survey status; survey completion mode, if applicable; survey
received/completion date, if applicable; language in which the survey was administered or
attempted to be administered; and lag time. In addition, this section should contain the following
information for the decedent: date of birth, date of death, sex, race/ethnicity, primary diagnosis,
admission date for final episode of hospice care, payers, last location/setting of care, and
caregiver relationship to decedent. The decedent/caregiver Decedent/Caregiver Administrative
Record also includes:
The “Number Survey Attempts – Telephone” is required when “Survey Mode” in the
Header Record is “2 – Telephone Only.” It is also required when “Survey Mode” in the
Header Record is “3 – Mixed mode” and “Survey Completion Mode” is “2 – Mixed
mode-phone.”
The “Number Survey Attempts – Mail” is required when “Survey Mode” in the Header
Record is “1 – Mail Only.”
A Decedent/Caregiver Administrative Record is required for each decedent/caregiver sampled
for the CAHPS Hospice Survey, whether or not the caregiver responded to the survey. For
successful submission of the monthly data file, each field of the Decedent/Caregiver
Administrative Record must contain a valid value. Use a code for “Not Applicable” if
appropriate.
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3. Survey Results Record
The third part of the monthly data submission file is the Survey Results Record. This set of
records contains the actual survey responses from each caregiver who responded to the CAHPS
Hospice Survey.
The Survey Results Record is required only when “Final Survey Status” in the
Decedent/Caregiver Administrative Record is coded either “1 – Completed Survey” or “7 – NonResponse: Break-off.” When the Survey Results Record is included, all response fields must
have a valid value, which may include “M – Missing/Don’t Know” and “88 – Not Applicable.”
The opening and closing XML tags (which enclose the Survey Results
Record) are not necessary when there are no survey responses to submit for a given
decedent/caregiver.
The decision on whether to key the responses to open-ended survey items, specifically, the
“Other” in Question 1 (response option 9) and Question 2 (response option 6), and “Some
other language” (response option 4) in Q47, is up to each individual hospice. Vendors will
not be required to key and include responses to open-ended survey items on the data files
submitted to the CAHPS Hospice Survey Data Warehouse. CMS, however, encourages
survey vendors to review the open-ended entries so that they can provide feedback to the
CAHPS Hospice Survey Project Team about adding additional preprinted response options to
these survey items in the future, if needed.
If the vendor includes the Consent to Share Responses question in the mail survey
questionnaire or telephone interview, we recommend that the vendor key the response to that
question. However, responses to the Consent to Share question will not be included on the
data files submitted to the CAHPS Hospice Survey Data Warehouse.
Note: The Survey Results Record is not required for “Final Survey Status” of anything other
than “1 – Completed survey” or “7 – Non-Response: Break-off,” however, if the Survey Results
Record is included, then all fields must have a valid value.
Decision Rules and Coding Guidelines
The CAHPS Hospice Survey decision rules and coding guidelines have been developed to
address situations in which survey responses are ambiguous, missing or incorrectly provided, and
to capture appropriate information for data submission. Survey vendors must adhere to the
following guidelines to ensure valid and consistent coding of these situations.
Mail Surveys
Survey vendors must employ the following decision rules for resolving common ambiguous
situations when scanning or key-entering mail surveys in order to ensure uniformity in data
coding:
If a mark falls between two response options but is obviously closer to one than the other,
then select the choice to which the mark is closest
If a mark falls equidistant between two response options, then code the value of the item
as “M – Missing/Don’t Know”
If a value is missing, then code as “M – Missing/Don’t Know.” Survey vendors must not
impute a response; in other words, do not try to determine what the caregiver would have
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responded for the missing value based on answers to other questions (see information
below with regard to coding skip pattern questions).
When more than one response option is marked, code the value as “M – Missing/Don’t
Know”
Exception: Question 2, “In what locations did your family member receive care
from this hospice? Please choose one or more.” For Question 2, enter responses
for ALL of the categories that the respondent has selected.
Exception: Question 43, “What was your family member’s race? Please choose
one or more.” For Question 43, enter responses for ALL of the categories that the
respondent has selected.
In instances where there are multiple marks but the caregiver’s intent is clear, survey vendors
should code the survey with the caregiver’s clearly identified intended response.
CATI
When a caregiver breaks off the interview and subsequent questions aren’t asked, then use “M –
Missing” to code the unanswered questions.
Survey Skip Patterns
There are several items in the CAHPS Hospice Survey that can and should be skipped by certain
respondents. These items form skip patterns. Ten questions in the CAHPS Hospice Survey serve
as screener questions (Questions 3, 4, 13, 15, 17, 21, 24, 26, 28, and 32) that determine whether
the associated dependent questions require an answer. The following decision rules are provided
to assist in the coding of caregiver responses to skip pattern questions.
Skip Patterns
Do not correct a screener question by imputing a response based on the caregiver’s
answers to the dependent questions. Enter the value provided by the caregiver.
For mail questionnaire skip patterns
If the screener question is left blank, code it as “M – Missing/Don’t Know.” In this
scenario, code any appropriately skipped dependent questions as “M – Missing/Don’t
Know.” Do not impute responses based on how the caregiver answers questions.
In instances where the caregiver made an error in the skip pattern, dependent
questions are coded with the response provided by the caregiver. That is, survey
vendors must not “clean” or correct skip pattern errors on surveys completed by a
caregiver.
Dependent questions that are appropriately skipped should be coded as “88 - Not
Applicable”
For CATI questionnaire skip patterns
In instances where the caregiver answers “I don’t know” or refuses to answer the
screener question, code response option of “M – Missing/Don’t know”
When answer options of “M – Missing/Don’t know” are used for coding screener
questions, the skip pattern should be programmed into the electronic telephone
interviewing system. The resulting associated dependent questions should be coded as
“88 – Not Applicable.”
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Appropriately skipped dependent questions should be coded as “88 – Not Applicable”
Note: For telephone follow-up via CATI, skip patterns should be programmed into the
electronic telephone interviewing system. Coding may be done automatically by the
telephone interviewing system or later during data preparation.
Header Record
All fields in the Header Record must have a valid value entered with the exception of
“NPI field.”
Once the “Survey Mode” field has been defined for the first month in a quarter, the
survey mode for the quarter can be changed by resubmitting this file ONLY if the data
files for another month in the quarter have not yet been submitted.
In calculating the “Eligible Sample” field, the number of survey-eligible
decedents/caregivers in the sample frame in the month must not include
decedents/caregivers who are determined to be ineligible or excluded, regardless of
whether they are selected for the survey sample
“Sample Size” can therefore be larger than the “Eligible Sample”. For example, if a
decedent/caregiver was selected for the survey sample and later determined to be
ineligible (i.e., “Final Survey Status” code of “3 – Ineligible: Not in eligible
population” or “6 – Ineligible: Never involved in decedent care”), then the
decedent/caregiver must be subtracted from the number of survey-eligible
decedents/caregivers in the month. However, this does NOT apply to “Final Survey
Status” codes of “2 – Ineligible: Deceased,” “4 – Ineligible: Language barrier” or “5 –
Ineligible: Mental/Physical incapacity.”
If a decedent/caregiver is not selected for the survey sample and is later
determined to be ineligible, then the decedent/caregiver must be subtracted from the
number of survey-eligible decedents/caregivers in the month
The “Eligible Sample” field must include the count of decedents/caregivers who
are eligible for the CAHPS Hospice Survey
Once the “Type of Sampling” field has been defined for the first month in a quarter, the
sample type for the quarter can be changed by resubmitting this file ONLY if the data
files for another month in the quarter have not yet been submitted
When hospices sample 100% of the survey-eligible decedents/caregivers (i.e., a
census), the “Type of Sampling” must be coded as “2 – Census Sample”
Note: Hospices with zero survey-eligible decedents/caregivers (zero cases) in a month must still
submit a CAHPS Hospice Survey Header Record.
Decedent/Caregiver Administrative Record
All fields in the Decedent/Caregiver Administrative Record must have a valid value.
Use code “M – Don’t Know” for all missing fields, with the following exceptions:
The “language” field must be completed with the appropriate valid value indicating
the survey language in which the survey was administered (English, Spanish or
Chinese), even if a caregiver does not complete the survey
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Decedent/Caregiver Administrative Record information must be submitted for all
decedents/caregivers selected for the survey sample, including decedents/caregivers
found to be ineligible prior to survey administration
If a decedent/caregiver is found to be ineligible or excluded after the sample is drawn,
the decedent/caregiver should be assigned a “Final Survey Status” code of “3 –
Ineligible: Not in eligible population”
If the decedent/caregiver is selected for the CAHPS Hospice Survey and the 42-day
initial contact period has lapsed prior to any contact attempt, then the
decedent/caregiver should be assigned a “Final Survey Status” code of “9 – NonResponse: Non- response after maximum attempts”
The “Survey Completion Mode” field must be submitted if the “Survey Mode” in the
Header Record is “3 – Mixed mode” and the “Final Survey Status” is “1 – Completed
survey” or “7 – Non-response: Break off.” For other “Final Survey Status” codes,
code “Survey Completion Mode” as “88 – Not applicable.”
Note: “Survey Completion Mode” is not a required field for “Survey Mode” of “1 – Mail
Only” and “2 – Telephone Only.”
The “Number Survey Attempts – Telephone” field must be submitted when:
the “Survey Mode” in the Header Record is “2 – Telephone Only”
the “Survey Mode” in the Header Record is “3 – Mixed mode” and “Survey
Completion Mode” is “2 – Mixed mode-phone”
the “Number Survey Attempts - Telephone” field is coded with the attempt that
corresponds to the time of final survey status determination
Note: “Number Survey Attempts – Telephone” is not a required field for “Survey Mode”
of “1 – Mail Only.” If this field (Number Survey Attempts – Telephone) is included with
“Survey Mode” of “1 – Mail Only,” then code “Number Survey Attempts – Telephone”
as “88 – Not applicable.”
The “Number Survey Attempts – Mail” field must be submitted when:
the “Survey Mode” in the Header Record is “1 – Mail Only”
the “Number Survey Attempts – Mail” field is coded with the attempt that
corresponds to the time of final survey status determination
Note: “Number Survey Attempts – Mail” is not a required field for “Survey Mode” of “2
– Telephone Only” or “3 – Mixed mode.” If this field (Number Survey Attempts – Mail)”
is included with “Survey Mode” of “2 – Telephone Only” or “3 – Mixed mode” then
code “Number Survey Attempts – Mail” as “88 – Not applicable.”
Note: The “Number Survey Attempts – Telephone” and the “Number Survey Attempts –
Mail” fields are submitted in accordance with the requirements identified above for all
CAHPS Hospice Survey Final Status Codes.
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The “Lag Time” is calculated for each decedent/caregiver in the sample and is defined
as the number of days between the decedent’s date of death and the date that data
collection activities ended for the decedent/caregiver
All surveys (i.e., “Final Survey Status” codes of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or
M) must contain the actual lag time.
Note: Although a completed or break-off survey may have a lag time of as much as 140
days, survey administration must be completed within 6 weeks (42 days) of initial
contact (first mailing of the mail survey or first telephone attempt).
The following are brief illustrations of how lag time would be determined for each
Final Survey Status ( or “Disposition of survey”):
Completed survey (code 1): Lag time is the number of days between the decedent’s
date of death and the receipt of a completed mail survey or the completion of a
telephone survey
Ineligible: Deceased (code 2): Lag time is the number of days between the
decedent’s date of death and the date it is determined that the caregiver is deceased
Ineligible: Not in eligible population (code 3): Lag time is the number of days
between the decedent’s date of death and the date it is determined that the
decedent/caregiver is not eligible for the CAHPS Hospice Survey
Ineligible: Language barrier (code 4): Lag time is the number of days between the
decedent’s date of death and the date it is determined that a language barrier prevents
the caregiver from completing the CAHPS Hospice Survey
Ineligible: Mental/physical incapacity (code 5): Lag time is the number of days
between the decedent’s date of death and the date it is determined that a mental or
physical incapacity prevents the caregiver from completing the CAHPS Hospice
Survey
Ineligible: Never involved in decedent care (code 6): Lag time is the number of
days between the decedent’s date of death and the date it is determined that the
caregiver was never involved in hospice care for the decedent
Non-response: Break off (code 7): Lag time is the number of days between the
decedent’s date of death and the date the caregiver “breaks off” or fails to complete
the CAHPS Hospice Survey after the survey has started
Non-response: Refusal (code 8): Lag time is the number of days between the
decedent’s date of death and the date the caregiver (or someone on the caregiver’s
behalf) refuses to take the CAHPS Hospice Survey
Non-response: Non-response after maximum attempts (code 9): Lag time is the
number of days between the decedent’s date of death and the date of the maximum
attempt (Mail: non-return of the second mailing of survey; Telephone: fifth call
attempt) to administer the CAHPS Hospice Survey
Non-response: Bad address (code 10): Lag time is the number of days between the
decedent’s date of death and the date it is determined that the caregiver’s actual
mailing address is not viable
Non-response: Bad/no phone number (code 11): Lag time is the number of days
between the decedent’s date of death and the date it is determined that the caregiver’s
actual telephone number is not viable
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To illustrate the calculation of lag time where a caregiver did not respond to the survey,
two examples are provided:
Example A: Lag Time Calculation Mail
Mode of Survey Administration
Decedent Date of Death
Date of First Mail Attempt
Date of Follow-up Mail Attempt
Date Data Collection Activities
Ended for this
Decedent/Caregiver
CAHPS Hospice Survey Final
Status
Lag Time
Mail Only
January 15
April 1 (75 days after death)
April 22 (21 days after first mail attempt)
May 12 (42 days after first mail attempt)
Caregiver never returned the CAHPS Hospice
Survey
Code as “9 – Non-response: non-response after
maximum attempts” because the data collection
protocol of 42 days has been reached and the
caregiver has not returned the CAHPS Hospice
Survey
Calculated as 117 Days (number of days
between the patient’s death [January 15] to the
date data collection activities ended [May 12])
Example B: Lag Time Calculation Telephone
Mode of Survey Administration
Decedent Date of Death
Date of First Attempt
Date Data Collection Activities
Ended for this
Decedent/Caregiver
CAHPS Hospice Survey Final
Status
Lag Time
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Telephone Only
January 15
April 1 (75 days after decedent death)
May 12 (42 days after the first telephone attempt)
Code as “9 – Non-response: non-response after
maximum attempts” because the data collection
protocol of 42 days had ended and the caregiver
had not been reached although five attempts were
made
Calculated as 117 Days (number of days
between the decedent’s death [January 15] to the
date data collection activities ended [May 12])
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To illustrate the calculation of lag time when a caregiver responds and completes the
survey, one example is provided:
Example C: Lag Time Calculation Mail
Mode of Survey Administration
Decedent Date of Death
Date of First Mail Attempt
Date of Response
CAHPS Hospice Survey Final
Status
Mail Only
January 15
April 1 (75 days after death)
April 15
Code as “1 – Completed survey
Lag Time
Calculated as 90 Days (number of days between
the patient’s death [January 15] to the date
response was received [April 15])
The “Supplemental Question Count” field must be submitted when the “Final Survey
Status” is “1 – Completed survey” or “7 – Non-response: Breakoff.” The value submitted
is the count of supplemental questions included in the survey for the given
decedent/caregiver (whether or not the supplemental questions were asked/responded to).
Decedent/Caregiver Administrative Record information must be submitted for all
decedents/caregivers selected for the survey sample, including decedents/caregivers
found to be ineligible prior to survey administration
Survey Results Record
Enter all survey responses as provided by the caregiver for each survey item
All survey questions must have a valid value. For “Final Survey Status” of “1 –
Completed survey” or “7 – Non-Response: Break-off,” code missing answers as “M –
Missing/Don’t Know” or “88 – Not Applicable.”
For Question 41, “What is the highest grade or level of school that your family member
completed?” if a caregiver indicates that he or she does not know the decedent’s
education, the interviewer should code “<7> Respondent indicates that he or she does
not know family member’s level of education.” This should not be recoded to “M –
Missing/Don’t Know” in the data file.
Caregivers may select more than one response category in Question 2, “In what
locations did your family member receive care from this hospice? Please choose one or
more” and in Question 43, “What was your family member’s race? Please choose one
or more.”
Mail Survey
o Enter all of the categories that the caregiver has selected. For any category not
selected, enter “0.” If no categories are selected, enter “M – Missing/Don’t Know”
for all categories.
Telephone Surveys
o Enter all of the categories that the caregiver has selected. If the caregiver
responds “Yes” to a category, enter “1.” If the caregiver responds “No” to a
category, enter “0.” If the caregiver does not provide a response to any of the
categories or skips the question, enter “M – Missing/Don’t Know.”
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Note: A valid value must be submitted for each category in Question 2 and Question 43.
If the same caregiver completes two surveys for the same decedent (i.e., the
caregiver returns both mail surveys), the survey vendor uses the first CAHPS Hospice
Survey received
Disposition of Survey Codes
Maintaining up-to-date dispositions of survey codes is a required part of the CAHPS Hospice
Survey administration process. Using the random, unique, de-identified Decedent ID, the survey
vendor assigns each decedent/caregiver in the sample a survey status code, which is used to track
and report whether the caregiver has completed a questionnaire or requires further follow-up.
Typically, survey status codes are either interim (which indicate the status of each sampled
decedent/caregiver during the data collection period), or final (which indicate the final outcome
of each decedent/caregiver surveyed at the end of data collection, that is – “Final Survey
Status”).
Interim disposition codes are to be used only for internal tracking purposes. The data files
that are submitted to the CAHPS Hospice Survey Data Warehouse must contain the CAHPS
Hospice Survey final survey status codes. Interim survey status codes allow the survey vendor
to calculate and report the number of completed questionnaires and the response rate at any
time during the data collection period. After data collection is completed, the survey vendor
assigns each sampled decedent/caregiver a final survey status code.
The following provides details on the assignment of the “Final Survey Status” field.
Code Description
1 Completed survey
Survey vendors assign a “Final Survey Status” code of “1 – Completed survey” when the
caregiver answers at least 50 percent of the questions applicable to all
decedents/caregivers. For detailed information on a completed survey, refer to Definition of a
Completed Survey in this section.
2
Ineligible: Deceased
Survey vendors assign a “Final Survey Status” code of “2 – Ineligible: Deceased” when the
caregiver is deceased by time of survey administration.
3
Ineligible: Not in Eligible Population
Survey vendors assign a “Final Survey Status” code of “3 – Ineligible: Not in eligible
population” when there is evidence that the decedent/caregiver does not meet the following
eligibility criteria:
Decedents age 18 and over
Decedents with death at least 48 hours following last admission to hospice care
Decedents for whom there is a caregiver of record
Decedents whose caregiver is someone other than a non-familial legal guardian
Decedents for whom the caregiver has a U.S. or U.S. Territory home address
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4
Ineligible: Language Barrier
Survey vendors assign a “Final Survey Status” code of “4 – Ineligible: Language barrier”
when there is evidence that the caregiver does not read or speak the language in which
the survey is being administered.
5
Ineligible: Mental or Physical Incapacity
Survey vendors assign a “Final Survey Status” code of “5 – Ineligible: Mental/physical
incapacity” when the caregiver is unable to complete the survey because he/she is mentally
or physically incapacitated. This includes caregivers who are visually/hearing impaired.
6
Ineligible: Never Involved in Decedent Care
Survey vendors assign a “Final Survey Status” code of “6 – Ineligible: Never involved in
decedent care” when the answer to Question 3, “While your family member was in hospice
care, how often did you take part in or oversee care for him or her?” is “Never” or when
calling the household the sampled caregiver indicates that he/she was not involved in the
patient’s hospice care and no alternative caregiver respondent resides in the household
(coded “NOT INVOLVED IN CARE AND NO PROXY IDENTIFIED” on INTRO of the
CATI script).
7
Non-response: Break-off
Survey vendors assign a “Final Survey Status” code of “7 – Non-response: Break-off” when
a caregiver provides a response to at least one CAHPS Hospice Survey Core question, but
answered too few Core questions to meet the criteria for a completed survey.
8
Non-response: Refusal
Survey vendors assign a “Final Survey Status” code of “8 – Non-response: Refusal” when a
caregiver returns an incomplete survey with a note stating they do not wish to participate,
or when a caregiver verbally refuses to respond to the survey. Surveys completed by a
respondent outside of the sampled caregiver household are coded as “8 – Non-response:
Refusal.” In the CATI survey, if a sampled caregiver disavows knowledge of the Hospice the
case should be coded “8 – Non-response: Refusal.”
Note: Respondents who reside outside of the household of the sampled caregiver are not
permitted. In the event that it is determined a survey has been completed by a respondent
outside of the sampled caregiver household, the decedent/caregiver is assigned a “Final
Survey Status” code of “8 – Non-Response: Refusal.” The survey vendor submits the
decedent/caregiver administrative record but does not submit the survey responses. The
survey vendor retains a copy of such a survey and any accompanying documentation. If a
survey is returned with a note or someone verbally refuses on behalf of the
decedent/caregiver, the vendor should code the survey as “8 – Non-Response: Refusal.”
9
Non-response: Non-response after Maximum Attempts
Survey vendors assign a “Final Survey Status” code of “9 – Non-response: Non-response
after maximum attempts” when one of the following occurs:
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there is no evidence to suggest that a caregiver’s contact information is bad (e.g., bad
address in Mail Only methodology, bad telephone number in Telephone Only, and both
bad address and bad telephone number in a Mixed mode methodology), or
if after the maximum number of attempts (two mail attempts for Mail Only; five
telephone attempts for Telephone Only; and one mail attempt and five telephone attempts
for Mixed mode), the caregiver has not completed the survey by the end of the survey
administration time period (i.e., 42 days from initial contact), or
if the survey is returned by mail or completed by telephone more than 42 days from initial
contact
10 Non-response: Bad Address
This disposition code applies only to the Mail Only mode. Survey vendors assign a “Final
Survey Status” code of “10 – Non-response: Bad address” when there is evidence that a
caregiver’s address is bad (e.g., the post office returns the questionnaire to the hospice/survey
vendor, etc.).
11 Non-response: Bad/No Telephone Number
This disposition code applies to the Telephone Only and Mixed modes of administration.
For the Telephone Only mode, survey vendors assign a “Final Survey Status” code of “11 –
Non-response: Bad/no phone number” when there is evidence that a caregiver’s telephone
number is bad (e.g., no telephone number available or a disconnected telephone number,
etc.). For the Mixed mode, “11 – Non-response: Bad/no phone number” is used when there is
evidence that a caregiver’s address and telephone number are both bad.
Assigning Bad Address and/or Bad Telephone Number Disposition Codes
The “Final Survey Status” codes of “9 – Non-response after maximum attempts,” “10 –
Non-response: Bad address,” and “11 – Non-response: Bad/no phone number” are assigned
based on the viability of the address and telephone number for the caregiver. Survey vendors
must track the viability of the mailing address and telephone number for each caregiver during
survey administration. In general, the contact information is assumed to be viable unless there is
sufficient evidence to suggest otherwise. If the evidence is insufficient, the survey vendor must
continue attempting to contact the caregiver until the required number of attempts has been
exhausted.
Note: Attempts must be made to contact every survey-eligible decedent/caregiver drawn into the
sample, whether or not they have a complete mailing address and/or telephone number.
Survey vendors have flexibility in not sending mail surveys to caregivers without mailing
addresses, such as the homeless. However, survey vendors must first make every reasonable
attempt to obtain a caregiver’s address including re-contacting the hospice client to inquire
about an address update for decedent/caregivers with no mailing address. Survey vendors must
use commercial software or other means to update addresses and/or telephone numbers
provided by the hospice for sampled decedent/caregivers. If the survey vendor is unsuccessful in
obtaining a viable mailing address and/or telephone number, they must retain a record of their
attempts to acquire the missing information. All materials relevant to survey administration are
subject to review by CMS.
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The following examples illustrate what constitutes sufficient or insufficient evidence of viability.
For a Mail Only survey, sufficient evidence regarding the viability of a caregiver’s address
includes:
The hospice does not provide an address in the decedent/caregiver list, and the survey
vendor is unable to obtain an address for the caregiver
Mail is returned marked “Address Unknown”
Mail is returned marked “Moved – No Forwarding Address”
For a Mail Only survey, insufficient evidence regarding the viability of a caregiver’s
address includes:
Address updating search does not result in an exact “match.” If the search does not result
in an exact “match,” the survey vendor must attempt to mail using the address that is
available.
For all modes of administration except Mail Only, sufficient evidence regarding the viability of
caregiver’s telephone number includes:
The hospice does not provide a telephone number in the decedent/caregiver list, and
the survey vendor is unable to obtain a telephone number for the caregiver
The telephone interviewer dials the caregiver’s telephone number and receives a
message that the telephone number is non-working or out of order, and no updated
number is available or obtained
The telephone interviewer dials the caregiver’s telephone number, speaks to a person,
and is informed that he/she has the wrong telephone number and other attempts to
obtain the correct telephone number are not successful
For all modes of administration except Mail Only, insufficient evidence regarding the viability of
a caregiver’s telephone number includes:
The survey vendor obtains a busy signal every time a telephone attempt is made
The following table summarizes how survey vendors assign the “Final Survey Status” codes of
“9 – Non-response: Non-response after maximum attempts,” “10 – Non-response: Bad address,”
and “11 – Non-response: Bad/no phone number” after assessing the caregiver’s contact
information for viability. Due to the nature of the information available in the three modes of
survey administration, different coding rules apply for surveys administered in each mode.
Mail Only Methodology
Assigning Final Survey Status/Disposition Codes 9, 10, and 11
Final Survey Status Code
Viable Address and
No Response After Maximum Attempts
Evidence of a Bad Address
9
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Telephone Only Methodology
Assigning Final Survey Status/Disposition Codes 9, 10, and 11
Viable Telephone Number and
No Response After Maximum Attempts
Evidence of a Bad/No
Telephone Number
9
11
Final Survey Status Code
Mixed Mode Methodology
Assigning Final Survey Status/Disposition Codes 9, 10, and 11
Viable Address and/or Telephone
Number and
No Response After Maximum Attempts
Evidence of Both a Bad Address
and a Bad/No Telephone Number
9
11
Final Survey Status Code
Definition of a Completed Survey
Survey vendors should be aware that a survey can be considered “complete” for CAHPS
Hospice Survey purposes even if a caregiver did not answer all items. Survey vendors assign a
decedent/caregiver’s survey a “Final Survey Status” code of “1 – Completed survey” when
at least 50 percent of the questions applicable to all decedents/caregivers (questions 1 – 4, 6 –
13, 15, 17, 21, 24, 26, 28, 30 – 32, and 35 – 47) are answered. Appropriately skipped questions
and the following questions are not included in the calculation of percentage complete: 5, 14, 16,
18 – 20, 22, 23, 25, 27, 29, 33, and 34.
The following steps describe how to determine if a survey is completed:
Step 1 – Sum the number of questions that have been answered by the caregiver that
are applicable to all decedents/caregivers
R = total number of questions answered
Step 2 – Divide the total number of questions answered by 34, which is the total
number of questions applicable to all decedents/caregivers, and then multiply by 100
Percentage Complete = (R/34) x 100
Step 3 – If the Percentage Complete is at least 50 percent, then assign the survey a
“Final Survey Status” code of “1 – Completed survey”
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Survey Response Rate
The following formula is included for informational purposes only; survey vendors are not required
to perform this calculation.
Response Rate =
Total Number of Completed Surveys
Total Number of Surveys Fielded – Total Number of Ineligible
Surveys
Total Number of Completed Surveys is the total number of surveys with a “Final
Survey Status” of 1
Total Number of Surveys Fielded is the total sample, which includes “Final
Survey Status” codes of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and M
Total Number of Ineligible Surveys is the total number of surveys with a “Final
Survey Status” code of 2, 3, 4, 5, or 6
It is important to emphasize that the remaining Non-Response disposition codes (i.e., “7 –
Break- off,” “8 – Refusal,” “9 – Non-response after maximum attempts,” “10 – Bad address,”
and “11 – Bad/No telephone number”) are not removed from the denominator of the response
rate calculation.
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Data Submission
Overview
The CAHPS Hospice Survey will use a standardized protocol for the preparation and submission
of all data. This section describes the preparation, registration, and submission of survey data
files to the CAHPS Hospice Survey Data Warehouse. If any problems occur when submitting
data to the CAHPS Hospice Survey Data Warehouse, the CAHPS Hospice Survey Data
Coordination Team can be reached by sending an email message to
[email protected].
Data Submission Process
The CAHPS Hospice Survey Data Coordination Team has developed a secure data warehouse
hosted by the RAND Corporation. This data warehouse will operate as a secure file transfer
system that survey vendors will use to submit survey data to CMS and where survey vendors and
hospices may review CAHPS Hospice Survey Data Submission Reports. Use of the CAHPS
Hospice Survey Data Warehouse for data submission does not require installation of special
software or a licensing fee on the part of survey vendors, except for the purchase of PGP for file
encryption. The interface for the data warehouse is user friendly and will require minimal
training.
Data File Submission Dates
As previously specified in this manual, survey vendors are required to submit data quarterly.
Survey vendors may submit an interim data file prior to the final submission date. Submitting an
interim data file will provide survey vendors an opportunity to test the data submission process
and correct any data file errors/problems before they have to submit the final data file and correct
any data file errors/problems.
Note: Survey vendors may submit interim data any time during the quarter; however, a fully
correct data file must be submitted by 11:59 PM Eastern Time on the required submission date.
Survey Vendor Authorization Process
Hospices must submit documentation to the CAHPS Hospice Survey Data Coordination Team
authorizing survey vendors to collect and submit data on their behalf before survey vendors can
access the data submission application hosted by RAND. Upon receipt of the CAHPS Hospice
Survey Vendor Authorization Form (see Appendix B), the CAHPS Hospice Survey Data
Coordination Team will confirm the authenticity of the authorizing entity verifying contact
information at both the hospice and survey vendor level. Only then will the survey vendor be
contacted and provided an account for the CAHPS Hospice Survey Data Warehouse.
Preparation for Data Submission
As mentioned earlier in this manual, each survey vendor participating in the CAHPS Hospice
Survey is required to designate a primary Data Administrator within their organization
responsible for submitting survey data to the CAHPS Hospice Survey Data Warehouse on behalf
of hospice clients. In addition to the primary Data Administrator, each survey vendor must
designate a second person within the organization to act as the Back-up Data Administrator who
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will also have access to the CAHPS Hospice Survey Data Warehouse. The Data Administrator
will be designated as the main point of contact between the CAHPS Hospice Survey Data
Coordination Team and the survey vendor regarding issues related to uploading files to the
CAHPS Hospice Survey Data Warehouse. In addition, the Data Administrator will have primary
responsibility for ensuring that the survey vendor follows procedures for preparing and
submitting survey data according to CMS requirements as outlined in this manual. The CAHPS
Hospice Survey Data Coordination Team must be notified of any personnel changes to the
survey vendor’s Data Administrator role. The new Data Administrator will be required to create
a new password for the survey vendor’s CAHPS Hospice Survey Data Warehouse account.
The CAHPS Hospice Survey Data Warehouse allows for data submission by vendors and review
of data submission reports by both hospices and vendors. Hospices may designate an individual
within their organization who will have access to CAHPS Hospice Survey Data Submission
Reports. The CAHPS Hospice Survey Data Coordination Team must be notified of any
personnel changes to the hospice’s designee. The new designee will be required to create a new
password for the hospice’s CAHPS Hospice Survey Data Warehouse account.
Each survey vendor’s Data Administrator, as well as the Back-up Administrator and the hospice
designee, will be required to register with the CAHPS Hospice Survey Data Coordination Team
by completing a CAHPS Hospice Survey Data Warehouse Access From (see Appendix D) and
emailing or faxing it to the CAHPS Hospice Survey Data Coordination Team. Once the CAHPS
Hospice Survey Data Coordination Team has verified the information on the form and, for
survey vendors, confirmed that a survey vendor has been authorized by one or more hospice
contracts to submit data on their behalf, unique ID and passwords will be assigned (created by
the CAHPS Hospice Survey Data Coordination Team). The CAHPS Hospice Survey Data
Coordination Team will contact each survey vendor or hospice designee by telephone to
communicate the password by speaking directly to the designated individual. The passwords will
not be transmitted through email, Internet or other electronic methods and will not be left on
voice mail.
The CAHPS Hospice Survey Data Coordination Team will copy the Data Administrator, Backup Data Administrator and the hospice designee on all email communications related to the data
warehouse on data submission.
Survey File Submission Naming Convention
In submitting CAHPS Hospice Survey data files, survey vendors must use the following file
naming convention:
Vendorname.submissionN.mmddyy.txt.pgp
Where
N = number within day to count the number of submissions; can be any number of
characters. If more than one submission is made on the same day this number must
be different for each submitted file.
mm = number of month of submission (justify leading zero)
dd = day of the month of submission (justify leading zero)
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yy = 2 digit year of submission
Example: XYZResearch.submission1.051514.txt.pgp
Notes:
Survey vendors must submit all records for all decedents/caregivers in a single file
Files submitted must include a record for every decedent/caregiver in the CAHPS
Hospice Survey sample frame file (for the interim data submission, the record for a
decedent/caregiver for whom the vendor has not yet completed a survey must be coded
with disposition code “33 – No response collected”)
Password Authentication
Upon successful authentication of the survey vendor’s or hospice designee’s username and
password, users will have access to their organization’s designated folder in the CAHPS Hospice
Survey Data Warehouse. Survey vendors and hospice designees will be provided instructions for
re-authenticating their password, including the requirements and recommended guidelines for
creating a password (passwords must be at least 7 characters in length and contain at least one
character from 3 of the 5 classes of characters: uppercase letters, lowercase letters, digits,
punctuation or symbols).
Organization of the CAHPS Hospice Survey Data Warehouse
Vendors will upload data files to a secure CAHPS Hospice Survey Data Warehouse at the
RAND Corporation. Each survey vendor will have its own folder in the CAHPS Hospice Survey
Data Warehouse and won’t be able to see, locate, or access another survey vendor’s folder.
Hospices will have its their own folders in the CAHPS Hospice Survey Data Warehouse and
won’t be able to see, locate, or access survey vendors’ or other hospices’ folders. Documents and
files of interest to all vendors and hospices will be placed in the top level folder of the CAHPS
Hospice Survey Data Warehouse and will be visible and available for download by any
authorized user of the CAHPS Hospice Survey Data Warehouse.
File Encryption
All survey vendors must adhere to file format specifications and, as an additional security
precaution, are required to encrypt survey data files using PGP software (www.pgp.com) prior
to submitting files to the CAHPS Hospice Survey Data Warehouse. PGP is a widely used,
commercially available data encryption computer program that provides cryptographic privacy
and authentication for data communication. Each survey vendor is responsible for purchasing a
PGP license if they do not already use PGP.
Files must be encrypted using the CAHPS Hospice Survey PGP Public Key before they are
uploaded to the CAHPS Hospice Survey Data Warehouse. The CAHPS Hospice Survey Data
Coordination Team will provide all survey vendors with the PGP Public Key by placing a copy
of the Public Key in the top level folder of the CAHPS Hospice Survey Data Warehouse. Data
files submitted to the CAHPS Hospice Survey Data Warehouse that are not encrypted will be
rejected and must be resubmitted.
Any file uploaded to the survey vendor’s folder that does not have the “.pgp” extension,
indicating the prescribed PGP encryption, will be quarantined and automatically deleted. An
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automated email will be sent to the survey vendor’s data administrator and backup data
administrator, informing them they have uploaded a file that does not comply with the
established naming standards and that the file therefore will not be processed and will need to be
resubmitted correctly. The CAHPS Hospice Survey Data Coordination Team will also be
notified by automated email that the event occurred.
Instructions for Accessing the CAHPS Hospice Survey Data
Warehouse
Refer to Appendix C for detailed instructions for survey vendors and hospices on accessing the
CAHPS Hospice Survey Data Warehouse. In brief, the process is as follows:
1. The Data Administrator will receive an email from the CAHPS Hospice Survey Data
Coordination Team with an invitation to the CAHPS Hospice Survey Data Warehouse. This
email will contain a link that will allow the Data Administrator to login to the CAHPS
Hospice Survey Data Warehouse.
2. After clicking the link the Data Administrator will be routed to the login page where he/she
will be prompted for his/her user ID and a password
3. On the first login only, the Data Administrator will be presented with a page to change
his/her password
4. Once the password has been updated, the Data Administrator will be transferred to the File
Manager tab of the CAHPS Hospice Survey Data Warehouse
5. Selecting the workspace name link in the File Manager tab will allow the user to Download
and Add Files
Note: These instructions should be followed for each authorized user of the CAHPS Hospice
Survey Data Warehouse.
Data Auditing and Validation Checks
The CAHPS Hospice Survey Data Coordination Team will audit the data files as they are
submitted by survey vendors for compliance with the file specifications outlined in the chapter
on Data Coding and Data Preparation in this manual.
The data audit process conducted by the CAHPS Hospice Survey Data Coordination Team
involves conducting various data checks of the survey data submitted by survey vendors. The
first check will be integrated into the CAHPS Hospice Survey Data Warehouse and involves
testing for the appropriate file extension .pgp to indicate that a survey file has been encrypted. As
described above, any file uploaded to the CAHPS Hospice Survey Data Warehouse that does not
have the “.pgp” extension will be automatically deleted. In such instances, an automated email
will be sent to the survey vendor’s Data Administrator and Back-up Data Administrator
informing them that they have uploaded a file that does not comply with the established naming
standards, and that the file will not be processed; and therefore, needs to be resubmitted
correctly. Properly encrypted files will receive additional edit checks on submitted data files,
including:
Morphological tests (appropriate character set, naming conventions, etc.)
Checks for the presence of required data fields
Range checks of data fields
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Survey vendors (Data Administrator and Back-up Data Administrator) and hospices will receive
a second email that contains the full detail of the edit check report by 8:00 PM Eastern Time on
the next business day after submission. If the submitted data file fails the edit checks described
above, the email notification to survey vendors and hospices will indicate that they are required
to resubmit a corrected survey data file and will include details of the discrepancies found during
the edit checking. If the data file they submitted passes the edit checks, the email notification will
indicate that no additional action is required and will include a summary of the submitted data
file for vendor verification. Survey vendors are responsible for submitting a corrected file by the
deadline for submission. Survey vendors and hospices will receive emailed reports until their
entire dataset has passed all edit checks.
Data Submission Reports
Three CAHPS Hospice Survey Data Submission Reports are accessible by hospices and survey
vendors. The reports will contain information related to each data submission as well as a
summary of submissions for each hospice. The reports and content are as follows:
Survey Status Summary Report – includes the number of surveys submitted for a
hospice for each month in the submission quarter. This report lists the accepted
administrative data records (which includes the number of respondents and nonrespondents to the survey) and the accepted survey results records (which includes only
the respondents to the survey).
Data Submission Detail Report – includes the upload date and status of files (accepted
or rejected) under a given Batch ID, and lists Decedent IDs and any error codes with
messages.
Review and Correction Report – contains the frequency of valid values submitted for a
hospice for each month in the submission quarter. Hospices/survey vendors are strongly
encouraged to review this report for possible data errors.
Data Submission Reports for hospices will include information only for their hospice; reports for
survey vendors will include information for all hospices for which they submit data.
Note: All hospices should review the Survey Status Summary and Data Submission Detail
reports on a regular basis.
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Oversight Activities
Overview
In order to verify compliance with CAHPS Hospice Survey protocols, the CMS-sponsored
CAHPS Hospice Survey Project Team conducts oversight of participating survey vendors. This
chapter describes the oversight activities for the CAHPS Hospice Survey. All materials and
procedures relevant to survey administration are subject to review. Signing the CAHPS Hospice
Survey Participation Form signifies agreement with all of the Rules of Participation,
including all CAHPS Hospice Survey oversight activities.
Oversight Activities
Survey vendors are required to participate in CAHPS Hospice Survey oversight. The purpose of
the oversight activities is to ensure that approved survey vendors follow the CAHPS Hospice
Survey administration protocols; and thereby, ensure the comparability of CAHPS Hospice
Survey data across hospices. These oversight activities include but are not limited to the
following:
CAHPS Hospice Survey Model QAP
The CAHPS Hospice Survey Model QAP is a comprehensive working document that is
developed, and periodically revised, by survey vendors in order to document their current
processes for the administration of the CAHPS Hospice Survey and correct
implementation of standard protocols. The QAP should also be used as a training tool for
project staff and subcontractors. The CAHPS Hospice Survey Project Team will review
survey vendor QAPs to ensure that the survey vendor’s stated processes are compliant
with CAHPS Hospice Survey protocols. Any approved Exception Requests must be
thoroughly discussed in the QAP. In addition, materials relevant to the CAHPS Hospice
Survey administration, including mailing materials (e.g., cover letters and questionnaires)
and/or telephone scripts and interviewer screen shots are required to be submitted for
each approved mode of survey administration. CMS may also request additional surveyrelated materials for review as needed.
Analysis of Submitted Data
All survey data submitted to the CAHPS Hospice Survey Data Warehouse by survey
vendors are reviewed by the CAHPS Hospice Survey Data Coordination Team. This
review includes, but is not limited to, statistical and comparative analyses; preparation of
data for reporting; and other activities as required by CMS. If data anomalies are found,
this will result in follow-up with the survey vendor.
Site Visits/Conference Calls
All survey vendors (and their subcontractors, as applicable) are required to participate in
site visits and/or conference calls conducted by the CAHPS Hospice Survey Project
Team. The site visits allow the CAHPS Hospice Survey Project Team to review and
observe systems, procedures, facilities, resources, and documentation related to
administering the CAHPS Hospice Survey. The conference calls allow the CAHPS
Hospice Survey Project Team to discuss issues with the survey vendor related to
administration of the CAHPS Hospice Survey.
Additional Activities
Additional activities as specified by CMS may be conducted in addition to the above.
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Note: If the site visit/conference call, or any other oversight activity conducted by the CAHPS
Hospice Survey Project Team, suggests that actual survey processes differ from CAHPS
Hospice Survey protocols, immediate corrective actions may be required and sanctions may be
applied.
CAHPS Hospice Survey Model Quality Assurance Plan (QAP)
Survey vendors approved to administer the CAHPS Hospice Survey are obligated to develop and
continually update a QAP. The QAP is a comprehensive working document that outlines the
survey vendor’s implementation of, and compliance with, the CAHPS Hospice Survey
guidelines. The main purposes of the Model QAP are as follows:
Provide documentation of survey vendors’ understanding, application and compliance
with the CAHPS Hospice Survey Quality Assurance Guidelines. The following
components must be addressed:
1. Organizational background and structure for project
2. Work plan for survey administration
3. Role of subcontractor(s), if applicable
4. Survey and data management system
Include a detailed description of the following:
o For Telephone Only and the Telephone component of Mixed Mode, how
interviewers redirect the call when the respondent is personally known by the
initial interviewer
5. Quality Controls for survey administration activities
6. Confidentiality, privacy and security procedures in accordance with HIPAA
7. Annual reporting of the results from quality control activities
8. CAHPS Hospice Survey materials
Serve as the organization-specific guide for administering the CAHPS Hospice Survey,
training project staff to conduct the survey and conducting quality control and oversight.
The QAP should be developed in enough step-by-step detail, including flow charts,
tracking forms and diagrams, such that the survey methodology is easily replicable
by a new staff member assigned to the organization’s survey operations.
Ensure high quality data collection and continuity in survey processes
The QAP should provide sufficient detail so that the project team can determine the survey
vendor’s adherence to survey administration guidelines and that rigorous quality checks or
controls have been put in place.
The CAHPS Hospice Survey Project Team will notify survey vendors of the due date to submit a
QAP to the CAHPS Hospice Survey Project Team. All QAPs must be dated and all changes
from prior versions must be clearly identified (i.e., use Microsoft Word track changes).
Along with the QAP, survey vendors may be required to submit other materials relevant to the
CAHPS Hospice Survey administration, when requested by CMS. The CAHPS Hospice Survey
Project Team’s acceptance of a submitted QAP and corresponding survey materials does not
constitute or imply approval or endorsement of the survey vendor’s CAHPS Hospice Survey
administration processes.
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Oversight Activities
The Model QAP can be found in Appendix H. It is required that survey vendors use the Model
QAP as a template for developing and updating their own QAP. The Model QAP can be
downloaded from the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org).
Analysis of Submitted Data
The CAHPS Hospice Survey Data Coordination Team reviews and analyzes all survey data
submitted to the CAHPS Hospice Survey Data Warehouse in order to ensure the integrity of the
data. If significant issues are identified, the survey vendor may be contacted. Survey vendors
must adhere to all submission requirements as specified in the CAHPS Hospice Survey Quality
Assurance Guidelines V1.0; posted on www.hospicecahpssurvey.org, as well as the deadline
dates as posted on the CAHPS Hospice Survey Web site. Please monitor the CAHPS Hospice
Survey Web site for additional data submission information and updates.
Site Visits/Conference Calls
The CAHPS Hospice Survey Project Team will conduct site visits and/or conference calls with
survey vendors to verify compliance with the CAHPS Hospice Survey protocols. The size and
composition of the review team will vary.
The CAHPS Hospice Survey Project Team conducts its site reviews in the presence of the survey
vendor’s staff, and a confidentiality agreement is signed by all parties at the start of the site visit.
The CAHPS Hospice Survey Project Team works with the visited organization to cover agenda
items presented in advance to the survey vendor. The CAHPS Hospice Survey Project Team may
also review any additional information or facilities determined to be necessary to complete the
site visit, including work performed by subcontractors, if applicable. Survey vendors must
make their subcontractors available to participate in the site visits and conference calls.
In addition to other activities, the CAHPS Hospice Survey Project Team will observe and review
data systems and processes, which may require access to confidential records and/or protected
health information. The site review includes a review of sampling procedures. The survey vendor
must retain CAHPS Hospice-related Survey data files, including decedents/caregivers lists and
de-identified electronic data files (e.g., CAHPS Hospice Survey sampling frame) for three years.
The CAHPS Hospice Survey Project Team will review specific data records and trace the
documentation of activities from the receipt of the decedent/caregiver list through the uploading
of the data to the CAHPS Hospice Survey Data Warehouse. The Project Director/Project
Manager at a minimum must be physically present during the site visit. The site review may also
include interviews with key staff members and interactions with project staff and subcontractors,
if applicable. Any information observed or obtained during the site visit review will remain
confidential, as per CMS guidelines. After the site visit, the CAHPS Hospice Survey Project
Team will provide the survey vendor with a summary of findings from the site visit, and may
pose follow-up questions and/or request additional information as needed.
Site visits may be announced and scheduled in advance, or they may be unannounced. Survey
vendors will be given a three-day window during which an unannounced site visit may be
conducted.
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During the site visit and/or conference call, the CAHPS Hospice Survey Project Team will
review the survey vendor’s survey systems and will assess protocols based upon the CAHPS
Hospice Survey Quality Assurance Guidelines. All materials relevant to survey administration
will be subject to review. The systems and program review includes, but is not necessarily
limited to:
Survey management
Staff training
Data systems
Sampling procedures
Printed materials
Printing, mailing and other related facilities
Telephone materials, interview areas and other related facilities
Telephone interviews
Data receipt and entry
Storage facilities
Confidentiality, privacy and security
Written documentation of survey processes
Specific and/or randomly selected records covering a time period to include the data in
the most recent report period, or earlier
After the site visit or conference call, survey vendors will be given a defined time period in
which to correct any problems and provide follow-up documentation of corrections for review.
Survey vendors will be subject to follow-up site visits and/or conference calls, as needed.
Non-compliance and Sanctions
Non-compliance with CAHPS Hospice Survey protocols including program requirements, timely
submission of the QAP as requested, and participation and cooperation in oversight activities,
may result in sanctions being applied to a survey vendor including:
increased oversight activities
loss of approved status to administer the CAHPS Hospice Survey
other sanctions as deemed appropriate by CMS
Note: Hospices that contract with a survey vendor should be aware that non-compliance by
either hospices or survey vendors could result in these, or other, sanctions.
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Exception Request Process
Overview
The exception request process and Exception Request Form have been established to handle
alternative methodologies that vary from standard CAHPS Hospice Survey protocols. The
proposed alternative methodology(ies) must not be implemented until the submitted Exception
Request Form has been approved.
Exception Request Process
The Exception Request process has been created to provide survey vendors with more flexibility
to meet individual organizations' need for certain variations from protocol, while still
maintaining the integrity of the data for standardized reporting. The Exception Request Form
must be completed with sufficient detail, including clearly defined timeframes, for the CAHPS
Hospice Survey Project Team to make an informed decision. The requested exception from
protocol must not be implemented prior to receiving approval from the CAHPS Hospice Survey
Project Team.
Exception Requests will be limited to a two-year approval timeframe. The two-year time
period will begin from the date of approval.
To request an exception, survey vendors are required to complete and submit an Exception
Request Form online via the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org).
The form is designed to capture information on the proposed alternative to the standard
protocol(s). Hospice CCNs (formerly known as Medicare Provider Numbers [MPNs]) must be
included on the form.
Survey vendors must complete and submit all Exception Request Forms on behalf of
their client hospice(s)
Survey vendors may submit one Exception Request Form on behalf of multiple hospices
with the same exception request. Survey vendors must include a list of contracted
hospices and each hospice CCN on whose behalf they are submitting the exception
request. Please be sure to include the information in the specified section of the
Exception Request Form.
A new Exception Request Form must be submitted for hospices not included in the
original request.
Exception Request Category
Survey vendors must request an exception for alternative strategies not identified in the CAHPS
Hospice Survey Quality Assurance Guidelines V1.0 manual
Note: No alternative modes of survey administration will be permitted other than those
prescribed for the survey (Mail Only, Telephone Only, and Mixed [mail with telephone followup] Modes).
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Review Process
The Exception Request will be reviewed by the CAHPS Hospice Survey Project Team. These
reviews will include an assessment of the methodological soundness of the proposed alternative
and the potential for introducing bias. Depending on the type of exception, a review of
procedures and/or a site visit or conference call may be required. The CAHPS Hospice Survey
Project Team will notify survey vendors whether or not their exception has been approved. If the
request is not approved, the CAHPS Hospice Survey Project Team will provide an explanation.
Survey vendors then have the option of appealing the decision.
Survey vendors have five business days from the date of the Exception Request denial
notification email to submit an appeal. To request an appeal, survey vendors must resubmit the
Exception Request Form (checking the box marked “Appeal of Exception Denial”) and provide
further information that addresses the explanation for the denial. The appeal is then submitted to
the CAHPS Hospice Survey Project Team for re-review. The second review will take
approximately 10 business days.
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Discrepancy Report Process
Overview
The discrepancy process and the Discrepancy Report Form have been established for use by
survey vendors to notify the CAHPS Hospice Survey Project Team of any discrepancies in
following standard CAHPS Hospice Survey protocols. Survey vendors are required to notify the
CAHPS Hospice Survey Project Team of any discrepancies in following the standard CAHPS
Hospice Survey protocols which have been encountered during survey administration. Survey
vendors must notify the CAHPS Hospice Survey Project Team as soon as the discrepancy is
identified.
Discrepancy Report Process
On occasion, a survey vendor may identify discrepancies from CAHPS Hospice Survey
protocols that require corrections to procedures and/or electronic processing to realign the
activity to comply with CAHPS Hospice Survey protocols. Survey vendors are required to notify
CMS of these discrepancies. In its oversight role, the CAHPS Hospice Survey Project Team may
also identify discrepancies that require correction. Examples of discrepancies include, but are not
limited to, missing survey-eligible decedents/caregivers from a particular month, or computer
programming that caused an otherwise survey-eligible decedent/caregiver to be excluded from
the sample frame.
Survey vendors must complete and submit all Discrepancy Reports on behalf of their
client hospices
Survey vendors are required to complete and submit a Discrepancy Report to formally
notify CMS immediately upon discovery of the discrepancy. The Discrepancy Report
Form must be submitted online via the CAHPS Hospice Survey Web site
(www.hospicecahpssurvey.org). This report notifies the CAHPS Hospice Survey Project
Team of the nature, timing, cause, and extent of the discrepancy, as well as the proposed
correction and timeline to correct the discrepancy. Hospice CCNs (formerly known as
Medicare Provider Numbers [MPNs]) must be included on the form.
Discrepancy Report Review Process
The Discrepancy Report will be thoroughly reviewed by the CAHPS Hospice Survey Project
Team, to assess the actual or potential impact of the discrepancy on reported CAHPS Hospice
Survey results. Notification of the outcome of the review may not be forthcoming until all the
data for the affected reporting periods have been submitted and reviewed, and the impact of the
discrepancy has been ascertained. Email notification will be distributed to the organization
submitting the Discrepancy Report once the outcome of the review has been determined.
Depending on the nature and extent of the discrepancy, a formal review of the survey vendor’s
procedures, and/or a site visit or conference call may be conducted. The CAHPS Hospice Survey
Project Team will notify survey vendors if additional information is required to document and
correct the issue.
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Data Quality Checks
Overview
Survey vendors must implement quality assurance processes to verify the integrity of the
collected and submitted CAHPS Hospice Survey data. This chapter describes suggested quality
check activities that survey vendors may implement, and should not be considered an exhaustive
list of possible quality check activities that can be used by survey vendors. It is important to note
that quality check activities must be performed by a different staff member than the individual
who originally performed the specific project task(s). The goals of conducting quality check
activities are to minimize the probability of errors occurring in the handling of the data
throughout the various steps of data processing; to verify that required fields are present and
protocols are met; and to identify and explain unusual or unexpected changes in the data files.
Therefore, quality checks must be operationalized for all of the key components or steps of
survey administration and data processing.
Traceable Data File Trail
Survey vendors should save both original and processed CAHPS Hospice Survey data files. This
allows for easier identification of issues. The information below provides suggestions regarding
CAHPS Hospice Survey related file retention:
Preserve a copy of every file received in original form and leave unchanged (including
files received from hospice clients)
Institute version controls for datasets, reports, and any software code and programs used
for collecting and processing CAHPS Hospice Survey data records
Do not delete old data files
Keep intermediate data files, not just original and final versions
Review of Data Files
Survey vendors should examine their own data files and all clients’ data files for any unusual or
unexpected changes, including missing data. Trending or comparing data elements for individual
hospices over different time periods is one technique that can be used to determine whether any
unusual or unexpected changes have occurred. Listed below are suggested activities:
Investigate data for notable changes in the counts of decedents/caregivers. Prior to
processing the decedents/caregivers list, run frequency/percentage tables for all
administrative variables received from the hospice, and compare to same-variable tables
from previous months. If notable differences are discovered, investigate to determine the
reason for the differences.
Look for missing administrative data elements, and follow-up with the hospice
immediately upon receipt of the decedents/caregivers list
Prior to preparing data files for submission to the CAHPS Hospice Survey Data
Warehouse, run frequency/percentage tables for all survey variables stored for a given
hospice and month. Compare to same-variable tables from previous months; if notable
differences are found, investigate and determine if the data are accurate.
Verify that the number of administrative records matches the value for sample size
for the given month
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Check that header record variables match back to raw data summary statistics for the
time period
Review a random selection of administrative records as a quality check against
original raw decedent/caregiver data. This same activity can be performed for actual
survey records.
Verify that required data elements for all decedents/caregivers in the CAHPS Hospice
Survey sample frame are submitted to the CAHPS Hospice Survey Data Warehouse
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Appendix A
CAHPS® Hospice Survey
Minimum Business Requirements
Appendix A
CAHPS® Hospice Survey
Minimum Business Requirements
A survey vendor must meet ALL of the Survey Vendor Minimum Business Requirements. In
addition, subcontractors performing major CAHPS Hospice Survey administration functions
(e.g., mail/telephone operations) must also meet all of the CAHPS Hospice Survey Minimum
Business Requirements that pertain to that role. The minimum business requirements for an
organization to become approved to administer the CAHPS Hospice Survey are as follows:
Relevant Survey Experience:
Criteria
Survey Vendor
Minimum four years
Number of Years in
Business
Minimum three years in conducting surveys in the selected
Number of Years
mode(s) of administration
Conducting Surveys in
the Requested Mode
Minimum two years conducting patient-specific surveys as an
Number of Years
organization
Conducting PatientSpecific Surveys
Two years prior experience selecting random sample based on
Sampling Experience
specific eligibility criteria:
• Work with contracted client(s) to obtain patient data for
sampling via HIPAA-compliant electronic data transfer
processes
• Adequately document sampling process
• Survey vendors are responsible for conducting the sampling
process and must not subcontract this activity
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Survey Capability and Capacity:
Criteria
Survey Vendor
Designated CAHPS Hospice Survey personnel:
Personnel
• Project Director with minimum two years prior experience
conducting patient-specific surveys in the requested mode
• Staff with minimum one year prior experience in sample
frame development and sample selection
• Programmer (subcontractor designee, if applicable) with
minimum one year prior experience receiving large encrypted
data files in different formats/software packages electronically
from an external organization; processing survey data needed
for survey administration and survey response data; preparing
data files for electronic submission; and submitting data files
to an external organization
• Call Center/Mail Center Supervisor (subcontractor designee, if
applicable) with minimum one year prior experience in role
Have appropriate organizational back-up staff for coverage of key
staff
Volunteers are not permitted to be involved in any aspect of the
CAHPS Hospice Survey administration process
Physical plant resources available to handle the volume of surveys
Physical Plant and
being administered, including computer and technical equipment:
System Resources
• A secure commercial work environment
• Home-based or virtual interviewers cannot be used to
administer the CAHPS Hospice Survey nor may conduct any
survey administration processes
• Physical facilities and electronic equipment and software to
collect, process, and report data securely
• If offering telephone surveys, must have the equipment,
software and facilities to conduct CATI interviews and to
monitor interviewers
Electronic or alternative survey management system to:
• Track fielded surveys throughout the protocol, avoiding
respondent burden and losing respondents
• Assign random, unique, de-identified identification number
(Tracking ID) to track each sampled patient/primary informal
caregiver (i.e., family member or friend of the hospice patient)
Organizations that are approved to administer the CAHPS
Hospice Survey must conduct all of their business operations
within the United States. This requirement applies to all staff and
subcontractors.
All System Resources are subject to oversight activities, including
site visits to physical locations
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Criteria
Sample Frame
Creation
Mail Administration
Telephone
Administration
Mixed Mode
Administration (Mail
with Telephone
Follow-up)
Survey Vendor
Two years prior experience selecting random sample based on
specific eligibility criteria:
• Generate the sample frame data file that contains all
individuals who meet the eligible population criteria
• Draw random sample of individuals for the survey, who meet
the eligible population criteria
Mail survey administration activities are not to be conducted from
a residence, nor from a virtual office
Obtain and update addresses of sampled patients/primary informal
caregivers
Produce and print professional quality survey instruments and
materials according to guidelines; a sample of all mailing
materials must be submitted for review
Merge and print sample name and address on personalized mail
survey cover letters and print unique Tracking ID on the survey
questionnaire
Mail out of survey materials
Receive and process (key-entry or scanning) completed
questionnaires
Track and identify non-respondents for follow-up mailing
Assign final survey status codes to describe the final result of
work on each sampled case
Telephone interviews are not to be conducted from a residence,
nor from a virtual office
Obtain, verify and update telephone numbers
Develop computer programs for electronically administering the
survey (CATI)
Collect telephone interview data for the survey, using CATI
system; a sample of the telephone script and interviewer screen
shots must be submitted for review
Identify non-respondents for follow-up telephone calls
Schedule and conduct callbacks to non-respondents at varying
times of the day and different days of the week
Assign final status codes to reflect results of attempts to obtain
completed interview with sampled cases
Mail survey administration and telephone interviews are not to be
conducted from a residence, nor from a virtual office
Adhere to all Mail Only and Telephone Only survey
administration requirements (described above).
Track cases from mail survey through telephone follow-up
activities
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Criteria
Data Submission
Technical Assistance/
Customer Support
Survey Vendor
Survey vendors are responsible for conducting data submission
and must not subcontract this process
Scan or key data from completed mail surveys
Import (as necessary) data from CATI system into a data file
Develop data files and edit and clean data according to standard
protocols
Follow all data cleaning and data submission rules, including
verifying that data files are de-identified and contain no duplicate
cases
Export data from the electronic data collection system to the
required format for data submission, confirm that the data were
exported correctly, that the data submission files are formatted
correctly and contain the correct data headers and data records
Submit data electronically in the specified format to the CAHPS
Hospice Survey Data Warehouse
Work with CMS’ contractor to resolve data problems and data
submission problems
Two years prior experience providing telephone customer support
Provide toll-free customer support line:
• Customer support must be offered in all languages that the
survey vendor administers the survey in
• Respond to calls within 24-48 hours
Participation in Quality Control Activities and Documentation Requirements:
Criteria
Survey Vendor
Demonstrated Quality Incorporate well-documented quality control procedures (as
applicable) for:
Control Procedures
• In-house training of staff and subcontractors involved in
survey operations
• Printing, mailing and recording receipt of survey
questionnaires, if applicable
• Telephone administration of survey, if applicable
• Coding and verifying of survey data and survey-related
materials
• Scanning or keying in survey data
• Preparation of final person-level data files for submission
• All other functions and processes that affect the
administration of the CAHPS Hospice Survey
Participate in any conference calls and site visits as part of overall
quality monitoring activities:
• Provide documentation as requested for site visits and
conference calls, including but not limited to: staff training
records, telephone interviewer monitoring records, and file
construction documentation
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Criteria
Documentation
Requirements
Survey Vendor
Keep electronic or hard copy files of staff training and training
dates
Maintain electronic documentation of telephone monitoring, if
applicable
Maintain documentation of mail production quality checks, if
applicable
Maintain documentation of all survey administration activities
and related quality checks for review during site visits
Adhere to all Protocols, Specifications and Agree to Participate in Training Sessions:
Criteria
Survey Vendor
Attend all CMS Introduction and Vendor Update training sessions
Survey Training
(subcontractors assigned key roles must attend training)
Administer the survey Review and follow all procedures described in the CAHPS
Hospice Survey Quality Assurance Guidelines that are applicable
according to all Survey
to the selected survey data collection mode
Specifications
Fully comply with the CAHPS Hospice Survey oversight
activities
Approved survey vendors are expected to maintain active
contract(s) for CAHPS Hospice Survey administration with client
hospice(s). An “active contract” is one in which the CAHPS
Hospice Survey vendor is authorized by hospice client(s) to
collect and submit CAHPS Hospice data to the CAHPS Hospice
Data Warehouse. If a CAHPS Hospice Survey vendor does not
have any contracted hospice clients within two years (a
consecutive 24 months) of the date they received approval to
administer the CAHPS Hospice Survey, then that survey vendor’s
“Approved” status for CAHPS Hospice Survey administration
will be withdrawn. If approval status is withdrawn, the
organization must once again follow the steps to apply for
reconsideration for approval to administer the CAHPS Hospice
Survey.
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Appendix B
CAHPS® Hospice Survey
Vendor Authorization Form
Appendix B
CAHPS® Hospice Survey
Survey Vendor Authorization Form
Hospice agencies must authorize an approved CAHPS®1 Hospice Survey vendor to submit data
on their behalf for the 2015 administration of the CAHPS Hospice Survey.
In order to authorize a survey vendor, a Hospice representative must complete the CAHPS
Hospice Survey Vendor Authorization Form and submit it to the RAND Corporation by
May 1, 2015. The individual who completes this form for the Hospice will be considered the
CAHPS Hospice Survey Administrator for that Hospice. Hospices should also designate, on the
form, an individual within the hospice organization to serve as the main point of contact with the
CAHPS Hospice Survey Project Team and to review data submissions by the vendor.
This form must be signed and dated in the presence of a notary public, notarized, and sent to the
RAND Corporation. Please note, when completing a Survey Vendor Authorization Form
pertaining to multiple hospice agencies, it would be appropriate to attach a list to the form
(signed and dated by the Survey Administrator) of all the hospices (names and CMS
Certification Numbers [CCN]). On the form itself, please note that “a document containing a list
of “XX” number of hospice agencies is attached to the form” in the spaces provided.
If sent via U.S. Mail, send to:
RAND Corporation
ATTN: Melissa A. Bradley
CAHPS Hospice Survey
1200 South Hayes Street
Arlington, VA 22202
If sent via Federal Express, UPS or other overnight delivery service, send to:
RAND Corporation
ATTN: Melissa A. Bradley
CAHPS Hospice Survey
1200 South Hayes Street
Arlington, VA 22202
Phone: 703-413-1100, extension 5614
Please note: After submission of the Survey Vendor Authorization Form, no further action is
required by the hospice to notify CMS of their survey vendor selection. RAND Corporation
communicates to CMS which hospice agencies have authorized a survey vendor to administer
the CAHPS Hospice Survey on their behalf.
1
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government agency.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
CAHPS® Hospice Survey
2015 Survey Vendor Authorization Form
I, ____________________________ (Print Hospice Administrator’s name), acknowledge and
accept the role and all of the responsibilities of the CAHPS Hospice Survey Administrator for
_____________________________________ (Print Name of Hospice and CMS CCN
Number). For multiple hospice agencies, notate “See listing of “XX [include count]” hospice
names and CCNs.”
In this role I will be responsible for:
1) Authorizing a survey vendor to collect data for ____________________________ (Print
Name of Hospice or “See Listing Attached”) as part of the 2015 CAHPS Hospice Survey and
to submit data to CMS on behalf of the hospice.
2) Notifying CMS and RAND immediately if the hospice de-authorizes a survey vendor.
3) Designating an individual within the hospice organization to serve as the main point of
contact with the CAHPS Hospice Survey Project Team and who will review data
submissions by the vendor.
4) Notifying the CAHPS Hospice Survey Project Team if my role as the CAHPS Hospice
Survey Administrator for the hospice will no longer be valid and identifying my successor.
By signing this form, I authorize ____________________________ (Print Survey Vendor
Name) to collect data for the hospice I represent as part of the 2015 CAHPS Hospice Survey and
to submit data to CMS on behalf of the hospice.
Hospice Administrator First and Last Name:
Hospice Administrator Signature:
Title:
Phone Number: (
)
Email:
Hospice Administrator Mailing Address:
City:
State:
Zip Code:
Hospice Point of Contact for the CAHPS Hospice Survey Project Team:
First and last name:
Phone number:
(
)
Email address:
Name of Survey Vendor authorizing:
Survey Vendor Name:
Survey Vendor Mailing Address:
City:
2
State:
Zip Code:
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Notary Public Signature:
Stamp:
Notary Public Date:
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
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Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Appendix C
CAHPS® Hospice Survey
Data Warehouse Access
Appendix C
CAHPS® Hospice Survey
2015 Vendor Access to
CAHPS Hospice Survey Data Warehouse
The CAHPS®1 Hospice Survey Data Warehouse is maintained by RAND. All vendors contracting
with hospices to implement the 2015 CAHPS Hospice Survey must have a user account on the
Data Warehouse. Complete this form and submit it as an email attachment to
[email protected] or by fax to CAHPS Hospice Survey Data Support Team
(703) 413-8111. Your form must be received by July 1, 2015.
Provide contact information for your organization’s Data Administrator, and Back-up Data
Administrator. Both are required to authorize a user account on the Data Warehouse.
Your Organization’s Name:
Data Administrator
First and last name:
Phone number:
(
)
Data administrator email address:
Back-up Data Administrator
First and last name:
Phone number:
(
)
Back-up administrator email address:
1
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government Agency.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
2
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Appendix D
CAHPS® Hospice Survey
Sample File Layout
Appendix D
CAHPS Hospice Survey
Sample File Layout
Below is an example of a sample file layout. Please note the following:
1. The Sample File Layout is for internal hospice/survey vendor use only. The file is used to
facilitate the standardized administration of the CAHPS Hospice Survey and includes the
data elements necessary for data submission, sampling and proper recording keeping. The
patient identifying information and other italicized Data Element fields will not be
submitted to the CAHPS Hospice Survey Data Warehouse.
2. CMS strongly recommends that hospices/survey vendors collect all data elements
whether or not they are required for data submission.
Sample File Layout
Data Element
Length
Value Labels and Use
Provider Name
Provider ID
100
10
NPI
Facility Name
10
100
Name of the Hospice
CMS Certification Number (formerly known
as Medicare Provider Number)
National Provider Identifier (optional)
Name of hospice, inpatient or nursing home
facility, if applicable (optional)
Total Number of
Live Discharges
Total Number of
Decedents/Caregivers
“No-Publicity”
decedents/caregivers
Decedent/Caregiver
Unique ID
10
10
10
16
Number of patients who were discharged alive
during the month
Number of decedents/caregivers during the
month
Number of “no-publicity”
decedents/caregivers during the month who
were excluded from the file
Hospice/Survey vendor generated, random,
unique, de-identified Decedent/Caregiver
ID used to de-duplicate the file, and to
track the decedent/caregiver’s survey
status through the survey administration
process
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Required
for Data
Submission
Yes
Yes
No
No
Yes
Yes
Yes
Yes
1
Sample File Layout
Caregiver First Name
30
Caregiver Middle
Initial
Caregiver Last Name
30
Caregiver Prefix
Caregiver Suffix Name
Decedent First Name
6
10
30
Decedent Middle
Initial
Decedent Last Name
Decedent Prefix Name
Decedent Suffix Name
Decedent Sex
Decedent Hispanic
Decedent Race
No
1
1
Name information used to personalize
materials to caregiver
No
30
6
10
1
1
1
Decedent Date of
Birth
8
Decedent Date of
Death
8
Decedent Hospice
Admission Date
8
2
Name information used to personalize
materials to caregiver
1 = Male
2 = Female
M = Unknown/Missing
1 = Hispanic/Latino/Spanish
2 = Not Hispanic/Latino/Spanish
M = Unknown/Missing
1 = White
2 = Black or African American
3 = Asian
4 = Native Hawaiian or Pacific Islander
5 = American Indian or Alaska Native
6 = More than one race
7 = Other
M = Unknown/Missing
MMDDYYYY
Used by hospice/survey vendor to calculate
patient age to confirm patient meets
eligibility criteria
MMDDYYYY
Used by hospice/survey vendor to calculate
patient age to confirm patient meets
eligibility criteria
MMDDYYYY
Decedent admission date for his/her final
episode of hospice care. Used by
hospice/survey vendor to confirm
caregiver/decedent meets eligibility criteria
Yes
Yes
Yes
Yes
Yes
Yes
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Sample File Layout
Decedent Last
Location/Setting of
Care
2
Decedent Payer
Primary
1
Decedent Payer
Secondary
1
Decedent Payer Other
1
Decedent Primary
Diagnosis
Caregiver Mailing
Address 1
10
50
1 = Home
2 = Assisted living
3 = Long-term care facility or non-skilled
nursing facility
4 = Skilled nursing facility
5 = Inpatient hospital
6 = Inpatient hospice facility
7 = Long-term care facility
8 = Inpatient psychiatric facility
9 = Location not otherwise specified
10 = Hospice facility
M = Unknown/Missing
1 = Medicare
2 = Medicaid
3 = Private
4 = Uninsured/no payer
5 = Program for All Inclusive Care for the
Elderly (PACE)
6 = Other
M = Unknown/Missing
1 = Medicare
2 = Medicaid
3 = Private
4 = Uninsured/no payer
5 = Program for All Inclusive Care for the
Elderly (PACE)
6 = Other
M = Unknown/Missing
1 = Medicare
2 = Medicaid
3 = Private
4 = Uninsured/no payer
5 = Program for All Inclusive Care for the
Elderly (PACE)
6 = Other
M = Unknown/Missing
ICD-9 codes (ICD-10 codes anticipated to be
implemented October 1, 2015)
Street address or post office box
Address information used in protocols that
have a mail mode of survey administration
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Yes
Yes
Yes
Yes
Yes
No
3
Sample File Layout
Caregiver Mailing
Address 2
Caregiver Mailing
City
Caregiver Mailing
State
50
Mailing address 2nd line (if needed)
No
50
Mailing city
No
2
2-character state abbreviation
No
Caregiver Mailing
Zip Code
9
Caregiver Telephone
Number 1
10
Caregiver Telephone
Number 2
10
Caregiver Telephone
Number 3
10
Caregiver Email
Address
30
Caregiver relationship
to the decedent
4
1
9-digit zip code; no hyphen, separators or
de-limiters
(i.e., 5 digit zip code followed by 4 digit
extension)
3-digit area code plus 7-digit telephone
number; no dashes, separators or de-limiters
Telephone information used in protocols that
involve a telephone component as part of the
mode of administration
3-digit area code plus 7-digit telephone
number; no dashes, separators or de-limiters
Telephone information used in protocols that
involve a telephone component as part of the
mode of administration
3-digit area code plus 7-digit telephone
number; no dashes, separators or de-limiters
Telephone information used in protocols that
involve a telephone component as part of the
mode of administration
Email address of caregiver
No
No
No
No
No
1 = Spouse / partner
2 = Parent
3 = Child
4 = Other family member
5 = Friend
6 = Legal guardian
7 = Other
M=Missing
YES
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Appendix E
CAHPS® Hospice Survey
XML File Specification
January 2015 and forward Decedent/Caregiver Data Collection
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
CAHPS Hospice Survey XML File Specification Version 1.0
This XML file specification (Version 1.0) applies to January 1, 2015 and forward decedent/caregiver data collection.
Each file submission will represent one month of survey data for each hospice.
The CAHPS Hospice Survey XML file is made up of 3 parts: 1) Header Record; 2) Decedent/Caregiver Administrative;
Record 3) Survey Results Record.
There should be only one header record for each CAHPS Hospice Survey xml file. Each decedent/caregiver sampled and included in the
CAHPS Hospice Survey XML file should have a decedent/caregiver administrative record, and if survey results are being submitted for the
decedent/caregiver there should be a survey results record.
Each field (except npi, facility name and several conditional items - see data element description for more details) of the header record
and decedent/caregiver administrative data requires an entry for a valid data submission.
Survey results records are not required for a valid data submission but if survey results are included, then all answers must have an entry.
Survey results records are required if the final is "1 - Completed survey" or "7 - Non-response: Break off".
August 2014
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Centers for Medicare and Medicaid Services
Page 1 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
This is the opening element of the file. The closing tag for this element will be at the end of the file.
Attributes describe the element and are included within the opening and closing <>
Opening Tag, defines the
monthly survey data
See example.
N/A
N/A
NA
N/A
Yes
The following section defines the format of the header record.
This is the opening element of the header record. The closing tag for this element will be at the end of the header record. Note: This tag
is required in the XML document, however, it contains no data. This header element should only occur once per file.
Opening Tag, defines the
header record of monthly
survey data
None
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: Sample Hospice
Sub-element of header
None
Sub-element of header
Sub-element of header
Name of the hospice represented by the
survey.
N/A
NA
Alphanumeric
Character
N/A
100
Yes
Yes
ID number of the hospice represented by the
survey.
Valid 6 digit CMS Certification
Number (formerly known as
Medicare Provider Number).
Alphanumeric
Character
10
Yes
Each element must have a closing tag that is the same as the opening tag, but with a forward slash. This header element should only
occur once per file. This is an optional data element at this time but may be required in the future.
Example: 1234567890
None
August 2014
N/A
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element will occur again
as an administration data element in the patient level data record.
Example: 123456
None
N/A
National Provider Identifier
Valid 10 digit National Provider
Identifier.
CMS
Centers for Medicare and Medicaid Services
Numeric
10
No
Page 2 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of header
Attributes
Sub-element of header
Sub-element of header
Sub-element of header
Data
Element
Required
Mode of survey administration.
1 - Mail only
Survey Mode must be the same for all three
2 - Telephone only
months within a quarter. Once you have
3 - Mixed mode
uploaded your first month of data, you have
the ability to re-upload that month and change
the survey mode if you'd like. However, once
you have uploaded data for two months within
a given quarter, you are locked into that
survey mode and cannot change it for that
quarter.
Alphanumeric
Character
1
Yes
The total number of decedent/caregiver cases N/A
received from the hospice in the month
Numeric
10
Yes
Number of patients who were discharged alive N/A
during the month.
Numeric
10
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: 150
None
August 2014
Max
Field
Size
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: 150
None
Data Type
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: 150
None
Valid Values
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header data element should
only occur once per file. Note: The Survey Mode must be the same for all three months within a quarter.
Example: 1
None
Description
Number of “no-publicity” decedents/caregivers N/A
during the month who were excluded from the
file
CMS
Centers for Medicare and Medicaid Services
Numeric
10
Yes
Page 3 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of header
Attributes
Sub-element of header
Sub-element of header
Closing tag for header
August 2014
Data Type
Max
Field
Size
Data
Element
Required
The number of decedents/caregivers
determined to be ineligible for all other
reasons in the month.
N/A
Numeric
10
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: 600
None
Valid Values
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file.
Example: 650
None
Description
Number of eligible decedents/caregivers
drawn into the sample for survey
administration.
N/A
Numeric
10
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This header element should only
occur once per file. Sampled decedents/caregivers must be age 18 or above at the time of death.
Example: 2
None
Sample type must be the same for all three
1 - Simple random sample
months within a quarter. Once you have
2 - Census Sample
uploaded your first month of data, you have
the ability to re-upload that month and change
the sample type if you'd like. However, once
you have uploaded data for two months within
a given quarter, you are locked into that
sample type and cannot change it for that
quarter.
None
Note: This closing element for the header is required in the XML document, however, it contains no data. This header
element should only occur once per file.
CMS
Centers for Medicare and Medicaid Services
Numeric
1
Yes
Page 4 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
The following section defines the format of the decedent/caregiver level data record.
Opening Tag, defines the
patient level data record of
monthly survey data
This is the opening element of the decedent/caregiver level data record. The closing tag for this element will be at the end of the
decedent/caregiver level data record. Note: The section includes the opening and closing
tags and all the tags between these two tags. The section is required in the XML file, if at least one
decedent/caregiver is being submitted. If the is 0, and no decedent/caregiver data is being submitted, the
section should not be included in the XML file. This decedent/caregiver level data element should only occur once
per decedent/caregiver.
None
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
August 2014
N/A
N/A
NA
N/A
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata element also
occurs in the previous header record.
Example: 123456
None
ID number of the hospice represented by the
survey.
Valid 6 digit CMS Certification
Number (formerly known as
Medicare Provider Number).
Alphanumeric
Character
10
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata element
will occur again as a data element in the caregiver response record.
Example: 12345
None
Unique de-identified decedent/caregiver id
assigned by the survey vendor to uniquely
identify the survey.
N/A
Alphanumeric
Character
16
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per decedent/caregiver.
Example: 1940
None
Year decedent was born provided by the
hospice
YYYY
YYYY (cannot be 9999)
Numeric
4
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Month decedent was born provided by the
hospice
MM
MM = (1 - 12)
(cannot be 00, 13 - 99)
CMS
Centers for Medicare and Medicaid Services
Numeric
2
Yes
Page 5 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
August 2014
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Day decedent was born provided by the
hospice
DD
DD = (1 - 31)
(cannot be 00, 32 - 99)
Numeric
2
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 2015
None
Year decedent died provided by the hospice
YYYY
YYYY = (2015 or greater)
(cannot be 9999)
Numeric
4
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Month decedent died provided by the hospice MM
MM = (1 - 12)
(cannot be 00, 13 - 99)
Numeric
2
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Day decedent died provided by the hospice
DD
DD = (1 - 31)
(cannot be 00, 32 - 99)
Numeric
2
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 2015
None
Year decedent was admitted for final episode YYYY
of hospice care provided by the hospice
YYYY = (2014 or later)
(cannot be 9999)
CMS
Centers for Medicare and Medicaid Services
Numeric
4
Yes
Page 6 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Month decedent was admitted for final
episode of hospice care provided by the
hospice
MM
MM = (1 - 12)
(cannot be 00, 13 - 99)
Numeric
2
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Day decedent was admitted for final episode
of hospice care provided by the hospice
DD
DD = (1 - 31)
(cannot be 00, 32 - 99)
Numeric
2
Yes
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Decedent sex provided by the hospice
1 - Male
Alphanumeric
Character
1
Yes
2 - Female
M - Missing
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Indication whether on not decendent is
hispanic provided by the hospice
1 - Hispanic
2 - Non-hispanic
Alphanumeric
Character
1
Yes
M - Missing
August 2014
CMS
Centers for Medicare and Medicaid Services
Page 7 of 36
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
decedentleveldata
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Decedent's race provided by the hospice
1 - White
2 - Black or African American
Alphanumeric
Character
1
Yes
3 - Asian
4 - Native Hawaiian or Pacific
Islander
5 - American Indian or Alaska
Native
6 - More than one race
7 - Other
M -Missing
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Caregiver relationship to decedent provided
by the hospice
1 - Spouse/partner
2 - Parent
Alphanumeric
Character
1
Yes
3 - Child
4 - Other family member
5 - Friend
6 - Legal guardian
7 - Other
M - Missing
August 2014
CMS
Centers for Medicare and Medicaid Services
Page 8 of 36
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per decedent/caregiver.
Example: 1
Sub-element of
decedentleveldata
None
Decedent's primary payer for healthcare
1 - Medicare
Alphanumeric
1
Yes
services provided by the hospice
2 - Medicaid
Character
3 - Private
4 - Uninsured/no payer
5 - Program for All Inclusive Care
for the Elderly (PACE)
6 - Other
M - Missing
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Decedent's secondary payer for healthcare
1 - Medicare
Alphanumeric
1
Yes
services provided by the hospice
Character
2 - Medicaid
3 - Private
4 - Uninsured/no payer
5 - Program for All Inclusive Care
for the Elderly (PACE)
6 - Other
M - Missing
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Decedent's other payer for healthcare
1 - Medicare
Alphanumeric
1
Yes
services provided by the hospice
Character
2 - Medicaid
3 - Private
4 - Uninsured/no payer
5 - Program for All Inclusive Care
for the Elderly (PACE)
6 - Other
August 2014
CMS
Centers for Medicare and Medicaid Services
Page 9 of 36
services provided by the hospice
Character
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
M - Missing
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 1
None
Decedent's last location/setting of hospice
care provided by the hospice
1 - Home
2 - Assisted living
Alphanumeric
Character
2
Yes
3 - Long-term care facility or nonskilled nursing facility
4 - Skilled nursing facilityl
5 - Inpatient hospital
6 - Inpatient hospice facility
7 - Long-term care facility
8 - Inpatient psychiatric facility
9 - Location not otherwise
specified
10 - Hospice facility
M - Missing
Sub-element of
decedentleveldata
Sub-element of
decedentleveldata
August 2014
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This is an optional data element at
this time but may be required in the future.
Example: Facility
None
Name of hospice, inpatient or nursing home
facility, if applicable (optional)
N/A
Alphanumeric
Character
100
No
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data
element should only occur once per decedent/caregiver.
Example: 310.11
None
The decedent's primary diagnois provided by
the hospice
ICD-9 codes (ICD-10 codes
anticipated to be implemented
October 1, 2015)
CMS
Centers for Medicare and Medicaid Services
Numeric
10
Yes
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
decedentleveldata
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per caregiver/decedent.
Example: 10
None
Disposition of survey.
1 - Completed survey
Alphanumeric
Character
2
Yes
2 - Ineligible: Deceased
3 - Ineligible: Not in eligible
population
4 - Ineligible: Language barrier
5 - Ineligible: Mental/physical
incapacity
6 - Ineligible: Not involved in
decedent care
7 - Non-response: Break off
8 - Non-response: Refusal
9 - Non-response: Non-response
after maximum attempts
10 - Non-response: Bad address
11 - Non-response: Bad/no phone
number
33- No response collected (used
only for interim data file
submission)
M - Missing
August 2014
CMS
Centers for Medicare and Medicaid Services
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CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash.This tag is required if the Survey
Mode is Mixed and the Survey Status is 1 - Completed Survey or 7 - Non-response: Break off. The values entered must match a value
corresponding to the Survey Mode defined in the header section of the XML file. If the XML Element is other than Mixed,
Sub-element of
this tag should not be included in the XML file.
decedentleveldata
Example: 1
None
Survey Mode used to complete a survey
administered via the Mixed mode.
1 - Mixed mode-mail
2 - Mixed mode-phone
88 - Not applicable
Numeric
2
No. Required
only if
Survey Mode
is Mixed and
Survey
Status is 1Completed
Survey or 7Nonresponse:
Break off.
Mode> is other than Telephone only or Mixed Mode (phone), this tag does not need to be included in the XML file.
Example: 1
Sub-element of
decedentleveldata
No,
None
Number of telephone contact attempts per
1 - First Telephone attempt
Numeric
2
conditionally
survey with a survey mode of Telephone Only
required only
or Mixed.
2 - Second Telephone attempt
3 - Third Telephone attempt
4 - Fourth Telephone attempt
if the Survey
Mode is
Telephone
Only Mode
or Mixed
Mode with
survey
completion
mode = 2Mixed modephone.
5 - Fifth Telephone attempt
88 - Not applicable
August 2014
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Centers for Medicare and Medicaid Services
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CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
is other than Mail only, this tag does not need to be included in the XML file.
mail>
Example: 1
Sub-element of
decedentleveldata
No,
None
Mail wave per survey for which final survey
1 - First wave mailing
Numeric
2
conditionally
status code is determined. Mail Only mode.
required only
if the Survey
Mode is Mail
Only
2 - Second wave mailing
88 - Not applicable
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per decedent/caregiver.
Example: 1
None
Identify survey language in which the survey 1 - English
was administered (English, Spanish, Chinese)
Numeric
2
Yes
2 - Spanish
3 - Chinese
88 - Not applicable
Sub-element of
decedentleveldata
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per decedent/caregiver. Note: The Lag Time should not be coded as "Missing."
Example: 84
None
Number of days between decedent date of
death and the date that data collection
activities ended for the decedent/caregiver.
0-365
Numeric
3
Yes
888 - Not applicable
(use only for interim data file
submission)
August 2014
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Centers for Medicare and Medicaid Services
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CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
decedentleveldata
Attributes
Description
Valid Values
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This decedentleveldata data element
should only occur once per decedent/caregiver.
Example: 4
None
A count of supplemental questions added to
the questionnaire.
0-15
M - Missing
Alphanumeric
Character
2
No.
Required
only if
Survey
Status is 1Completed
Survey or 7Nonresponse:
Break off.
A survey results (caregiver response) record is defined as the and is defined as follows:
(Note: Survey results (caregiver response) records are not required for a valid data submission, however if survey results are included then all answers
must have an entry. Survey results (caregiver response) record is required, if the final is "1 - Completed survey" or "7 - Non-response:
Break off".)
This is the opening element of the caregiver response record. The closing tag for this element will be at the end of the caregiver
response record.
Note: There will be one section for each caregiver if survey results are being submitted for the caregiver The
Opening Tag, defines the
patient response data record section includes the opening and closing tags and all the tags between these two tags. This
within the caregiver level
section is required in the XML file only if survey results are being submitted for the caregiver If survey results are
data record of monthly
not being submitted for the caregiver the section should not be submitted. This caregiver response element should
survey data
only occur once per patient.
None
August 2014
N/A
N/A
CMS
Centers for Medicare and Medicaid Services
NA
N/A
Yes
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This element also occurs in the
previous decedent level data record.
Example: 12345
None
Unique de-identified decedent/caregiver id
N/A
Alphanumeric
16
Yes
assigned by thesurvey vendor to uniquely
Character
identify the survey.
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver
Example: 4
None
Question 1: Related.
1 - My spouse or partner
Alphanumeric
Character
1
Yes
2 - My parent
3 - My mother-in-law or father-inlaw
4 - My grandparent
5 - My aunt or uncle
6 - My sister or brother
7 - My child
8 - My friend
9 - Other
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Home' is selected, enter value '1' for this data element
If the check box for 'Home' is not selected (and at least one other check box for race is selected), enter value '0' for this data element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: at home.
1 - Home
Alphanumeric
Character
1
Yes
0 - Not home
M - Missing/Don't know
August 2014
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Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Assisted living facility' is selected, enter value '1' for this data element
If the check box for 'Assisted living facility' is not selected (and at least one other check box for race is selected), enter value '0' for this
data element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: assisted living facility.
1 - Assisted living facility
Alphanumeric
Character
1
Yes
0 - Not assisted living facility
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Nursing Home' is selected, enter value '1' for this data element
If the check box for 'Nursing Home' is not selected (and at least one other check box for race is selected), enter value '0' for this data
element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: nursing home.
1 - Nursing Home
Alphanumeric
Character
1
Yes
0 - Not nursing home
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Hospital' is selected, enter value '1' for this data element
If the check box for 'Hospital' is not selected (and at least one other check box for race is selected), enter value '0' for this data element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: hospital
1 - Hospital
Alphanumeric
Character
1
Yes
0 - Not hospital
August 2014
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Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
M - Missing/Don't know
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Hospice facility/hospice house' is selected, enter value '1' for this data
element
Sub-element of
If the check box for 'Hospice facility/hospice house' is not selected (and at least one other check box for race is selected), enter value '0'
caregiverresponse
for this data element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: hospice facility/hospice
house
1 - Hospice facility/hospice house
Alphanumeric
Character
1
Yes
0 - Not hospice facility/hospice
house
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver. If the check box for 'Other' is selected, enter value '1' for this data element
If the check box for 'Other' is not selected (and at least one other check box for race is selected), enter value '0' for this data element
If none of the check boxes for this question are selected on the survey, enter the value 'M' for this data element and for all other data
elements
Example: 0
None
Question 2: Location: other
1 - Other
Alphanumeric
Character
1
Yes
0 - Not other
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver
Example: 4
None
Question 3: Oversee.
1 - Never
Alphanumeric
Character
1
Yes
2 - Sometimes
3 - Usually
4 - Always
August 2014
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Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 4: Need help.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 5: Get help.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver
Example: 4
None
Question 6: Hospice inform.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 7: Help As Soon as Need.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 8: Hospice explain.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 9: Hospice inform.
1 - Never
Alphanumeric
2
Yes
Character
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 10: Hospice confuse.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 11: Hospice dignity.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 12: Hospice cared.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
Page 20 of 36
January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 13: Hospice talk.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 14: Hospice talk and listen.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 15: Pain.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 16: Pain help.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 17: Pain medicine.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 18: Pain medication info
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 19: Pain medicine watch.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 20: Pain medicine train.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
4 - I did not need to give pain
medicine to my family member
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 21: Breath.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 22: Breath help.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 23: Breath train.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
4 - I did not need to help my family
member with trouble breathing.
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 24: Constipation.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
August 2014
M - Missing/Don't know
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Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 25: Constipation Help.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 26: Sad.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 27: Sad Get Help.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 28: Restless.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 29: Restless train.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 30: Move train.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
4 - I did not need to move my
family member
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 31: Expect info.
1 - Yes, definitely
Alphanumeric
Character
2
Yes
2 - Yes, somewhat
3 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 32: Received nursing home.
1 - Yes
Alphanumeric
Character
2
Yes
2 - No
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 33: Cooperate hospice and nursing
home.
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
August 2014
CMS
Centers for Medicare and Medicaid Services
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January 2015 and forward Decedent/Caregiver Data Collection
XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 34: Difference between hospice and 1 - Never
nursing home.
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 35: Hospice listenining carefully to
caregiver
1 - Never
Alphanumeric
Character
2
Yes
2 - Sometimes
3 - Usually
4 - Always
88 - Not applicable
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 36: Caregiver beliefs respected.
1 - Too little
Alphanumeric
Character
2
Yes
2 - Right amount
3 - Too much
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 37: Caregiver emotion.
1 - Too little
Alphanumeric
Character
2
Yes
2 - Right amount
3 - Too much
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 38: Caregiver emotion after.
1 - Too little
Alphanumeric
Character
2
Yes
2 - Right amount
3 - Too much
88 - Not applicable
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 39: Rate hospice.
0 - Worst hospice care possible
Alphanumeric
Character
2
Yes
1
2
3
4
5
6
7
8
9
10 - Best hospice care possible
88 - Not applicable
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 40: Hospice recommended.
1 - Definitely no
Alphanumeric
Character
2
Yes
2 - Probably no
3 - Probably yes
4 - Definitely yes
88 - Not applicable
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 41: Patient educaton.
1 - 8th grade or less
Alphanumeric
Character
1
Yes
2 - Some high school, but did not
graduate
3 - High school graduate or GED
4 - Some college or 2-year degree
5 - 4-year college graduate
6 - More than 4-year college
degree
7- Don't know
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 42: Patient Latino.
1 - No, not
Spanish/Hispanic/Latino
Alphanumeric
Character
1
Yes
2 - Yes, Puerto Rican
3 - Yes, Mexican, Mexican
American, Chicano/a
4 - Yes, Cuban
5 - Yes, other
Spanish/Hispanic/Latino
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
If the check box for the race 'White' is selected, enter value '1' for this data element
If the check box for the race 'White' is not selected (and at least one other check box for race is selected), enter value '0' for this data
element
If none of the check boxes for the race question are selected on the survey, enter the value 'M' for this data element and for all other race
data elements
None
Question 43: Race, White.
1 - White
Alphanumeric
Character
1
Yes
0 - Not White
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 0
If the check box for the race 'Black or African-American' is selected, enter value '1' for this data element
If the check box for the race 'Black or African-American' is not selected (and at least one other check box for race is selected), enter
value '0' for this data element
If none of the check boxes for the race question are selected on the survey, enter the value 'M' for this data element and for all other race
data elements
None
Question 43: Race, African-American.
1 - Black or African-American
Alphanumeric
Character
1
Yes
0 - Not Black or African-American
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 0
If the check box for the race 'Asian' is selected, enter value '1' for this data element
If the check box for the race 'Asian' is not selected (and at least one other check box for race is selected), enter value '0' for this data
element
If none of the check boxes for the race question are selected on the survey, enter the value 'M' for this data element and for all other race
data elements
None
Question 43: Race, Asian.
1 - Asian
Alphanumeric
Character
1
Yes
0 - Not Asian
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 0
If the check box for the race 'Native Hawaiian or Pacific Islander' is selected, enter value '1' for this data element
If the check box for the race 'Native Hawaiian or Pacific Islander' is not selected (and at least one other check box for race is selected),
enter value '0' for this data element
If none of the check boxes for the race question are selected on the survey, enter the value 'M' for this data element and for all other race
data elements
None
Question 43: Race, Pacific Islander.
1 - Native Hawaiian or Pacific
Islander
Alphanumeric
Character
1
Yes
0 - Not Native Hawaiian or Pacific
Islander
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 0
If the check box for the race 'American Indian or Alaska native' is selected, enter value '1' for this data element
If the check box for the race 'American Indian or Alaska native' is not selected (and at least one other check box for race is selected),
enter value '0' for this data element
If none of the check boxes for the race question are selected on the survey, enter the value 'M' for this data element and for all other race
data elements
None
Question 43: Race, American Indian/Alaska
Native.
1 - American Indian or Alaska
native
Alphanumeric
Character
1
Yes
0 - Not American Indian or Alaska
native
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 44: Caregiver, age.
1 - 18 to 24
Alphanumeric
Character
1
Yes
2 - 25 to 34
3 - 35 to 44
4 - 45 to 54
5 - 55 to 64
6 - 65 to 74
7 - 75 to 84
8 - 85 or older
M - Missing/Don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 1
None
Question 45: Caregiver, Sex.
1 - Male
Alphanumeric
Character
1
Yes
2 - Female
M - Missing/Don't know
Sub-element of
caregiverresponse
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 46: Caregiver Education.
1 - 8th grade or less
Alphanumeric
Character
1
Yes
2 - Some high school, but did not
graduate
3 - High school graduate or GED
4 - Some college or 2-year degree
5 - 4-year college graduate
6 - More than 4-year college
degree
M - Missing/don't know
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XML Element
Sub-element of
caregiverresponse
Attributes
Description
Valid Values
CAHPS HOSPICE SURVEY XML FILE LAYOUT Version 1.0
Data Type
Max
Field
Size
Data
Element
Required
Each element must have a closing tag that is the same as the opening tag but with a forward slash. This caregiver response data
element should only occur once per caregiver.
Example: 4
None
Question 47: Language spoken at home.
1 - English
Alphanumeric
Character
1
Yes
2 - Spanish
3 - Chinese
4 - Some other language
M - Missing/don't know
Closing tag for
caregiverresponse
None
Note: This tag is required in the XML file, however, it contains no data. This caregiver response element should only
occur once per caregiver
Closing tag for
decedentleveldata
None
Note: This tag is required in the XML file, however, it contains no data. This administration element should only occur
once per caregiver.
Closing tag, defines the
monthly survey data
None
Note: This tag is required in the XML file, however, it contains no data. This monthly data element should only occur
once per caregiver
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CAHPS Hospice Survey Sample XML File Layout Version 1
-
Sample Hospice
123456
1234567890
1
150
150
150
650
600
2
-
123456
12345
1940
1
1
2015
1
1
2015
1
1
1
1
1
1
1
1
1
1
Facility
310.11
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1
1
1
1
125
4
-
12345
4
0
0
0
0
0
0
4
1
4
4
4
4
4
4
4
4
1
4
1
1
1
1
1
4
1
4
4
1
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1
4
1
1
4
1
1
4
4
4
1
1
1
4
4
4
1
1
0
0
0
0
1
1
4
4
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Appendix F
CAHPS® Hospice Survey
Interviewing Guidelines for Telephone Surveys
Appendix F
CAHPS® Hospice Survey
Interviewing Guidelines for Telephone
Overview
These guidelines address expectations for interviewers conducting the CAHPS®1 Hospice Survey
by telephone. To collect the highest quality data possible, telephone interviewers must follow
these guidelines while conducting telephone interviews.
As an interviewer, your role in the success of this survey is important. You will interact with
many respondents and you are the person who assures the respondents that their participation is
important.
Due to the nature of this survey you may experience a little more resistance on behalf of the
respondent; therefore, it will be necessary for you to familiarize yourself with the organizations
Distressed Respondent Procedures.
General Interviewing Techniques
As an Interviewer you must:
• study and thoroughly familiarize yourself with the Frequently Asked Questions (FAQ)
list before you begin conducting telephone interviews so that you are knowledgeable
about the CAHPS Hospice Survey
• read all questions and response choices in the indicated order and exactly as worded, so
that all respondents are answering the same question. Questions that are re-worded can
bias the respondent’s response and the overall survey results.
• not attempt to increase the likelihood of the respondent providing one answer over
another answer
• read all transitional statements
• never skip over a question because you think the respondent has answered it already
• speak in an upbeat and courteous tone
• maintain a professional and neutral relationship with the respondent at all times
• not provide personal information or opinions about the survey
• listen carefully to any respondent questions and offer concise responses. You may not
provide extra information or lengthy explanations.
• tell the respondent that there are no more questions and thank the respondent for his or
her time at the end of the survey
• not administer the CAHPS Hospice Survey to any respondent whom you know
personally
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CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government agency.
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Introduction and Refusal Avoidance
For optimal response rates, it is important that telephone interviewers attempt to avoid telephone
refusals from the respondent. The introduction and initial moments of the interview are critical to
gaining cooperation from the respondent.
Interviewers/Operators must:
• read the telephone script introductions verbatim, unless the respondent/respondent
interrupts to ask a question or voices a concern
• speak clearly and politely to establish a rapport with the respondent
• avoid long pauses
• not rush through the introduction
• be prepared to answer questions about the survey by familiarizing themselves with the
survey and the FAQ document
• attempt to gain cooperation, but if the respondent refuses, the interviewer should politely
end the call. The interviewer should not argue with or antagonize the respondent.
Answering Questions and Probing
Telephone interviewers need to probe when a respondent fails to give a complete or an adequate
answer. Interviewers must never interpret respondent answers. Interviewers must not ask the
respondent probing questions about their health such as “How are you feeling today?” or “Are
you having any pain?” before asking the CAHPS Hospice Survey questions.
• Interviewer probes must be neutral and must not increase the likelihood of the respondent
providing one answer over another answer. Probes should stimulate the respondent to
give answers that meet the question objectives.
• Types of probes:
o Repeat the question or the answer categories
o Interviewer says:
“Take a minute to think about it.” REPEAT QUESTION, IF APPROPRIATE
“So, would you say that it is…” REPEAT ANSWER CATEGORIES
“Which would be closer?” REPEAT ANSWER CATEGORIES THAT ARE
CLOSEST TO THE CAREGIVER’S RESPONSE
• Interviewers must not interpret survey questions for the respondent
Conventions on Telephone Survey Instruments
• All text that appears in lowercase letters must be read out loud
• Text in UPPERCASE letters must not be read out loud
• Text that is underlined must be emphasized
• Characters in < > must not be read
• [Square brackets] are used to show programming instructions that must not actually
appear on electronic telephone interviewing system screens
• MISSING/DON’T KNOW (DK) is a valid response option for each item in the electronic
telephone interviewing system scripts. This allows the telephone interviewer to go to the
next question if a respondent is unable to provide a response for a given question (or
refuses to provide a response). In the survey file layouts, a value of MISSING/DK is
coded as “M – Missing/Don't know.”
• Skip patterns should be programmed into the electronic telephone system
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•
o Appropriately skipped questions should be coded as “88 – Not applicable.” For
example, if a respondent answers “No” to Question 4 of the CAHPS Hospice Survey,
the program should skip Question 5, and go to Question 6. Question 5 must then be
coded as “88 – Not applicable.” Coding may be done automatically by the telephone
system or later during data preparation.
o When a response to a screener question is not obtained, the screener question and any
questions in the skip pattern should be coded as “M – Missing/Don't know.” For
example, if the respondent does not provide an answer to Question 17 of the CAHPS
Hospice Survey and the interviewer selects “M – Missing/Don’t know” to Question
17, then the telephone system should be programmed to skip Questions 18, 19, & 20
and go to Question 21. Questions 18, 19 & 20 must then be coded as “M –
Missing/Don't know.” Coding may be done automatically by the telephone
interviewing system or later during data preparation.
There must be only one language (i.e., English or Spanish) that appears on the electronic
telephone interviewing system screen
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Appendix G
CAHPS® Hospice Survey
Frequently Asked Questions
For Customer Support
Appendix G
CAHPS® Hospice Survey
Frequently Asked Questions for Customer Support
Overview
This document provides survey customer support personnel guidance on responding to
frequently asked questions (FAQs) from caregivers answering the CAHPS® 1 Hospice
Survey. It provides answers to general questions about the survey, concerns about
participating in the survey, and questions about completing/returning the survey. Survey
vendors may amend the document to be specific to their operations, or revise individual
responses for clarity.
Note: Survey vendors conducting the CAHPS Hospice Survey must NOT attempt to influence or
encourage caregivers to answer items in a particular way. For example, the survey vendor
conducting the CAHPS Hospice Survey must NOT say, imply or persuade caregivers to respond
to items in a particular way. In addition, survey vendors must NOT indicate or imply in any
manner that the hospice, its personnel or its agents will appreciate or gain benefits if caregivers
respond to the items in a particular way. Please refer to the “Program Requirements” section of
the CAHPS Hospice Survey Quality Assurance Guidelines V1.0 for more information on
communicating with caregivers.
I. General Questions About the Survey
Who is conducting this survey? Who is sponsoring this survey?
[SURVEY VENDOR:] I’m an interviewer from the research organization [SURVEY
VENDOR NAME]. [HOSPICE NAME] has asked our organization to help conduct this
survey to enable them to get feedback from caregivers whose family member or friend
recently died while in hospice care.
What is the purpose of the survey? How will the data be used?
The survey is part of a national initiative by the United States Department of Health and
Human Services to measure the quality of care in hospices.
The survey is designed to measure caregiver’s perspectives on hospice care for public
reporting. The data collected from the survey will be provided to consumers to help them
make informed choices when selecting a hospice. It will also be used to help improve the
quality of care provided by hospices. Your participation is important.
1
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government
agency.
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How can I verify this survey is legitimate?
You can contact [HOSPICE NAME] at [TELEPHONE NUMBER] for information about
the survey.
NOTE: SURVEY VENDORS OBTAIN CONTACT INFORMATION FROM THE
HOSPICE ABOUT WHO TO CONTACT TO VERIFY THE LEGITIMACY OF THE
SURVEY.
Is there a government agency that I can contact to find out more about this
survey?
Yes, you can contact the Centers for Medicare & Medicaid Services, a federal agency
within the Department of Health and Human Services through the CAHPS Hospice
Survey Technical Assistance telephone number at 1-844-472-4621 or by email at
[email protected].
Are my answers confidential? Who will see my answers?
Your answers will be seen by the research staff, and may be shared with the hospice for
purposes of quality improvement.
How long will this take?
The survey takes about 10 minutes [OR SURVEY VENDOR SPECIFY].
NOTE: THE NUMBER OF MINUTES WILL DEPEND ON WHETHER SURVEY IS
INTEGRATED WITH HOSPICE-SPECIFIC SUPPLEMENTAL QUESTIONS.
What questions will be asked?
The survey asks questions about the experiences your family member or friend had
receiving care and services from the hospice. There will be questions asking you about
any problems they may have had receiving care or services. It asks you to rate different
types of care and services your family member or friend may have received.
How did you get my name? How was I chosen for the survey?
Your name was randomly selected from all recent patient deaths from [HOSPICE
NAME].
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II. Concerns About Participating in the Survey
I don’t do surveys.
I understand, however I hope you will consider participating. This is a very important
study for [HOSPICE NAME]. The results of the survey will help them understand what
they are doing well and what needs improvement.
I’m not interested.
[HOSPICE NAME] could really use your help. Could you tell me why you’re not
interested in participating?
I'm extremely busy. I don't really have the time.
I know your time is limited; however, it is a very important survey, and I really
appreciate your help today. The interview will take about 10 minutes [OR SURVEY
VENDOR SPECIFY]. Perhaps we could get started, and see what the questions are like.
We can stop any time you like.
[IF NECESSARY:] The interview can be broken into parts, if necessary; you don’t have
to do the whole thing in one sitting.
[IF NECESSARY:] I can schedule it for any time that is convenient for you, including
evenings or weekends if you prefer.
NOTE: THE NUMBER OF MINUTES WILL DEPEND ON WHETHER THE HOSPICE
SURVEY IS INTEGRATED WITH HOSPICE-SPECIFIC SUPPLEMENTAL
QUESTIONS.
You called my cell phone. Can you call back after [CAREGIVER SPECIFY
TIME]?
Yes, we can call you back at [CAREGIVER SPECIFY]?
[IF “NO”:] Set future date/time.
NOTE: TELEPHONE CALL ATTEMPTS ARE TO BE MADE BETWEEN THE HOURS
OF 9 AM AND 9 PM, RESPONDENT TIME, UNLESS AN ALTERNATIVE TIME IS
REQUESTED BY CAREGIVER.
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I don’t want to answer a lot of personal questions.
I understand your concern. This is a very important survey. If a question bothers you, just
tell me you’d rather not answer it, and I’ll move on to the next question. Why don’t we
get started and you can see what the questions are like?
I’m very unhappy with [HOSPICE NAME] and I don’t see why I should help
them with this survey.
I’m sorry you’re unhappy. This is a good reason for you to participate. Your responses
will help the hospice understand what improvements are needed.
Do I have to complete the survey? What happens if I do not? Why should I?
Your participation is voluntary. There are no penalties for not participating. But, it is a
very important survey and your answers will help us to improve the quality of care
[HOSPICE NAME] provides and will also help other consumers make informed
decisions when they choose a hospice for themselves or their family members or friends.
Will I get junk mail if I answer this survey?
No, you will not get any junk mail as a result of answering this survey.
I am on the Do Not Call List. Are you supposed to be calling me?
The Do Not Call List prohibits sales and telemarketing calls. We’re not selling anything
nor asking for money. We are a survey research firm. Your hospice has asked us to help
conduct this survey.
I don’t want to buy anything.
We’re not selling anything or asking for money. We want to ask you some questions
about the care and services provided by [HOSPICE NAME].
III. Questions About Completing/Returning the Survey
Is there a deadline to fill out the survey?
[FOR MAIL SURVEY:] Since we need to contact so many people, it would really help if
you could return it within the next several days.
[FOR TELEPHONE SURVEY:] We need to finish all the interviews as soon as possible,
but since we need to contact so many people, it would really help if we could do the
interview right now. If you don’t have the time, maybe I could schedule an appointment
for sometime within the next several days.
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Where do I put my name and address on the questionnaire?
You should not write your name or address on the questionnaire. Each survey has been
assigned an identification number that allows us to keep track of which respondents have
returned a completed questionnaire.
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Appendix H
CAHPS® Hospice Survey
Model Quality Assurance Plan
Appendix H
CAHPS® Hospice Survey
Model Quality Assurance Plan
Overview and Background
Survey vendors that are approved to administer the CAHPS Hospice Survey will be required to
submit an annual Quality Assurance Plan (QAP). The QAP must describe the survey vendor’s
implementation of and compliance with all required protocols to administer the CAHPS Hospice
Survey.
The purpose of this document is to serve as a model or guide in the preparation of a survey
vendor’s QAP in order to ensure that all required items are addressed in sufficient detail for
review by the CAHPS Hospice Survey Project Team. Following review by the project team, the
survey vendor will be provided with feedback that indicates whether the QAP has been accepted,
conditionally accepted (pending completion of follow-up of required items – usually minor) or
requires revision (major changes needed in order for the QAP to be considered complete).
It will be important that sufficient detail is provided in the QAP so that the project team can
determine a survey vendor’s adherence to survey administration guidelines and that rigorous
quality checks or controls have been put in place. All survey materials (mail materials and screen
shots of the telephone script in English and Spanish) must be submitted for review. In addition,
examples of templates, logs, tracking tools or other relevant documentation should be included
as appendices to the QAP.
The following sections below outline the required content to be addressed and the specified
sequence that must be followed in the survey vendor’s QAP.
Organizational Background and Structure
1. Provide survey vendor contact information on the first page of the QAP. Please include:
A. Survey vendor name
B. Survey vendor’s mailing address
C. Physical location, if mailing address is different
D. Web site address, if one is available
E. Name of contact person, his or her direct telephone number and email address
F. Number of contracted client hospices, if applicable
G. Survey vendor’s approved survey mode(s)
H. Date of the QAP
2. Briefly describe the survey vendor’s history and affiliations, including the scope of business
and number of years in business
3. Describe the survey vendor’s survey experience with all patient populations, including a
description of the mode(s) of survey administration and the number of years conducted, for
each mode the survey vendor is approved to administer the CAHPS Hospice Survey
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4. Provide and attach a CAHPS Hospice Survey organizational chart that identifies, by name
and title, the staff and subcontractors, if applicable, responsible for each of the major project
tasks. Include in the organizational chart the reporting relationships for all CAHPS Hospice
Survey project staff, and identify any key staff who work from remote locations. Also, please
specify the name and title of the staff members (primary and secondary/backup) who perform
the following project tasks:
A. Overall project management, including training and supervision
B. Tracking of key survey events
C. Creation of the sample frame
D. Drawing the sample
E. Assignment of the random, unique de-identified decedent/caregiver identification
numbers
F. Administering the survey by the approved mode (Mail Only, Telephone Only, Mixed
Mode)
G. Data receipt and data entry
H. Data submission; list all staff members authorized to upload data to the CAHPS
Hospice Survey Data Warehouse
I. Quality checks of all key events including, but not limited to, survey administration,
sample frame creation, data entry, data submission, electronic backup systems, etc.
5. Describe the background and qualifications of all key personnel (e.g., Project Director,
Project Manager, Programmer, Call Center/Mail Center Supervisor) involved in the CAHPS
Hospice Survey, including a description of the capabilities of all subcontractors and the
survey vendor’s experience with its subcontractors, if applicable. Background and
qualifications of all key personnel and subcontractor(s) should include experience in
conducting patient-specific surveys and experience in the appropriate project task(s)
assigned to the project staff. Staff resumes are not required; however, these resumes may be
requested during oversight activities.
6. Identify who participated in the CAHPS Hospice Survey webinar training in the current year.
Describe the training that has been or will be provided to all personnel involved in CAHPS
Hospice Survey processes, including subcontractors, if subcontractors are used during the
CAHPS Hospice Survey process. Survey vendors should also describe training that they
provide to their client hospices.
Work Plan for Survey Administration
This section of the QAP should be written in a manner so that a new member of the
CAHPS Hospice Survey team could carry out the processes necessary to administer the
CAHPS Hospice Survey. The QAP should provide sufficient detail for this person to
completely understand and accurately follow the processes to administer the survey, and
should include a comprehensive timeline of key events (number of days between key
events), showing who will do what, when they will do it, and how they will get it done. The
QAP should be free of extraneous information. The emphasis should be on providing concise
explanations of required CAHPS Hospice Survey processes.
Note: If survey vendors are approved for multiple modes of survey administration, they must
separately list responses for each mode.
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7. Provide the information requested below for the survey vendor’s approved mode of survey
administration, including a timeline of key survey administration events.
A. Mail Only Mode – describe the process for updating addresses, producing mailing
materials, and process for mailing out the surveys (Mail Only Survey Administration
chapter)
B. Telephone Only Mode – describe the process for updating telephone numbers,
programming and operating the interviewing systems, and contacting sampled
caregivers (Telephone Only Survey Administration chapter)
1. Describe how interviewers respond to respondents who request or are in need of
bereavement services
C. Mixed Mode – see above for Mail Only and Telephone Only (Mixed Mode Survey
Administration chapter)
D. describe your organization’s Distressed Respondent Procedures
8. Describe the steps involved in creating the sample frame and selecting the sample size. (Do
not include programming code.)
A. Describe the process for receiving and updating the decedent/caregiver information,
including electronic security utilized for exchange of decedent/caregiver lists between
client hospices and survey vendors. Describe what the hospice will provide for sample
frame creation.
1. Include a list of all data elements the hospice will provide
B. Describe the database(s)/document(s) that will be used to identify the eligible
decedents/caregivers
C. Describe the method of sampling to be used, including the process for selecting the
sample size (Sampling Protocol chapter)
D. Describe the procedure for ensuring hospices with sufficient eligible population sizes
sample at least 700 decedents/caregivers in a 12-month timeframe
E. List the CAHPS Hospice Survey eligibility and exclusion criteria and describe the
process for applying them to determine decedent/caregiver eligibility for inclusion in
the CAHPS Hospice Survey sample frame (Sampling Protocol chapter)
F. If administering the survey in multiple languages identify the language(s) and describe
how the survey language to be administered to the eligible caregiver is chosen
9. Describe the process and steps used to assign the random, unique de-identified
decedent/caregiver identification numbers. (NOTE: Identification numbers must not be based
on a coding structure that could potentially reveal decedent/caregiver identities, such as
those that incorporate the decedent’s/caregiver’s last name, initials, date of birth, hospice
account number, month, date, etc.)
10. List all Exceptions Requests for which the survey vendor has received approval and describe
how these approved exceptions requests are incorporated into the CAHPS Hospice Survey
process
11. Describe the data receipt and data entry procedures. (Do not include programming code.)
A. Describe how the surveys are handled and recorded when they are returned by mail (if
applicable) or completed by telephone (if applicable)
B. Describe the use of the decision rules, if applicable
C. Describe the scanning procedure, if applicable
D. Describe how and when in the process the final survey status code is assigned
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E. Provide the crosswalk of your organization’s interim disposition codes to final CAHPS
Hospice Survey disposition codes, if applicable
12. Describe the data preparation and submission procedures. (Do not include programming
code.)
A. Describe the process of updating the eligibility status of decedents/caregivers (i.e.,
process for updating any missing fields in the decedent/caregiver list received from the
hospice), if applicable
B. Describe the process for converting data into XML files and uploading the data to the
CAHPS Hospice Survey Data Warehouse, if applicable
C. Describe the time frames for completing data submission
Survey and Data Management System and Quality Controls
13. Describe the system resources (hardware and software) available, if not previously described
in sections above, such as:
A. Telephone (CATI) interviewing systems
B. Mailing equipment
C. Scanning systems
D. Software used for tracking, assigning de-identifying numbers, generating sample frame,
producing mail survey packets, telephone survey administration, XML file generation
E. Address and telephone number updating resources
14. Describe the customer support telephone line and how it will be operated
A. Identify who is responsible for responding to questions regarding the CAHPS Hospice
Survey
B. Specify the customer support telephone number
C. Include a written transcript of the voice mail message that specifies the caller can leave
a message about the survey
D. Include the hours of live/voice mail operations for the customer support line and the
time frame for returning voice mail messages
E. Describe how survey vendor will provide customer support in all languages that the
survey vendor administers the survey in
F. Describe how survey vendor will handle respondents who request or are in need of
bereavement services
15. Tracking of key events should be part of a survey vendor’s quality oversight processes.
Describe how key events are tracked throughout the survey process, including, but not
limited to:
A. Receipt of the decedent/caregiver list
B. Creation of the sample frame
C. Drawing the sample
D. Assignment of random, unique de-identified decedent/caregiver identification numbers
E. Administering the survey by the approved mode(s) of administration
F. Data receipt
G. Data entry
H. Data submission
I. Data Retention
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For items 14 –19, please be sure to include the following in your description.
Identify who performs the checks
Identify what checks are performed
Identify how the checks are performed
Identify how frequently the checks occur
Identify the number or percentage of records that are checked
Identify the documentation that provides evidence that the checks are performed
16. Describe the process for monitoring on-site work and subcontractors’ work to ensure high
quality results. Include monitoring of telephone interviewers, and checks of printed mailing
materials.
17. Describe the quality control checks implemented to validate that eligibility and exclusion
criteria are applied correctly and that sample frame creation is accurate
A. Describe the method used to verify the sample is a random selection (unless using
100% census sample)
18. Describe the quality control process to validate the accuracy of manual data entry and/or
electronic scanning procedures. Include the quality control process to verify the accuracy of
the application of CAHPS Hospice Survey decision rules (mail surveys).
19. Describe the quality control checks of telephone (CATI) procedures to confirm that
programming is accurate and in accordance with CAHPS Hospice Survey protocols, and
that data integrity is maintained (if applicable to your CAHPS Hospice Survey processes)
20. Describe the quality control process to validate the accuracy of data submission including
the review of the CAHPS Hospice Survey Data Warehouse Submission Reports
21. Describe the process for electronic back-up, including the quality control checks that are in
place to ensure the backup files are retrievable
Confidentiality, Privacy and Security Procedures
22. Describe the confidentiality agreements with staff and subcontractors involved in any aspect
of survey administration. Be sure to include information as to whether the confidentiality
agreement contains content for surveys in general or if CAHPS Hospice Survey-specific
language is included in the confidentiality agreement.
23. Describe the physical and electronic security and storage procedures to protect
decedent/caregiver-identified files, survey questionnaires, audio-recorded interviews, and
sample files, including the length of time that the survey materials will be retained
QAP Update: Discussion of Results of Quality Control Activities
24. Discuss the results and “lessons learned” from the quality review activities listed below.
Describe in detail the outcomes of these reviews.
A. Describe CAHPS Hospice Survey administration challenges and how these were
handled
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B. Describe the discovery of any variations from CAHPS Hospice Survey protocols and
how these variations were corrected
C. Describe the process for communicating the results of your quality checks to upper
management
D. Describe any opportunities for improvement to your CAHPS Hospice Survey
administration processes that were identified
E. Document in the QAP any changes in survey administration resulting from quality
process improvement activities
Other
25. Include any forms used in CAHPS Hospice Survey administration that may assist the CAHPS
Hospice Survey Project Team in reviewing the survey vendor’s processes (e.g., tracking logs,
sample frame format, etc.). NOTE: These items should be templates only and must not
contain any Protected Health Information (PHI).
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Appendix I
CAHPS® Hospice Survey
Exception Request Form
Appendix I
CAHPS® Hospice Survey
Exception Request Form
To complete and submit the Exception Request Form online, visit the CAHPS® 1 Hospice Survey
Web site at www.hospicecahpssurvey.org. Section I is to be completed by the survey vendor
submitting this form. The hospice(s) for which this Exception Request relates to must be listed in
Section II along with each hospice’s CMS Certification Number (CCN). All required fields are
indicated with an asterisk (*). NOTE: This form does not accept any special characters or symbols
in the text boxes. Use only alphanumeric characters when completing this form.
I. General Information
Tracking ID
Submission Date
[Auto Populated]
[Auto Populated]
Name of Survey Vendor submitting the Exception Request *
II. Contact Person for this Exception Request (Confirmation email will be sent to the Contact Person.)
2a. First Name: *
2b. Middle Initial:
2c. Last Name: *
2d. Title:*
2e. Mailing Address 1: *
2f. Mailing Address 2:
2g. City: *
2h. State: *
2i. Zip Code: *
2j. Telephone: * (xxx-xxx-xxxx)
EXT:
2k. Fax Number:
2l. Email Address: *
III. Exception Request
Please complete items 1, 2 and 3 below for each requested exception
1. Exception Request For (Check one in each category):
1a.
New Exception
Appeal of Exception Denial
1b.
1
Exception (specify)
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2. List of Hospices applicable to this Exception Request
Hospice Name: *
CCN: *
3. Description of Exception Request
3a. Purpose of Proposed Exception Request (e.g., sampling, other): *
3b. Rationale for Proposed Exception Request: *
3c. Explanation of Implementation of Proposed Exception Request: *
3d. Evidence that Exception Will Not Affect Survey Results: *
Print Exception Request
Submit Form
The Exception Request Form must be completed and submitted online at www.hospicecahpssurvey.org.
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Appendix J
CAHPS® Hospice Survey
Discrepancy Report Form
Appendix J
CAHPS® Hospice Survey
Discrepancy Request Form
Section 1 is to be completed by the survey vendor submitting this form. The requested information regarding
®1
the affected hospices must be provided in Section 4 in order to complete the CAHPS Hospice Survey
Discrepancy Report. THIS FORM MUST BE SUBMITTED ONLINE (www.hospicecahpssurvey.org). All required
fields are indicated with an asterisk (*). NOTE: This form does not accept any special characters or symbols
in the text boxes. Use only alphanumeric characters when completing this form.
1. General Information
Tracking ID
Submission Date
[Auto Populated]
[Auto Populated]
Name of Survey Vendor submitting Discrepancy Report *
2. Contact Person for this Discrepancy Report (Confirmation email will be sent to the Contact Person.)
2a. First Name: *
2b. Middle Initial:
2c. Last Name: *
2d. Title:*
2e. Mailing Address 1: *
2f. Mailing Address 2:
2g. City: *
2h. State: *
2i. Zip Code: *
2j. Telephone: * (xxx-xxx-xxxx)
EXT:
2k. Fax Number:
2l. Email Address: *
3. Information About the Discrepancy
3a. Description of the discrepancy: *
3b. Description of how the discrepancy was identified: *
3c. Description of the corrective action to fix the discrepancy, including estimated time for implementation: *
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3d. Additional information that would be helpful that has not been included above: *
4. List of Hospices Applicable to this Discrepancy
4a. Total number of affected hospices: *
4b. Add the information for the affected hospices by populating the following 10 fields. A hospice may be
added more than once if there are multiple time frames for the hospice. It is important that the impact of the
discrepancy is quantified; however “unknown” will be accepted as a valid response in the fields below, if the
requested information is not known at the time this form is completed.
Name of
Hospice
CCN
Hospice
Contact
Person
Print Discrepancy Report
Email
Address
Eligible
Decedents/
Caregivers
Affected
Avg.
Eligible
Decedents/
Caregivers/
Month
Sampled
Decedents/
Caregivers
Affected
Avg.
Surveys
Admin/
Month
Time
Frame
Begin
Date
xx/xx/xx
Time
Frame
End Date
xx/xx/xx
Submit Form
This form must be submitted online via the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org).
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Appendix K
CAHPS® Hospice Survey
Participation Exemption for Size Form
Appendix K
CAHPS® Hospice Survey
Participation Exemption for Size Form
To complete and submit the Participation Exemption for Size Form online, visit the CAHPS® 1
Hospice Survey Web site at www.hospicecahpssurvey.org. All required fields are indicated with an
asterisk (*). Note: For multiple hospice programs sharing one CCN, the survey-eligible
decedent/caregiver count is the total from all programs.
I. General Information
CCN Number: *
Submission Date
Name of Hospice: *
[Auto Populated]
II. Contact Person at Hospice for this Exemption for Size Request (Confirmation email will be sent to the
Contact Person)
2a. First Name: *
2b. Middle Initial:
2c. Last Name: *
2d. Title:*
2e. Mailing Address 1: *
2f. Mailing Address 2:
2g. City: *
2h. State: *
2i. Zip Code: *
2j. Telephone: * (xxx-xxx-xxxx)
EXT:
2k. Fax Number:
2l. Email Address: *
III. Participation Exemption for Size Request (Do not leave any fields blank – enter 0 [zero] if applicable)
1. Enter the total number of patients who died while in hospice care between January 1, 2014
and December 31, 2014 (CY 2014)*
2. Enter the total number of patients during CY 2014 who fall into the following categories. Do not include a patient
in more than one of the following categories:
a. Enter the number of patients who were discharged alive*
b. Enter the number of decedents:
i. who were under the age of 18*
ii. who died within 48 hours of admission to hospice care*
iii. for whom there is no caregiver of record*
iv. for whom the caregiver is a non-familial legal guardian*
v. for whom the caregiver has a foreign (non-US or US Territory) home address*
vi. for whom the caregiver requested not to be contacted*
Print Participation
Exemption for Size Form
Submit Form
The Participation Exemption for Size Form must be completed and submitted online at
www.hospicecahpssurvey.org.
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Appendix L
CAHPS® Hospice Survey
Examples of Additional Supplemental Questions
For Survey Vendor Use
Appendix L
CAHPS® Hospice Survey
Examples of Additional Supplemental Questions
For Survey Vendor Use
S1.
While your family member was in hospice care, how often did you have a hard
time speaking with or understanding members of the hospice team because you
spoke different languages?
3
4
1
2
S2.
Never
Sometimes
Usually
Always
In thinking about your experiences with hospice, was there anything that went
especially well or that you wish had gone differently for you and your family
member? Please tell us about those experiences.
Special Medical Equipment 1
S3.
Special medical equipment includes things like hospital beds, wheelchairs, or
oxygen. While your family member was in hospice care, did your family member
need special medical equipment?
1
2
Yes
No If No, please go to Question S5.
1
The items regarding special medical equipment were designed and tested to assess care within a home setting.
Care should be taken when interpreting results from respondents whose family members did not receive care in a
home setting. It is recommended that Question S3 be used as a screener for the subsequent Special Medical
Equipment items.
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S4.
Did your family member get the equipment as soon as he or she needed it?
1
2
S5.
Yes
No
Was the equipment picked up in a timely manner when your family member no
longer needed it?
1
2
Yes
No
Personal Care Needs 2
S6.
Personal care needs include bathing, dressing, eating meals and changing
bedding. While your family member was in hospice care, how often did your
family member get as much help with personal care as he or she needed?
3
4
1
2
Never
Sometimes
Usually
Always
Hospice Care Received in a Hospital or Hospice Facility
S7.
Some people receive hospice care while they are in a hospital or hospice facility.
Did your family member receive care from this hospice while he or she was in a
hospital or hospice facility?
1
2
S8.
Yes
No
While your family member was in hospice care, did you speak to a doctor as
often as you needed?
3
1
2
Yes, definitely
Yes, somewhat
No
2
Note: The item regarding personal care needs was designed and tested to assess care within nursing home or
inpatient settings. Care should be taken when interpreting results from respondents whose family members
received care only in a home setting.
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S9.
While your family member was in hospice care, were his or her room and
bathroom kept clean?
3
1
2
Yes, definitely
Yes, somewhat
No
Consent to Share Responses
In addition, one supplemental question must be included in the mail and telephone
questionnaire if the hospice wishes to view the survey responses linked to respondents’
name and other identifying information. The survey question, referred to as the Consent
to Share Responses, must be printed in the mail questionnaire and included in the
telephone questionnaire. The respondent must check the “Yes” response option in the
mail questionnaire or answer “Yes” to the question during the telephone interview for
the vendor to provide the hospice with the respondent’s answers linked to the
respondent’s name and identifying information. The question is typically placed at the
end of the questionnaire or interview, as the last question.
The hospice that provided care to your family member may want to review your answers
so that they can decide how to address any concerns that you have. We will not share
your answers to this survey linked to your name unless you give your permission for this
information to be shared with the hospice.
Do you give your permission to provide your answers to this survey linked to your name
to the hospice?
Yes, I give my permission to share my name and survey responses with the
hospice.
No, I do not give permission to share my name and survey responses with the
hospice.
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Appendix M
CAHPS® Hospice Survey
Mail Survey Materials (English)
CAHPS® Hospice Survey
Please answer the survey questions about the care the patient received from this hospice:
[NAME OF HOSPICE]
All of the questions in this survey will ask about the experiences with this hospice.
If you want to know more about this survey, please call [TOLL FREE NUMBER]. All calls to
that number are free.
OMB#XXXX-XXXX
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CAHPS® Hospice Survey
SURVEY INSTRUCTIONS
♦
Please give this survey to the person in your household who knows the most about the
hospice care received by the person listed on the survey cover letter.
♦
Use a dark colored pen to fill out the survey.
♦
Place an X directly inside the square indicating a response, like in the sample below.
Yes
No
♦
♦
To indicate an answer selected was in error clearly draw a line through the square and
select another square.
You are sometimes told to skip over some questions in this survey. When this happens you
will see an arrow with a note that tells you what question to answer next, like this:
Yes If Yes, Go to Question 1
No
THE HOSPICE PATIENT
1. How are you related to the person
listed on the survey cover letter?
2
3
4
5
6
7
8
9
1
2
My spouse or partner
My parent
My mother-in-law or father-in-law
My grandparent
My aunt or uncle
My sister or brother
My child
My friend
Other (please print):
2. For this survey, the phrase "family
member" refers to the person listed
on the survey cover letter. In what
locations did your family member
receive care from this hospice?
Please choose one or more.
3
4
5
6
1
2
Home
Assisted living facility
Nursing home
Hospital
Hospice facility/hospice house
Other (please print):
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YOUR ROLE
3. While your family member was in
hospice care, how often did you take
part in or oversee care for him or
her?
1
4
2
3
As you answer the rest of the questions
in this survey, please think only about
your family member's experience with
the hospice named on the survey cover.
4. For this survey, the hospice team
includes all the nurses, doctors,
social workers, chaplains and other
people who provided hospice care to
your family member. While your
family member was in hospice care,
did you need to contact the hospice
team during evenings, weekends, or
holidays for questions or help with
your family member’s care?
2
3
4
2
2
Never
Sometimes
Usually
Always
7. While your family member was in
hospice care, when you or your
family member asked for help from
the hospice team, how often did you
get help as soon as you needed it?
3
4
1
2
Never
Sometimes
Usually
Always
8. While your family member was in
hospice care, how often did the
hospice team explain things in a way
that was easy to understand?
3
4
1
2
Yes
No If No, go to Question 6
5. How often did you get the help you
needed from the hospice team during
evenings, weekends, or holidays?
1
3
4
1
Never If Never, go to Question
41
Sometimes
Usually
Always
YOUR FAMILY MEMBER’S HOSPICE
CARE
1
6. While your family member was in
hospice care, how often did the
hospice team keep you informed
about when they would arrive to care
for your family member?
Never
Sometimes
Usually
Always
9. While your family member was in
hospice care, how often did the
hospice team keep you informed
about your family member’s
condition?
Never
Sometimes
Usually
Always
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4
1
2
Never
Sometimes
Usually
Always
3
10. While your family member was in
hospice care, how often did anyone
from the hospice team give you
confusing or contradictory
information about your family
member’s condition or care?
3
4
1
2
Never
Sometimes
Usually
Always
3
4
2
3
4
2
2
Never
Sometimes
Usually
Always
2
4
Never
Sometimes
Usually
Always
Yes
No If No, go to Question 17
16. Did your family member get as much
help with pain as he or she needed?
3
1
2
Never
Sometimes
Usually
Always
2
Yes
No If No, go to Question 15
Yes, definitely
Yes, somewhat
No
17. While your family member was in
hospice care, did he or she receive
any pain medicine?
1
13. While your family member was in
hospice care, did you talk with the
hospice team about any problems
with your family member’s hospice
care?
1
2
1
12. While your family member was in
hospice care, how often did you feel
that the hospice team really cared
about your family member?
1
3
4
1
15. While your family member was in
hospice care, did he or she have any
pain?
11. While your family member was in
hospice care, how often did the
hospice team treat your family
member with dignity and respect?
1
14. How often did the hospice team listen
carefully to you when you talked with
them about problems with your
family member’s hospice care?
Yes
No If No, go to Question 21
18. Side effects of pain medicine include
things like sleepiness. Did any
member of the hospice team discuss
side effects of pain medicine with
you or your family member?
3
1
2
Yes, definitely
Yes, somewhat
No
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19. Did the hospice team give you the
training you needed about what side
effects to watch for from pain
medicine?
2
3
1
3
4
2
Yes, definitely
Yes, somewhat
No
I did not need to give pain medicine
to my family member
21. While your family member was in
hospice care, did your family member
ever have trouble breathing or
receive treatment for trouble
breathing?
1
2
Yes
No If No, go to Question 24
22. How often did your family member
get the help he or she needed for
trouble breathing?
3
4
1
2
3
4
1
Yes, definitely
Yes, somewhat
No
20. Did the hospice team give you the
training you needed about if and
when to give more pain medicine to
your family member?
1
23. Did the hospice team give you the
training you needed about how to
help your family member if he or she
had trouble breathing?
2
24. While your family member was in
hospice care, did your family member
ever have trouble with constipation?
1
2
Yes
No If No, go to Question 26
25. How often did your family member
get the help he or she needed for
trouble with constipation?
2
3
4
1
Never
Sometimes
Usually
Always
26. While your family member was in
hospice care, did he or she show any
feelings of anxiety or sadness?
1
2
Never
Sometimes
Usually
Always
Yes, definitely
Yes, somewhat
No
I did not need to help my family
member with trouble breathing
Yes
No If No, go to Question 28
27. How often did your family member
get the help he or she needed from
the hospice team for feelings of
anxiety or sadness?
3
4
1
2
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Never
Sometimes
Usually
Always
5
28. While your family member was in
hospice care, did he or she ever
become restless or agitated?
2
1
HOSPICE CARE RECEIVED IN A
NURSING HOME
Yes
No If No, go to Question 30
29. Did the hospice team give you the
training you needed about what to do
if your family member became
restless or agitated?
2
3
1
Yes, definitely
Yes, somewhat
No
30. Moving your family member includes
things like helping him or her turn
over in bed, or get in and out of bed
or a wheelchair. Did the hospice
team give you the training you
needed about how to safely move
your family member?
3
4
1
2
Yes, definitely
Yes, somewhat
No
I did not need to move my family
member
31. Did the hospice team give you as
much information as you wanted
about what to expect while your
family member was dying?
3
1
2
6
Yes, definitely
Yes, somewhat
No
32. Some people receive hospice care
while they are living in a nursing
home. Did your family member
receive care from this hospice while
he or she was living in a nursing
home?
1
2
Yes
No If No, go to Question 35
33. While your family member was in
hospice care, how often did the
nursing home staff and hospice team
work well together to care for your
family member?
3
4
1
2
Never
Sometimes
Usually
Always
34. While your family member was in
hospice care, how often was the
information you were given about
your family member by the nursing
home staff different from the
information you were given by the
hospice team?
3
4
1
2
Never
Sometimes
Usually
Always
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
YOUR OWN EXPERIENCE WITH
HOSPICE
35. While your family member was in
hospice care, how often did the
hospice team listen carefully to you?
3
4
1
2
Never
Sometimes
Usually
Always
OVERALL RATING OF HOSPICE
CARE
39. Please answer the following
questions about your family
member’s care from the hospice
named on the survey cover. Do not
include care from other hospices in
your answers.
Using any number from 0 to 10,
where 0 is the worst hospice care
possible and 10 is the best hospice
care possible, what number would
you use to rate your family member’s
hospice care?
36. Support for religious or spiritual
beliefs includes talking, praying,
quiet time, or other ways of meeting
your religious or spiritual needs.
While your family member was in
hospice care, how much support for
your religious and spiritual beliefs
did you get from the hospice team?
3
1
2
0
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
0
Too little
Right amount
Too much
37. While your family member was in
hospice care, how much emotional
support did you get from the hospice
team?
3
1
2
Too little
Right amount
Too much
38. In the weeks after your family
member died, how much emotional
support did you get from the hospice
team?
3
2
Best hospice care possible
40. Would you recommend this hospice
to your friends and family?
3
4
1
1
Worst hospice care possible
1
2
Definitely no
Probably no
Probably yes
Definitely yes
Too little
Right amount
Too much
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
7
ABOUT YOUR FAMILY MEMBER
41. What is the highest grade or level of
school that your family member
completed?
2
1
5
6
7
3
4
8th grade or less
Some high school but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
Don’t know
42. Was your family member of Hispanic,
Latino, or Spanish origin or descent?
3
1
2
4
5
No, not Spanish/Hispanic/Latino
Yes, Puerto Rican
Yes, Mexican, Mexican American,
Chicano/a
Yes, Cuban
Yes, Other Spanish/Hispanic/
Latino
43. What was your family member’s
race? Please choose one or more.
3
4
1
2
5
8
White
Black or African American
Asian
Native Hawaiian or other Pacific
Islander
American Indian or Alaska Native
ABOUT YOU
44. What is your age?
2
3
4
5
6
7
8
1
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 or older
45. Are you male or female?
1
2
Male
Female
46. What is the highest grade or level of
school that you have completed?
2
1
5
6
3
4
8th grade or less
Some high school but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
47. What language do you mainly speak
at home?
3
4
1
2
English
Spanish
Chinese
Some other language (please
print):
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
THANK YOU
Please return the completed survey in the postage-paid envelope.
[NAME OF SURVEY VENDOR]
[RETURN ADDRESS OF SURVEY VENDOR]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
9
10
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
CAHPS® Hospice Survey
Please answer the survey questions about the care the patient received from this hospice:
[NAME OF HOSPICE]
All of the questions in this survey will ask about the experiences with this hospice.
If you want to know more about this survey, please call [TOLL FREE NUMBER]. All calls to
that number are free.
OMB#XXXX-XXXX
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
11
CAHPS® Hospice Survey
SURVEY INSTRUCTIONS
♦
Please give this survey to the person in your household who knows the most about the
hospice care received by the person listed on the survey cover letter.
♦
Use a dark colored pen to fill out the survey.
♦
Place an X directly inside the square indicating a response, like in the sample below.
0
♦
♦
Yes
No
To indicate an answer selected was in error clearly draw a line through the square and
select another square.
You are sometimes told to skip over some questions in this survey. When this happens you
will see an arrow with a note that tells you what question to answer next, like this:
0
Yes If Yes, Go to Question 1
No
2. For this survey, the phrase "family
member" refers to the person listed
on the survey cover letter. In what
locations did your family member
receive care from this hospice?
Please choose one or more.
THE HOSPICE PATIENT
1. How are you related to the person
listed on the survey cover letter?
0
0
3
0
4
0
5
0
6
0
7
0
8
0
9
0
12
1
My spouse or partner
2
My parent
My mother-in-law or father-in-law
1
Home
My grandparent
2
Assisted living facility
My aunt or uncle
My sister or brother
My child
My friend
0
0
3
0
4
0
5
0
6
0
Nursing home
Hospital
Hospice facility/hospice house
Other (please print):
Other (please print):
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
YOUR ROLE
3. While your family member was in
hospice care, how often did you take
part in or oversee care for him or
her?
6. While your family member was in
hospice care, how often did the
hospice team keep you informed
about when they would arrive to care
for your family member?
0
2
0
3
0
4
0
1
0
1
0
3
0
4
0
2
Never If Never, go to Question
41
Sometimes
Usually
As you answer the rest of the questions
in this survey, please think only about
your family member's experience with
the hospice named on the survey cover.
4. For this survey, the hospice team
includes all the nurses, doctors,
social workers, chaplains and other
people who provided hospice care to
your family member. While your
family member was in hospice care,
did you need to contact the hospice
team during evenings, weekends, or
holidays for questions or help with
your family member’s care?
0
2
0
0
2
0
3
0
4
0
Usually
Always
7. While your family member was in
hospice care, when you or your
family member asked for help from
the hospice team, how often did you
get help as soon as you needed it?
0
2
0
3
0
4
0
1
0
0
3
0
4
0
No If No, go to Question 6
Never
Never
Sometimes
Usually
Always
8. While your family member was in
hospice care, how often did the
hospice team explain things in a way
that was easy to understand?
Yes
5. How often did you get the help you
needed from the hospice team during
evenings, weekends, or holidays?
1
Sometimes
Always
YOUR FAMILY MEMBER’S HOSPICE
CARE
1
Never
1
Never
2
Sometimes
Usually
Always
9. While your family member was in
hospice care, how often did the
hospice team keep you informed
about your family member’s
condition?
Sometimes
Usually
Always
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
0
0
3
0
4
0
1
Never
2
Sometimes
Usually
Always
13
10. While your family member was in
hospice care, how often did anyone
from the hospice team give you
confusing or contradictory
information about your family
member’s condition or care?
0
2
0
3
0
4
0
1
Never
Sometimes
Usually
Always
0
2
0
3
0
4
0
Usually
Always
1
Yes
2
No If No, go to Question 17
16. Did your family member get as much
help with pain as he or she needed?
Sometimes
Usually
Always
Never
2
Sometimes
0
0
3
0
1
Yes, definitely
2
Yes, somewhat
Usually
No
17. While your family member was in
hospice care, did he or she receive
any pain medicine?
0
0
1
Yes
2
No If No, go to Question 21
Always
13. While your family member was in
hospice care, did you talk with the
hospice team about any problems
with your family member’s hospice
care?
14
Sometimes
Never
1
0
0
Never
2
0
0
12. While your family member was in
hospice care, how often did you feel
that the hospice team really cared
about your family member?
0
0
3
0
4
0
0
0
3
0
4
0
1
15. While your family member was in
hospice care, did he or she have any
pain?
11. While your family member was in
hospice care, how often did the
hospice team treat your family
member with dignity and respect?
1
14. How often did the hospice team listen
carefully to you when you talked with
them about problems with your
family member’s hospice care?
1
Yes
2
No If No, go to Question 15
18. Side effects of pain medicine include
things like sleepiness. Did any
member of the hospice team discuss
side effects of pain medicine with
you or your family member?
0
0
3
0
1
Yes, definitely
2
Yes, somewhat
No
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19. Did the hospice team give you the
training you needed about what side
effects to watch for from pain
medicine?
0
2
0
3
0
1
0
0
3
0
4
0
Yes, definitely
1
Yes, definitely
Yes, somewhat
2
Yes, somewhat
No
20. Did the hospice team give you the
training you needed about if and
when to give more pain medicine to
your family member?
0
0
3
0
4
0
23. Did the hospice team give you the
training you needed about how to
help your family member if he or she
had trouble breathing?
No
I did not need to help my family
member with trouble breathing
24. While your family member was in
hospice care, did your family member
ever have trouble with constipation?
1
Yes, definitely
2
Yes, somewhat
1
Yes
No
2
No If No, go to Question 26
I did not need to give pain medicine
to my family member
21. While your family member was in
hospice care, did your family member
ever have trouble breathing or
receive treatment for trouble
breathing?
0
2
0
1
0
2
0
3
0
4
0
25. How often did your family member
get the help he or she needed for
trouble with constipation?
0
0
3
0
4
0
Yes
1
Never
2
Sometimes
Usually
Always
No If No, go to Question 24
22. How often did your family member
get the help he or she needed for
trouble breathing?
1
0
0
26. While your family member was in
hospice care, did he or she show any
feelings of anxiety or sadness?
0
0
Never
1
Yes
2
No If No, go to Question 28
Sometimes
Usually
Always
27. How often did your family member
get the help he or she needed from
the hospice team for feelings of
anxiety or sadness?
0
0
3
0
4
0
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
Never
2
Sometimes
Usually
Always
15
28. While your family member was in
hospice care, did he or she ever
become restless or agitated?
0
2
0
1
HOSPICE CARE RECEIVED IN A
NURSING HOME
Yes
No If No, go to Question 30
29. Did the hospice team give you the
training you needed about what to do
if your family member became
restless or agitated?
0
0
3
0
1
Yes, definitely
2
Yes, somewhat
No
30. Moving your family member includes
things like helping him or her turn
over in bed, or get in and out of bed
or a wheelchair. Did the hospice
team give you the training you
needed about how to safely move
your family member?
0
2
0
3
0
4
0
1
Yes, definitely
Yes, somewhat
No
I did not need to move my family
member
31. Did the hospice team give you as
much information as you wanted
about what to expect while your
family member was dying?
0
2
0
3
0
1
16
Yes, definitely
32. Some people receive hospice care
while they are living in a nursing
home. Did your family member
receive care from this hospice while
he or she was living in a nursing
home?
0
0
1
Yes
2
No If No, go to Question 35
33. While your family member was in
hospice care, how often did the
nursing home staff and hospice team
work well together to care for your
family member?
0
0
3
0
4
0
1
Never
2
Sometimes
Usually
Always
34. While your family member was in
hospice care, how often was the
information you were given about
your family member by the nursing
home staff different from the
information you were given by the
hospice team?
0
0
3
0
4
0
1
Never
2
Sometimes
Usually
Always
Yes, somewhat
No
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
YOUR OWN EXPERIENCE WITH
HOSPICE
35. While your family member was in
hospice care, how often did the
hospice team listen carefully to you?
0
0
3
0
4
0
1
Never
2
Sometimes
OVERALL RATING OF HOSPICE
CARE
39. Please answer the following
questions about your family
member’s care from the hospice
named on the survey cover. Do not
include care from other hospices in
your answers.
Usually
Using any number from 0 to 10,
where 0 is the worst hospice care
possible and 10 is the best hospice
care possible, what number would
you use to rate your family member’s
hospice care?
Always
36. Support for religious or spiritual
beliefs includes talking, praying,
quiet time, or other ways of meeting
your religious or spiritual needs.
While your family member was in
hospice care, how much support for
your religious and spiritual beliefs
did you get from the hospice team?
0
2
0
3
0
1
0
0
2
0
3
0
4
0
5
0
6
0
7
0
8
0
9
0
10
0
Too little
Right amount
Too much
37. While your family member was in
hospice care, how much emotional
support did you get from the hospice
team?
0
0
3
0
1
Too little
2
Right amount
Too much
0
2
0
3
0
0 Worst hospice care possible
1
1
2
3
4
5
6
7
8
9
10 Best hospice care possible
40. Would you recommend this hospice
to your friends and family?
38. In the weeks after your family
member died, how much emotional
support did you get from the hospice
team?
1
0
0
0
3
0
4
0
1
Definitely no
2
Probably no
Probably yes
Definitely yes
Too little
Right amount
Too much
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
17
ABOUT YOUR FAMILY MEMBER
41. What is the highest grade or level of
school that your family member
completed?
0
2
0
1
0
4
0
5
0
6
0
7
0
3
8th grade or less
Some high school but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
No, not Spanish/Hispanic/Latino
2
Yes, Puerto Rican
0
5
0
0
0
3
0
4
0
5
0
6
0
7
0
8
0
1
18 to 24
2
25 to 34
Yes, Mexican, Mexican American,
Chicano/a
Yes, Cuban
Yes, Other Spanish/Hispanic/
Latino
1
White
2
Black or African American
0
18
55 to 64
65 to 74
75 to 84
85 or older
0
0
Male
2
Female
46. What is the highest grade or level of
school that you have completed?
0
2
0
1
0
0
5
0
6
0
3
43. What was your family member’s
race? Please choose one or more.
5
45 to 54
1
4
0
0
3
0
4
0
35 to 44
45. Are you male or female?
1
4
44. What is your age?
Don’t know
42. Was your family member of Hispanic,
Latino, or Spanish origin or descent?
0
0
3
0
ABOUT YOU
8th grade or less
Some high school but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
47. What language do you mainly speak
at home?
Asian
Native Hawaiian or other Pacific
Islander
American Indian or Alaska Native
0
0
3
0
4
0
1
English
2
Spanish
Chinese
Some other language (please
print):
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
THANK YOU
Please return the completed survey in the postage-paid envelope.
[NAME OF SURVEY VENDOR]
[RETURN ADDRESS OF SURVEY VENDOR]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19
20
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Sample Initial Cover Letter for the CAHPS Hospice Survey
[HOSPICE OR VENDOR LETTERHEAD]
[HOSPICE OR VENDOR LETTERHEAD]
[SAMPLED CAREGIVER NAME]
[ADDRESS]
[CITY, STATE ZIP]
Dear [SAMPLED CAREGIVER NAME]:
[HOSPICE NAME] is conducting a survey about the hospice services that patients and their families
receive. You were selected for this survey because you were identified as the caregiver of [DECEDENT
NAME]. We realize this may be a difficult time for you, but we hope that you will help us learn about
the quality of care that you and your family member or friend received from the hospice.
Questions [NOTE THE QUESTION NUMBERS] in the enclosed survey are part of a national initiative
sponsored by the United States Department of Health and Human Services (HHS) to measure the quality
of care in hospices. The Centers for Medicare & Medicaid Services (CMS), which is part of HHS, is
conducting this survey to improve hospice care. CMS pays for most of the hospice care in the U.S. It is
CMS’s responsibility to ensure that hospice patients and their family members and friends get high
quality care. One of the ways they can fulfill this responsibility is to find out directly from you about
the hospice care your family member or friend received. Your participation is voluntary and will not
affect any health care or benefits you receive.
We hope that you will take the time to complete the survey. After you have completed the survey, please
return it in the pre-paid envelope. Your answers will be combined with other respondents and may be
shared with the hospice for purposes of quality improvement. [OPTIONAL: You may notice a number
on the survey. This number is used to let us know if you returned your survey so we don’t have to send
you reminders.]
If you have any questions about the enclosed survey, please call the toll-free number 1-800-xxx-xxxx.
Thank you for helping to improve hospice care for all consumers.
Sincerely,
[HOSPICE ADMINISTRATOR]
[HOSPICE NAME]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
21
22
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Sample Follow-up Cover Letter for the CAHPS Hospice Survey
[HOSPICE OR VENDOR LETTERHEAD]
[HOSPICE OR VENDOR LETTERHEAD]
[SAMPLED CAREGIVER NAME]
[ADDRESS]
[CITY, STATE ZIP]
Dear [SAMPLED CAREGIVER NAME]:
Our records show that you were recently a caregiver for [DECEDENT NAME] at [NAME OF
HOSPICE]. Approximately three weeks ago, we sent you a survey regarding the care you and your
family member or friend received from this hospice. If you have already returned the survey to us,
please accept our thanks and disregard this letter. However, if you have not done so already, we would
greatly appreciate it if you would take the time to complete this important questionnaire.
We hope that you will take this opportunity to help us learn about the quality of care your family
member or friend received. The results from this survey will be used to help ensure that all Americans
get the highest quality hospice care.
Questions [NOTE THE QUESTION NUMBERS] in the enclosed survey are part of a national initiative
sponsored by the United States Department of Health and Human Services (HHS) to measure the quality
of care in hospices. Your participation is voluntary and will not affect any health care or benefits you
receive.
Please take a few minutes and complete the enclosed survey. After you have completed the survey,
please return it in the pre-paid envelope. Your answers will be combined with other respondents and
may be shared with the hospice for purposes of quality improvement. [OPTIONAL: You may notice a
number on the survey. This number is used to let us know if you returned your survey so we don’t have
to send you reminders.]
If you have any questions about the enclosed survey, please call the toll-free number 1-800-xxx-xxxx.
Thank you for helping to improve hospice care for all consumers.
Sincerely,
[HOSPICE ADMINISTRATOR]
[HOSPICE NAME]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
23
24
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
.
Appendix N
CAHPS® Hospice Survey
Mail Survey Materials (Spanish)
CAHPS® Hospice Survey
Por favor conteste las preguntas en esta encuesta sobre la atencion que recibio este
paciente de este hospicio:
NAME OF HOSPICE
Todas las preguntas en esta encuesta se tratan sobre las experiencias de este paciente
con este hospicio.
Si desea saber más sobre este estudio, llama a [TOLL FREE NUMBER}. Todas las
llamadas son gratis.
OMB# XXXX-XXXX
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
CAHPS® Hospice Survey
INSTRUCCIONES PARA LA ENCUESTA
Por favor entréguele esta encuesta a la persona de su hogar que sepa más sobre los
cuidados que recibió de este centro la persona cuyo nombre aparece en la carta de
presentación de esta encuesta.
Use un bolígrafo de tinta negra para completar el cuestionario
Marque con una ‘X’ el cuadrito para indicar su respuesta. Vea el siguiente ejemplo:
Si
No
Si quiere cambiar una respuesta, tache con una línea el cuadrito que usted quiere cambiar
y en su lugar marque con una ‘X’ el cuadrito que desea escoger, así:
A veces hay que saltarse alguna pregunta. Cuando esto ocurra, una flecha a la derecha
de la respuesta le indicará a qué pregunta hay que pasar. Por ejemplo:
Si
Si contestó Sí, pase a la Pregunta 1 en la Página 1.
No
2
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
EL PACIENTE DEL HOSPICIO
1. ¿Qué relación tiene con usted la
persona cuyo nombre aparece en la
carta de presentación de esta
encuesta?
SU PAPEL
3. Mientras su familiar estuvo bajo los
cuidados del hospicio, ¿con qué
frecuencia supervisó usted o
participó en dichos cuidados?
1
Es mi esposo/a o pareja
2
Es mi padre/madre
3
Es mi suegro/a
4
Es mi abuelo/a
5
Es mi tío/a
6
Es mi hermano/a
7
Es mi hijo/a
8
Es un/a amigo/a
9
Otro (por favor imprima):
1
________________________
2. Para esta encuesta, utilizaremos las
palabras “su familiar” para referirnos
a la persona cuyo nombre aparece en
la carta de presentación de esta
encuesta. ¿En qué lugar o lugares
recibió su familiar los cuidados de
este hospicio? Marque uno o más
En su casa
2
En un hogar de asistencia parcial
3
En una casa de ancianos y
1
convalecencia
Nunca
Si contestó Nunca, pase
a la Pregunta 41.
A veces
3
La mayoría de las veces
4
Siempre
2
LOS CUIDADOS QUE EL HOSPICIO
PROPORCIONÓ A SU FAMILIAR
Al responder el resto de las preguntas de
esta encuesta, por favor piense sólo en
la experiencia de su familiar con el
hospicio nombrado en la en la portada
de esta encuesta.
4. Para esta encuesta, el equipo del
hospicio incluye a todos los doctores,
enfermeras, trabajadores sociales,
religiosos y demás personas que le
proporcionaron cuidados paliativos a
su familiar.
Mientras su familiar estaba bajo los
cuidados del hospicio, ¿tuvo usted
que ponerse en contacto con el
equipo del hospicio durante la noche,
en fin de semana o en día festivo
porque tenía alguna duda o
necesitaba ayuda para el cuidado de
su familiar?
En un hospital
5
En un centro u hogar de hospicio
6
Otro (Por favor imprima):
4
Sí
2
No
1
Si contestó No, pase a la
Pregunta 6.
__________________
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
3
5. ¿Con qué frecuencia obtuvo la ayuda
que necesitaba del equipo del
hospicio durante la noche, en fin de
semana o en día festivo?
Nunca
2
A veces
3
La mayoría de las
4
Siempre
1
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre.
veces
1
7. Mientras su familiar estaba bajo los
cuidados de este hospicio, cuando
usted o un miembro de su familia le
pedían ayuda al equipo del hospicio,
¿con qué frecuencia obtenían la
ayuda tan pronto como la
necesitaban?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
9. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del hospicio lo
mantenía a usted informado sobre el
estado de su familiar?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
4
Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del hospicio
explicaba las cosas de un modo fácil
de entender?
1
6. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo de personal del
hospicio lo mantuvo a usted
informado de cuando iban a llegar a
cuidar a su familiar?
1
8.
10. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia alguien del equipo del
hospicio le dio a usted informes
confusos o contradictorios sobre el
estado o los cuidados de su familiar?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
11. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del centro
trataba a su familiar con dignidad y
respeto?
14. ¿Con qué frecuencia el equipo del
hospicio lo escuchó con atención
cuando usted les habló sobre
problemas relacionados con los
cuidados de su familiar?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
12. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia sintió usted que al equipo
del hospicio realmente le importaba
su familiar?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
15. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿tuvo
él/ella algún tipo de dolor?
Sí
2
No
1
1
16. ¿Recibió su familiar toda la ayuda que
necesitaba contra el dolor?
2
3
1
13. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿habló usted
con el equipo del hospicio sobre
algún problema relacionado con los
cuidados de su familiar?
Sí
2
No
1
Si contestó No, pase a la
Pregunta 15.
Si contestó No, pase a la
Pregunta 17.
Sí, definitivamente
Sí, más o menos
No
17. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿le dieron a él
o a ella algún medicamento contra el
dolor?
Sí
2
No
1
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Si contestó No, pase a la
Pregunta 21.
5
18. Entre los efectos secundarios de la
medicina contra el dolor está la
somnolencia. ¿Algún personal del
equipo del hospicio habló con usted
o su familiar sobre los efectos
secundarios del medicamento contra
el dolor?
Sí, definitivamente
2
Sí, más o menos
3
No
19. ¿El equipo del hospicio le dio la
capacitación que usted necesitaba
para saber de qué efectos
secundarios del medicamento contra
el dolor tenía usted que estar
pendiente?
Sí, definitivamente
2
Sí, más o menos
3
No
1
20. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber si había que darle a su
familiar más medicamento contra el
dolor y, si sí, cuándo dárselo?
2
3
4
Sí, definitivamente
Sí, más o menos
Sí
2
No
1
Si contestó No, pase a la
Pregunta 24.
1
1
21. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento tuvo su familiar dificultad
para respirar o recibió tratamiento
para su dificultad para respirar?
22. ¿Con qué frecuencia su familiar
recibió la ayuda que necesitaba para
su dificultad para respirar?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
23. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber cómo ayudar a su familiar
si él/ella tenía problemas para
respirar?
Sí, definitivamente
2
Sí, más o menos
3
No
4
No tuve que ayudar a mi familiar
1
con problemas para respirar
No
No tuve necesidad de dar
medicamento para el dolor a mi
familiar
24. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento tuvo su familiar problemas
de estreñimiento?
Sí
2
No
1
6
Si contestó No, pase a la
Pregunta 26.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
25. ¿Con qué frecuencia su familiar
recibió la ayuda que necesitaba para
sus problemas de estreñimiento?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
26. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿en algún
momento él/ella sitió ansiedad o
tristeza?
Sí
2
No
1
Si contestó No, pase a la
Pregunta 28.
29. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber qué hacer si su familiar se
ponía inquieto o agitado?
Sí, definitivamente
2
Sí, más o menos
3
No
1
30. Mover a su familiar incluye acciones
como ayudarlo/a a darse la vuelta en
la cama, o meterse y salir de la cama
o sentarse y levantarse de una silla de
ruedas. ¿El equipo del hospicio le dio
a usted la capacitación que usted
necesitaba para saber cómo mover a
su familiar de manera segura?
Sí, definitivamente
2
Sí, más o menos
3
No
4
No tuve que mover a mi familiar
1
27. ¿Con qué frecuencia su familiar
recibió del equipo del hospicio la
ayuda que necesitaba para su
ansiedad o tristeza?
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
31. ¿Le dio el equipo del hospicio tanta
información como usted quería sobre
qué acontecimientos esperar
mientras su familiar estuviera
muriéndose?
Sí, definitivamente
2
Sí, más o menos
3
No
1
28. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento se puso su familiar inquieto
o agitado?
Sí
2
No
1
Si contestó No, pase a la
Pregunta 30.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
7
CUIDADOS DE HOSPICIO
BRINDADOS EN UN HOGAR DE
ANCIANOS Y CONVALECENCIA
32. Algunas personas que viven en un
hogar de ancianos o de
convalecencia reciben allí mismo los
cuidados de hospicio que necesitan.
¿Su familiar recibió cuidados
paliativos de este hospicio cuando
vivía en una casa de convalecencia?
Sí
2
No
1
Si contestó No, pase a la
Pregunta 35.
33. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia el equipo del hospicio y el
personal del hogar de ancianos y
convalecencia se pusieron de
acuerdo y acoplaron bien para
proporcionarle los cuidados a su
familiar?
2
3
4
1
Nunca
A veces
2
3
4
Siempre
8
A veces
Nunca
2
A veces
3
La mayoría de las veces
4
Siempre
1
36. Apoyo respecto a sus creencias
religiosas o espirituales incluye
hablar, rezar, momentos de
recogimiento, u otras maneras de
satisfacer sus necesidades religiosas
o espirituales.
Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿cuánto
apoyo recibió usted respecto a sus
creencias religiosas y espirituales por
parte del equipo del hospicio?
Demasiado poco
2
Justo el necesario
3
Demasiado
La mayoría de las veces
Nunca
35. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia el equipo del hospicio le
escuchó a usted con atención?
1
34. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia los informes que el
personal de la casa de convalecencia
le daban sobre su familiar eran
diferentes de los informes que le daba
el equipo del hospicio?
1
SU PROPIA EXPERIENCIA CON EL
CENTRO DE HOSPICIO
37. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿cuánto
apoyo emocional recibió usted del
equipo del hospicio?
Demasiado poco
2
Justo el necesario
3
Demasiado
1
La mayoría de las veces
Siempre
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
38. Durante las semanas posteriores a la
muerte de su familiar, ¿recibió usted
todo el apoyo emocional que usted
quería por parte del equipo del
hospicio?
40. ¿Le recomendaría este hospicio a sus
amigos y familiares?
Definitivamente no
2
Probablemente no
3
Probablemente Sí
4
Definitivamente Sí
1
Demasiado poco
2
Justo el necesario
3
Demasiado
1
CALIFICACIÓN GENERAL DE LOS
CUIDADOS DEL HOSPICIO
SOBRE SU FAMILIAR
41. ¿Cuál es el grado o nivel escolar más
alto que ha completado su familiar?
8 años de escuela o menos
2
Estudios de escuela secundaria,
1
39. Por favor conteste las siguientes
preguntas sobre los cuidados
paliativos que recibió su familiar por
parte del hospicio cuyo nombre
aparece en la portada de esta
encuesta. No incluya en sus
respuestas cuidados proporcionados
por otros centros.
pero sin graduarse
3
secundaria, o diploma de la
secundaria), o su equivalente (o
GED)
4
Usando un número del 0 al 10, el 0
siendo los peores cuidados de
hospicio posibles y 10 los mejores
cuidados paliativos posibles de un
hospicio, ¿qué número usaría para
calificar los cuidados que recibió su
familiar por parte de este hospicio?
0
3
4
5
6
7
8
9
10
1
2
0 Los peores cuidados posibles
de un hospicio
1
2
3
4
5
6
7
8
9
10 Los mejores cuidados posibles
de un hospicio
Graduado de escuela de
Algunos cursos universitarios o un
título universitario de un programa
de 2 años
Título universitario de 4 años
6
Título universitario de más de 4
5
años
7
No sé
42. ¿Su familiar es de origen hispano,
latino o español?
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
No, ni hispano, ni latino, ni español
2
Sí, puertorriqueño
3
Sí, mexicano, mexicano-americano,
1
chicano
Sí, cubano
5
Sí, de otro origen hispano, latino o
4
español
9
43. ¿A qué raza pertenece su familiar?
Marque una o más.
Blanca
2
Negra o afroamericana
3
Asiática
4
Nativa de Hawái u otras Islas del
1
46. ¿Cuál es el grado o nivel escolar más
alto que ha completado?
8 años de escuela o menos
2
Estudios de escuela secundario,
1
pero sin graduarse
3
o diploma de la secundaria), o su
equivalente (o GED)
Pacífico
15
Indígena americana o nativa de
4
Alaska
SOBRE USTED
44. ¿Qué edad tiene usted?
de 18 a 24 años
2
de 25 a 34 años
3
de 35 a 44 años
4
de 45 a 54 años
5
de 55 a 64 años
6
de 65 a 74 años
7
de 75 a 80 años
8
85 años o más
1
Graduado de escuela de secundaria
Algunos cursos universitarios o un
título universitario de un programa
de 2 años
Título universitario de 4 años
6
Título universitario de más de 4
5
años
7
No sé
47. ¿En qué idioma habla usted
principalmente en casa?
Inglés
2
Español
3
Chino
4
Otro idioma:
1
________________________
(Por favor imprima.)
45. ¿Es usted hombre o mujer?
Hombre
2
Mujer
1
10
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
____________________________________________________________
Gracias.
Por favor regrese la encuesta completa en el sobre con el porte o franqueo
pagado.
[NAME OF SURVEY VENDOR]
[ADDRESS OF SURVEY VENDOR]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
11
12
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
CAHPS® Hospice Survey
Por favor conteste las preguntas en esta encuesta sobre la atencion que recibio este
paciente de este hospicio:
NAME OF HOSPICE
Todas las preguntas en esta encuesta se tratan sobre las experiencias de este paciente
con este hospicio.
Si desea saber más sobre este estudio, llama a [TOLL FREE NUMBER}. Todas las
llamadas son gratis.
OMB# XXXX-XXXX
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
13
CAHPS® Hospice Survey
INSTRUCCIONES PARA LA ENCUESTA
Por favor entréguele esta encuesta a la persona de su hogar que sepa más sobre los
cuidados que recibió de este centro la persona cuyo nombre aparece en la carta de
presentación de esta encuesta.
Use un bolígrafo de tinta negra para completar el cuestionario
Marque con una ‘X’ el cuadrito para indicar su respuesta. Vea el siguiente ejemplo:
0
Si
No
Si quiere cambiar una respuesta, tache con una línea el cuadrito que usted quiere cambiar
y en su lugar marque con una ‘X’ el cuadrito que desea escoger, así:
A veces hay que saltarse alguna pregunta. Cuando esto ocurra, una flecha a la derecha
de la respuesta le indicará a qué pregunta hay que pasar. Por ejemplo:
Si
0
14
Si contestó Sí, pase a la Pregunta 1 en la Página 1.
No
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
EL PACIENTE DEL HOSPICIO
1. ¿Qué relación tiene con usted la
persona cuyo nombre aparece en la
carta de presentación de esta
encuesta?
1
0
Es mi esposo/a o pareja
2
0
Es mi padre/madre
3
0
Es mi suegro/a
4
0
Es mi abuelo/a
5
0
Es mi tío/a
6
0
Es mi hermano/a
7
0
Es mi hijo/a
8
0
Es un/a amigo/a
9
0
Otro (Por favor imprima):
________________________
(Por favor imprima)
2. Para esta encuesta, utilizaremos las
palabras “su familiar” para referirnos
a la persona cuyo nombre aparece en
la carta de presentación de esta
encuesta. ¿En qué lugar o lugares
recibió su familiar los cuidados de
este hospicio? Marque uno o más
1
0
En su casa
2
0
En un hogar de asistencia parcial
3
0
En una casa de ancianos y
convalecencia
0
En un hospital
5
0
En un centro u hogar de hospicio
6
0
Otro (Por favor imprima):
__________________
4
SU PAPEL
3. Mientras su familiar estuvo bajo los
cuidados del hospicio, ¿con qué
frecuencia supervisó usted o
participó en dichos cuidados?
1
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
Si contestó Nunca, pase
a la Pregunta 41.
LOS CUIDADOS QUE EL HOSPICIO
PROPORCIONÓ A SU FAMILIAR
Al responder el resto de las preguntas de
esta encuesta, por favor piense sólo en
la experiencia de su familiar con el
hospicio nombrado en la en la portada
de esta encuesta.
4. Para esta encuesta, el equipo del
hospicio incluye a todos los doctores,
enfermeras, trabajadores sociales,
religiosos y demás personas que le
proporcionaron cuidados paliativos a
su familiar.
Mientras su familiar estaba bajo los
cuidados del hospicio, ¿tuvo usted
que ponerse en contacto con el
equipo del hospicio durante la noche,
en fin de semana o en día festivo
porque tenía alguna duda o
necesitaba ayuda para el cuidado de
su familiar?
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
0
Sí
2
0
No
Si contestó No, pase a la
Pregunta 6.
15
5. ¿Con qué frecuencia obtuvo la ayuda
que necesitaba del equipo del
hospicio durante la noche, en fin de
semana o en día festivo?
1
2
3
4
0
Nunca
0
A veces
0
La mayoría de las veces
0
Siempre
6. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo de personal del
hospicio lo mantuvo a usted
informado de cuando iban a llegar a
cuidar a su familiar?
1
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
16
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del hospicio
explicaba las cosas de un modo fácil
de entender?
1
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre.
9. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del hospicio lo
mantenía a usted informado sobre el
estado de su familiar?
0
2
0
3
0
4
0
1
7. Mientras su familiar estaba bajo los
cuidados de este hospicio, cuando
usted o un miembro de su familia le
pedían ayuda al equipo del hospicio,
¿con qué frecuencia obtenían la
ayuda tan pronto como la
necesitaban?
1
8.
Nunca
A veces
La mayoría de las veces
Siempre
10. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia alguien del equipo del
hospicio le dio a usted informes
confusos o contradictorios sobre el
estado o los cuidados de su familiar?
0
2
0
3
0
4
0
1
Nunca
A veces
La mayoría de las veces
Siempre
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
11. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia el equipo del centro
trataba a su familiar con dignidad y
respeto?
0
2
0
3
0
4
0
1
Nunca
1
0
Nunca
A veces
2
0
A veces
La mayoría de las veces
3
0
La mayoría de las veces
Siempre
4
0
Siempre
12. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿con qué
frecuencia sintió usted que al equipo
del hospicio realmente le importaba
su familiar?
0
2
0
3
0
4
0
1
14. ¿Con qué frecuencia el equipo del
hospicio lo escuchó con atención
cuando usted les habló sobre
problemas relacionados con los
cuidados de su familiar?
15. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿tuvo
él/ella algún tipo de dolor?
Nunca
1
0
Sí
2
0
No
A veces
La mayoría de las veces
Siempre
16. ¿Recibió su familiar toda la ayuda que
necesitaba contra el dolor?
13. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿habló usted
con el equipo del hospicio sobre
algún problema relacionado con los
cuidados de su familiar?
1
0
Sí
2
0
No
Si contestó No, pase a la
Pregunta 15.
Si contestó No, pase a la
Pregunta 17.
1
0
Sí, definitivamente
2
0
Sí, más o menos
3
0
No
17. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿le dieron a él
o a ella algún medicamento contra el
dolor?
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
0
Sí
2
0
No
Si contestó No, pase a la
Pregunta 21.
17
18. Entre los efectos secundarios de la
medicina contra el dolor está la
somnolencia. ¿Algún personal del
equipo del hospicio habló con usted
o su familiar sobre los efectos
secundarios del medicamento contra
el dolor?
1
0 Sí, definitivamente
2
0 Sí, más o menos
3
0 No
19. ¿El equipo del hospicio le dio la
capacitación que usted necesitaba
para saber de qué efectos
secundarios del medicamento contra
el dolor tenía usted que estar
pendiente?
1
0 Sí, definitivamente
2
0 Sí, más o menos
3
0 No
20. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber si había que darle a su
familiar más medicamento contra el
dolor y, si sí, cuándo dárselo?
1
0 Sí
2
0
No Si contestó No, pase a la
Pregunta 24.
22. ¿Con qué frecuencia su familiar
recibió la ayuda que necesitaba para
su dificultad para respirar?
1
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
23. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber cómo ayudar a su familiar
si él/ella tenía problemas para
respirar?
1
0
Sí, definitivamente
2
0
Sí, más o menos
1
0 Sí, definitivamente
3
0
No
2
0 Sí, más o menos
4
0
3
0 No
No tuve que ayudar a mi familiar
con problemas para respirar
4
0 No tuve necesidad de dar
medicamentos para el dolor a mi
familiar
18
21. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento tuvo su familiar dificultad
para respirar o recibió tratamiento
para su dificultad para respirar?
24. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento tuvo su familiar problemas
de estreñimiento?
1
0
Sí
2
0
No
Si contestó No, pase a la
Pregunta 26.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
25. ¿Con qué frecuencia su familiar
recibió la ayuda que necesitaba para
sus problemas de estreñimiento?
1
2
3
4
0
Nunca
0
A veces
0
La mayoría de las veces
0
Siempre
26. Mientras su familiar estaba bajo los
cuidados del hospicio, ¿en algún
momento él/ella sitió ansiedad o
tristeza?
1
0
Sí
2
0
No
Si contestó No, pase a la
Pregunta 28.
29. ¿El equipo del hospicio le dio a usted
la capacitación que usted necesitaba
para saber qué hacer si su familiar se
ponía inquieto o agitado?
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
0
Sí
2
0
No
Sí, definitivamente
2
0
Sí, más o menos
3
0
No
1
0
Sí, definitivamente
2
0
Sí, más o menos
3
0
No
4
0
No tuve que mover a mi familiar
31. ¿Le dio el equipo del hospicio tanta
información como usted quería sobre
qué acontecimientos esperar
mientras su familiar estuviera
muriéndose?
28. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿en algún
momento se puso su familiar inquieto
o agitado?
1
0
30. Mover a su familiar incluye acciones
como ayudarlo/a a darse la vuelta en
la cama, o meterse y salir de la cama
o sentarse y levantarse de una silla de
ruedas. ¿El equipo del hospicio le dio
a usted la capacitación que usted
necesitaba para saber cómo mover a
su familiar de manera segura?
27. ¿Con qué frecuencia su familiar
recibió del equipo del hospicio la
ayuda que necesitaba para su
ansiedad o tristeza?
1
1
1
0
Sí, definitivamente
2
0
Sí, más o menos
3
0
No
Si contestó No, pase a la
Pregunta 30.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19
CUIDADOS DE HOSPICIO
BRINDADOS EN UN HOGAR DE
ANCIANOS Y CONVALECENCIA
32. Algunas personas que viven en un
hogar de ancianos o de
convalecencia reciben allí mismo los
cuidados de hospicio que necesitan.
¿Su familiar recibió cuidados
paliativos de este hospicio cuando
vivía en una casa de convalecencia?
1
2
0
Sí
0
No
Si contestó No, pase a la
Pregunta 35.
33. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia el equipo del hospicio y el
personal del hogar de ancianos y
convalecencia se pusieron de
acuerdo y acoplaron bien para
proporcionarle los cuidados a su
familiar?
1
0
Nunca
2
0
A veces
3
0
La mayoría de las veces
4
0
Siempre
SU PROPIA EXPERIENCIA CON EL
CENTRO DE HOSPICIO
35. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia el equipo del hospicio le
escuchó a usted con atención?
1
0
Nunca
2
0
A veces
1
0
Nunca
3
0
La mayoría de las veces
2
0
A veces
4
0
Siempre
3
0
La mayoría de las veces
0
Siempre
4
20
34. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿con qué
frecuencia los informes que el
personal de la casa de convalecencia
le daban sobre su familiar eran
diferentes de los informes que le daba
el equipo del hospicio?
36. Apoyo respecto a sus creencias
religiosas o espirituales incluye
hablar, rezar, momentos de
recogimiento, u otras maneras de
satisfacer sus necesidades religiosas
o espirituales.
Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿cuánto
apoyo recibió usted respecto a sus
creencias religiosas y espirituales por
parte del equipo del hospicio?
1
0
Demasiado poco
2
0
Justo el necesario
3
0
Demasiado
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
37. Mientras su familiar estaba bajo los
cuidados de este hospicio, ¿cuánto
apoyo emocional recibió usted del
equipo del hospicio?
1
0
Demasiado poco
2
0
Justo el necesario
3
0
Demasiado
38. Durante las semanas posteriores a la
muerte de su familiar, ¿recibió usted
todo el apoyo emocional que usted
quería por parte del equipo del
hospicio?
CALIFICACIÓN GENERAL DE LOS
CUIDADOS DEL HOSPICIO
39. Por favor conteste las siguientes
preguntas sobre los cuidados
paliativos que recibió su familiar por
parte del hospicio cuyo nombre
aparece en la portada de esta
encuesta. No incluya en sus
respuestas cuidados proporcionados
por otros centros.
Usando un número del 0 al 10, el 0
siendo los peores cuidados de
hospicio posibles y 10 los mejores
cuidados paliativos posibles de un
hospicio, ¿qué número usaría para
calificar los cuidados que recibió su
familiar por parte de este hospicio?
0 Demasiado poco
2
0 Justo el necesario
1
3
0
0
0
Demasiado
0
0
3
0
4
0
5
0
6
0
7
0
8
0
9
0
10
0
1
2
Los peores cuidados posibles de un
hospicio
1
2
3
4
5
6
7
8
9
10 Los mejores cuidados posibles
de un hospicio
40. ¿Le recomendaría este hospicio a sus
amigos y familiares?
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
0
Definitivamente no
2
0
Probablemente no
3
0
Probablemente Sí
4
0
Definitivamente Sí
21
43. ¿A qué raza pertenece su familiar?
Marque una o más.
SOBRE SU FAMILIAR
41. ¿Cuál es el grado o nivel escolar más
alto que ha completado su familiar?
1
2
3
4
5
6
7
0
0
0
0
Estudios de escuela secundaria,
pero sin graduarse
Graduado de escuela de
secundaria, o diploma de la
secundaria), o su equivalente (o
GED)
2
Título universitario de 4 años
0
Título universitario de más de 4
años
0
No sé
0
Negra o afroamericana
3
0
Asiática
4
0
Nativa de Hawái u otras Islas del
Pacífico
0
Sí, mexicano, mexicano-americano,
chicano
4
0
Sí, cubano
Indígena americana o nativa de
Alaska
SOBRE USTED
44. ¿Qué edad tiene usted?
1
0
de 18 a 24 años
2
0
de 25 a 34 años
3
0
de 35 a 44 años
4
0
de 45 a 54 años
5
0
de 55 a 64 años
6
0
de 65 a 74 años
7
0
de 75 a 80 años
8
0
85 años o más
Sí, puertorriqueño
0
0
2
No, ni hispano, ni latino, ni español
3
5
22
0
Blanca
5
Algunos cursos universitarios o un
título universitario de un programa
de 2 años
0
0
0
8 años de escuela o menos
42. ¿Su familiar es de origen hispano,
latino o español?
1
1
45. ¿Es usted hombre o mujer?
Sí, de otro origen hispano, latino o
español
1
0
Hombre
2
0
Mujer
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
46. ¿Cuál es el grado o nivel escolar más
alto que ha completado?
47. ¿En qué idioma habla usted
principalmente en casa?
1
0
8 años de escuela o menos
1
0
Inglés
2
0
Estudios de escuela secundario,
pero sin graduarse
2
0
Español
3
0
Chino
4
0
Otro idioma:
3
0
Graduado de escuela de secundaria
o diploma de la secundaria), o su
equivalente (o GED)
4
0
Algunos cursos universitarios o un
título universitario de un programa
de 2 años
5
0
Título universitario de 4 años
6
0
Título universitario de más de 4
años
7
0
No sé
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
________________________
(Por favor imprima.)
23
____________________________________________________________
Gracias.
Por favor regrese la encuesta completa en el sobre con el porte o franqueo
pagado.
[NAME OF SURVEY VENDOR]
[ADDRESS OF SURVEY VENDOR]
24
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Sample Initial Cover Letter for the CAHPS Hospice Survey
[HOSPICE OR VENDOR LETTERHEAD]
[HOSPICE OR VENDOR LETTERHEAD]
[SAMPLED CAREGIVER NAME]
[ADDRESS]
[CITY, STATE ZIP]
Estimado/a [SAMPLED CAREGIVER NAME]:
[HOSPICE NAME] está llevando a cabo una encuesta sobre los servicios de cuidados paliativos que los
pacientes y sus familias reciben. Se le ha seleccionado a usted para este estudio porque ha sido
identificado como la persona encargada del cuidado de [DECEDENT NAME]. Entendemos que éste debe
de ser un momento difícil para usted, pero esperamos que pueda ayudarnos a conocer la calidad de la
atención que usted y su familiar o amigo recibieron del hospicio.
Las preguntas [NOTE THE QUESTION NUMBERS] del cuestionario adjunto son parte de una iniciativa
nacional patrocinada por el Departamento de Salud y Servicios Humanos (HHS) de los Estados Unidos
para evaluar la calidad de la atención de los hospicios. Los Centros de Servicios de Medicare y Medicaid
(CMS, por sus siglas en inglés), que es una parte del HHS, está realizando esta encuesta con el fin de
mejorar los cuidados paliativos. El CMS paga la mayoría de los cuidados paliativos de los EE.UU. El
CMS tiene la responsabilidad de garantizar que los pacientes de los hospicios así como los miembros de
su familia y amigos reciban atención de alta calidad. Una de las maneras en que puede cumplir con esta
responsabilidad es enterarse directamente por usted de la calidad de los cuidados paliativos que recibió su
familiar o amigo. Su participación es voluntaria y no afectará los beneficios o la atención médica que
usted recibe.
Esperamos que se tome el tiempo para contestar la encuesta. Después de haber llenado la encuesta, por
favor envíela en el sobre con el porte o franqueo pagado. Sus respuestas se combinarán con las de otras
personas y, en conjunto, se compartirán con el hospicio con el fin de mejorar la calidad. [OPTIONAL:
Podrá ver que hay un número en la encuesta. Ese número sirve para que sepamos si usted devolvió la
encuesta y así no tengamos que enviarle recordatorios.]
Si tiene alguna pregunta sobre la encuesta adjunta, no dude en llamarnos a nuestro número gratuito
1-800-XXX-XXXX.
Gracias por ayudar a mejorar los cuidados paliativos para todos los consumidores.
Atentamente,
[HOSPICE ADMINISTRATOR]
[HOSPICE NAME]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
25
26
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Sample Follow-up Cover Letter for the CAHPS Hospice Survey
[HOSPICE OR VENDOR LETTERHEAD]
[HOSPICE OR VENDOR LETTERHEAD]
[SAMPLED CAREGIVER NAME]
[ADDRESS]
[CITY, STATE ZIP]
Estimado/a [SAMPLED CAREGIVER NAME]:
Nuestros registros indican que recientemente usted fue una de las personas encargadas del cuidado de
[DECEDENT NAME] en [NAME OF HOSPICE]. Hace aproximadamente tres semanas, le enviamos una
encuesta sobre la atención que usted y su familiar o amigo recibieron en ese hospicio. Si ya nos devolvió
la encuesta, por favor acepte nuestras disculpas y haga caso omiso de esta carta. Si no lo ha hecho ya, le
agradeceríamos que se tomara el tiempo de contestar este importante cuestionario.
Esperamos que usted aproveche esta oportunidad para ayudarnos a saber qué calidad de atención recibió
su familiar o amigo. Los resultados de esta encuesta se utilizarán para ayudar a garantizar que todos los
estadounidenses reciban la más alta calidad de cuidados paliativos.
Las preguntas [NOTE THE QUESTION NUMBERS] del cuestionario adjunto son parte de una iniciativa
nacional patrocinada por el Departamento de Salud y Servicios Humanos (HHS) de los Estados Unidos
para evaluar la calidad de la atención de los hospicios. Su participación es voluntaria y no afectará los
beneficios o la atención médica que usted recibe.
Por favor, tómese unos minutos para contestar la encuesta adjunta. Después de haber llenado la encuesta,
por favor envíela en el sobre con el porte o franqueo pagado. Sus respuestas se combinarán con las de
otras personas y, en conjunto, se compartirán con el hospicio con el fin de mejorar la calidad.
[OPTIONAL: Podrá ver que hay un número en la encuesta. Ese número sirve para que sepamos si usted
devolvió la encuesta y así no tengamos que enviarle recordatorios.]
Si tiene alguna pregunta sobre la encuesta adjunta, no dude en llamarnos a nuestro número gratuito
1-800-XXX-XXXX.
Gracias por ayudar a mejorar los cuidados paliativos para todos los consumidores.
Atentamente,
[HOSPICE ADMINISTRATOR]
[HOSPICE NAME]
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
27
28
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Appendix O
CAHPS® Hospice Survey
Telephone Script (English)
Appendix O
CAHPS® Hospice Survey
Telephone Script (English)
Overview
This telephone interview script is provided to assist interviewers while attempting to
reach the caregiver of the sampled decedent. The script explains the purpose of the
survey and confirms necessary information about the caregiver and decedent.
General Interviewing Conventions and Instructions
• The telephone introduction script must be read verbatim
• All text that appears in lowercase letters must be read out loud
• Text in UPPERCASE letters must not be read out loud, however, YES and NO
response options are to be read if necessary
• All questions and all answer categories must be read exactly as they are worded
• No changes are permitted to the order of the question and answer categories for
the “Core,” “About Your Family” and “About You” CAHPS Hospice Survey
questions
o The first forty “ Core” questions must remain together
o The next three “About Your Family” questions must remain together and the
last four questions “About You” questions must remain together
• All transitional statements must be read
• Text that is underlined must be emphasized
• Characters in < > must not be read
• [Square brackets] are used to show programming instructions that must not
actually appear on electronic telephone interviewing system screens
• Only one language (i.e., English or Spanish) must appear on the electronic
interviewing system screen
• MISSING/DON’T KNOW (DK) is a valid response option for each item in the
electronic telephone interviewing system scripts. This allows the telephone
interviewer to go to the next question if a patient is unable to provide a response
for a given question (or refuses to provide a response). In the survey file layouts, a
value of MISSING/DK is coded as “M – Missing/Don't know.”
• Skip patterns should be programmed into the electronic telephone interviewing
system
o Appropriately skipped questions should be coded as “88 - Not applicable.”
For example, if a patient answers “No” to Question 4 of the CAHPS Hospice
Survey, the program should skip Question 5, and go to Question 6. Question 5
must then be coded as “88 - Not applicable.” Coding may be done
automatically by the telephone interviewing system or later during data
preparation.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
1
o
When a response to a screener question is not obtained, the screener question
and any questions in the skip pattern should be coded as “M - Missing/Don't
know.” For example, if the patient does not provide an answer to Question 4
of the CAHPS Hospice Survey and the interviewer selects “M –
Missing/Don’t Know” to Question 4, then the telephone interviewing system
should be programmed to skip Question 5, and go to Question 6. Question 5
must then be coded as “M - Missing/Don't know.” Coding may be done automatically
by the telephone interviewing system or later during data preparation.
INITIATING CONTACT
START: Hello, may I please speak to [SAMPLED CAREGIVER NAME]?
<1> YES [GO TO INTRO]
<2> PROXY IDENTIFIED – [COLLECT PROXY INFORMATION
THEN RETURN TO INTRO]
<3> NO, REFUSAL [GO TO REFUSAL]
<4> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
<5> ALREADY RETURNED SURVEY BY MAIL [GO TO MAILED]
<6> PATIENT DIDN’T RECEIVE CARE AT NAMED HOSPICE [GO
TO DISAVOWAL]
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from [VENDOR NAME].
We are working with [HOSPICE NAME] and the U.S. Department of
Health and Human Services to conduct a survey about hospice care.
IF THE SAMPLED CAREGIVER IS NOT AVAILABLE:
Can you tell me a convenient time to call back to speak with
(him/her)?
IF THE SAMPLED CAREGIVER SAYS THIS IS NOT A GOOD TIME:
If you don’t have the time now, when is a more convenient time to call
you back?
IF SOMEONE OTHER THAN THE SAMPLED CAREGIVER ANSWERS THE
PHONE RECONFIRM THAT YOU ARE SPEAKING WITH THE SAMPLED
CAREGIVER WHEN HE OR SHE PICKS UP.
******
2
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
INITIATING CONTACT WITH A PROXY RESPONDENT
START: Hello, may I please speak to [PROXY CAREGIVER NAME]?
<1> YES [GO TO INTRO]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from [VENDOR NAME].
We are working with [HOSPICE NAME] and the U.S. Department of
Health and Human Services to conduct a survey about hospice care.
IF THE PROXY CAREGIVER IS NOT AVAILABLE:
Can you tell me a convenient time to call back to speak with
(him/her)?
IF THE PROXY CAREGIVER SAYS THIS IS NOT A GOOD TIME:
If you don’t have the time now, when is a more convenient time to call
you back?
IF SOMEONE OTHER THAN THE PROXY CAREGIVER ANSWERS THE
PHONE RECONFIRM THAT YOU ARE SPEAKING WITH THE PROXY
CAREGIVER WHEN HE OR SHE PICKS UP.
******
CALL BACK TO COMPLETE A PREVIOUSLY STARTED SURVEY
START:
Hello, may I please speak to [SAMPLED CAREGIVER NAME/PROXY
CAREGIVER NAME]?
<1> YES [GO TO CONFIRM RESPONDENT]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING: This is [INTERVIEWER NAME]
calling from [SURVEY VENDOR]. Is [SAMPLED CAREGIVER
NAME/PROXY CAREGIVER NAME] available to complete
survey that [HE/SHE] started at an earlier date?
CONFIRM RESPONDENT: Before we continue with the survey, I would like to
confirm that I speaking with [SAMPLED CAREGIVER NAME/PROXY
CAREGIVER NAME].
CONTINUE SURVEY WHERE PREVIOUSLY LEFT OFF.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
3
SPEAKING WITH CAREGIVER
INTRO
Hi, my name is [INTERVIEWER NAME] and I’m calling from the
[VENDOR NAME].
[HOSPICE NAME] is conducting a survey about the hospice services
that patients and their families receive. It is part of a national
initiative sponsored by the United States Department of Health and
Human Services (HHS) to measure the quality of care in hospices.
We realize this may be a difficult time for you, but we hope that you
will take a few minutes to help us learn about the quality of hospice
care that you and your loved one received.
Your participation is voluntary and will not affect any health care or
benefits you receive. The interview will take [FILL: approximately 11
minutes /OR SURVEY VENDOR SPECIFY]. Your answers will be
combined with other respondents and shared with the hospice for
purposes of quality improvement.
IF ASKED WHETHER SOMEONE ELSE CAN SERVE AS PROXY
FOR SAMPLED CAREGIVER:
For this survey, we need to speak to the person in your household who is
the most knowledgeable, ONCE THE MOST KNOWLEDGEABLE
PERSON’S NAME IS PROVIDED: [Is he/she OR are you] the most
knowledgeable about the hospice care received by [DECEDENT NAME]
IF
NEEDED AND SPEAKING WITH THE SAMPLED
CAREGIVER: We received your name from [HOSPICE
NAME] because you were listed as the caregiver for
[DECEDENT NAME].
IF NEEDED AND SPEAKING WITH PROXY FOR SAMPLED
CAREGIVER: We received your name from [SAMPLED
CAREGIVER] because he/she indicated that you were
knowledgeable about the hospice care received by [DECEDENT
NAME].
<1> YES – [GO TO CONTINUE]
<2> PROXY IDENTIFIED – [COLLECT PROXY INFORMATION
THEN RETURN TO PROXY INTRO]
<3> NO WILL RETURN COMPLETED MAILED SURVEY – [GO TO
CALLBACK]
<4> NO, CALL BACK - [GO TO CALLBACK]
<5> NO, R UNAVAILABLE DURING FIELD PERIOD – [GO TO
ITEM TO CODE ILL, ETC.]
4
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
<6> REFUSE – [GO TO REFUSAL]
<7> ALREADY RETURNED SURVEY BY MAIL [GO TO MAILED]
<8> NOT INVOLVED IN CARE AND NO PROXY IDENTIFIED [GO
TO INELIGIBLE]
<9> PATIENT DIDN’T RECEIVE CARE AT NAMED HOSPICE [GO
TO DISAVOWAL]
**************
CONTINUE
This call may be monitored [OPTIONAL: and/or recorded] for quality
improvement purposes. May we begin?
<1> YES – [BEGIN SURVEY]
<2> NO, CALL BACK - [GO TO CALLBACK]
<3> REFUSE – [GO TO REFUSAL]
**************
MAILED
Thank you so much for completing the survey by mail. Perhaps we
still have not gotten it but we’ll check our records again. We may need
to contact you again in case we still have not received it. [END CALL]
**************
INELIGIBLE4 I’m sorry, for this project we are only speaking with family members
or friends who took part in or oversaw hospice care for their family
members. Thank you for your time. Have a good (day/evening). [END
CALL]
**************
DISAVOWAL
Perhaps there was an error in our records. Thank you for your time.
Have a good (day/evening). [END CALL]
BEGIN CAHPS HOSPICE SURVEY QUESTIONS
Q1_INTRO
Please answer all questions in this survey about the care the patient
received at [HOSPICE NAME]. When thinking about your answers, do
not include any other hospice stays.
BE PREPARED TO PROBE IF THE PATIENT ANSWERS OUTSIDE
OF THE ANSWER CATEGORIES PROVIDED. PROBE BY
REPEATING THE ANSWER CATEGORIES ONLY; DO NOT
INTERPRET FOR THE PATIENT.
Centers for Medicare & Medicaid Services
CAHPS Hospice Survey Quality Assurance Guidelines V1.0
5
Q1
Q1A
How are you related to [DECEDENT NAME]?
<1> MY SPOUSE OR PARTNER
<2> MY PARENT
<3> MY MOTHER-IN-LAW
OR FATHER-IN-LAW
<4> MY GRANDPARENT
<5> MY AUNT OR UNCLE
<6> MY SISTER OR BROTHER
<7> MY CHILD
<8> MY FRIEND
<9> OTHER (PLEASE SPECIFY)
[GO TO Q2]
[GO TO Q2]
MISSING/DK
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q1A]
How are you related to [DECEDENT NAME]?
[NOTE: PLEASE DOCUMENT THE RELATIONSHIP AND MAINTAIN IN YOUR
INTERNAL RECORDS.]
Q2
For this survey, the phrase “family member” refers to [DECEDENT
NAME]. In what locations did your family member receive care from
[HOSPICE NAME]? Please answer yes or no to each of the categories.
Q2A
At home?
<1> YES
<0> NO
MISSING/DK
Q2B
At an assisted living facility?
<1> YES
<0> NO
MISSING/DK
Q2C
At a nursing home?
<1> YES
<0> NO
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q2D
At a hospital?
<1> YES
<0> NO
MISSING/DK
Q2E
At a hospice facility or hospice house?
<1> YES
<0> NO
MISSING/DK
Q2F
At some other place?
<1> YES
<0> NO
[GO TO Q2F]
[GO TO Q3]
MISSING/DK [GO TO Q3]
Q2G
Where did your family member receive care?
[NOTE: PLEASE DOCUMENT THE OTHER PLACE AND MAINTAIN IN YOUR
INTERNAL RECORDS.]
Q3
While your family member was in hospice care, how often did you take
part in or oversee care for him or her? Would you say:
<1>
<2>
<3>
<4>
Never, [GO TO Q41_INTRO]
Sometimes,
Usually, or
Always?
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
7
Q4_INTRO
As you answer the rest of the questions in this survey, please think only
about your family member's experience with [HOSPICE NAME]
Q4
For this survey, the hospice team includes all the nurses, doctors, social
workers, chaplains and other people who provided hospice care to your
family member. While your family member was in hospice care, did you
need to contact the hospice team during evenings, weekends, or holidays
for questions or help with your family member’s care?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q6]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q6]
Q5
How often did you get the help you needed from the hospice team during
evenings, weekends, or holidays? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q6
While your family member was in hospice care, how often did the hospice
team keep you informed about when they would arrive to care for your
family member? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
8
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q7
While your family member was in hospice care, when you or your family
member asked for help from the hospice team, how often did you get help
as soon as you needed it? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q8
While your family member was in hospice care, how often did the hospice
team explain things in a way that was easy to understand? Would you
say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q9
While your family member was in hospice care, how often did the hospice
team keep you informed about your family member’s condition? Would
you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q10
While your family member was in hospice care, how often did anyone
from the hospice team give you confusing or contradictory information
about your family member’s condition or care? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
9
Q11
While your family member was in hospice care, how often did the hospice
team treat your family member with dignity and respect? Would you
say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q12
While your family member was in hospice care, how often did you feel
that the hospice team really cared about your family member? Would you
say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q13
While your family member was in hospice care, did you talk with the
hospice team about any problems with your family member’s hospice
care?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q15]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q15]
Q14.
How often did the hospice team listen carefully to you when you talked
with them about problems with your family member’s hospice care?
Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
10
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q15
While your family member was in hospice care, did he or she have any
pain?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q17]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q17]
Q16
Did your family member get as much help with pain as he or she needed?
Would you say…
<1> Yes, definitely,
<2> Yes, somewhat, or
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q17
While your family member was in hospice care, did he or she receive any
pain medicine?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q21]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q21]
Q18
Side effects of pain medicine include things like sleepiness. Did any
member of the hospice team discuss side effects of pain medicine with
you or your family member? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat, or
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
11
Q19
Did the hospice team give you the training you needed about what side
effects to watch for from pain medicine? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat, or
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q20
Did the hospice team give you the training you needed about if and when
to give more pain medicine to your family member? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat,
<3> No, or
<4> I did not need to give pain medicine to my family member.
[<88> NOT APPLICABLE]
MISSING/DK
Q21
While your family member was in hospice care, did your family member
ever have trouble breathing or receive treatment for trouble breathing?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q24]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q24]
Q22
How often did your family member get the help he or she needed for
trouble breathing? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q23
Did the hospice team give you the training you needed about how to help
your family member if he or she had trouble breathing? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat,
<3> No, or
<4> I did not need to help my family member with trouble breathing.
[<88> NOT APPLICABLE]
MISSING/DK
Q24
While your family member was in hospice care, did your family member
ever have trouble with constipation?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q26]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q26]
Q25
How often did your family member get the help he or she needed for
trouble with constipation? Would you say...
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q26
While your family member was in hospice care, did he or she show any
feelings of anxiety or sadness?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q28]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q28]
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13
Q27
How often did your family member get the help he or she needed from the
hospice team for feelings of anxiety or sadness? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q28
While your family member was in hospice care, did he or she ever
become restless or agitated?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q30]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q30]
Q29
Did the hospice team give you the training you needed about what to do if
your family member became restless or agitated? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat, or
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q30
Moving your family member includes things like helping him or her turn
over in bed, or get in and out of bed or a wheelchair. Did the hospice team
give you the training you needed about how to safely move your family
member? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat,
<3> No, or
<4> I did not need to move my family member.
[<88> NOT APPLICABLE]
MISSING/DK
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Q31
Did the hospice team give you as much information as you wanted about
what to expect while your family member was dying? Would you say…
<1> Yes, definitely,
<2> Yes, somewhat, or
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q32
Some people receive hospice care while they are living in a nursing home.
Did your family member receive care from this hospice while he or she
was living in a nursing home?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
[GO TO Q35]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q35]
Q33
While your family member was in hospice care, how often did the nursing
home staff and hospice team work well together to care for your family
member? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q34
While your family member was in hospice care, how often was the
information you were given about your family member by the nursing
home staff different from the information you were given by the hospice
team? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
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15
Q35_INTRO The next set of questions is about you.
Q35
While your family member was in hospice care, how often did the hospice
team listen to you? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
[<88> NOT APPLICABLE]
MISSING/DK
Q36
Support for religious or spiritual beliefs includes talking, praying, quiet
time, or other ways of meeting your religious or spiritual needs. While
your family member was in hospice care, how much support for your
religious and spiritual beliefs did you get from the hospice team? Would
you say…
<1> Too little,
<2> The right amount, or
<3> Too much?
[<88> NOT APPLICABLE]
MISSING/DK
Q37
While your family member was in hospice care, how much emotional
support did you get from the hospice team? Would you say…
<1> Too little,
<2> The right amount, or
<3> Too much?
[<88> NOT APPLICABLE]
MISSING/DK
Q38
In the weeks after your family member died, how much emotional support
did you get from the hospice team? Would you say…
<1> Too little,
<2> The right amount, or
<3> Too much?
[<88> NOT APPLICABLE]
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q39
Please answer the following questions about your family member’s care
from [HOSPICE NAME]. Do not include care from other hospices in your
answers.
Using any number from 0 to 10, where 0 is the worst hospice care possible
and 10 is the best hospice care possible, what number would you use to
rate your family member’s hospice care?
IF THE RESPONDENT DOES NOT PROVIDE AN APPROPRIATE
RESPONSE, PROBE BY REPEATING: Using any number from 0 to 10,
where 0 is the worst hospice care possible and 10 is the best hospice care
possible, what number would you use to rate your family member’s
hospice care?
<0> 0
<1> 1
<2> 2
<3> 3
<4> 4
<5> 5
<6> 6
<7> 7
<8> 8
<9> 9
<10> 10
[<88> NOT APPLICABLE]
MISSING/DK
Q40
Would you recommend this hospice to your friends and family? Would
you say…
<1> Definitely no,
<2> Probably no,
<3> Probably yes, or
<4> Definitely yes?
[<88> NOT APPLICABLE]
MISSING/DK
Q41_INTRO The next questions are about your family member.
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
17
Q41
What is the highest grade or level of school that your family member
completed? Did he or she…
READ ANSWER CHOICES ONLY IF NECESSARY
<1> Complete 8th grade or less,
<2> Complete some high school, but did not graduate,
<3> Graduate from high school or earn a GED,
<4> Complete some college or earn a 2-year degree,
<5> Graduate from a 4-year college, or
<6> Complete more than 4-year college degree?
<7> Respondent indicates that he or she does not know family member’s
level of education
MISSING
ACADEMIC TRAINING BEYOND A HIGH SCHOOL DIPLOMA
THAT DOES NOT LEAD TO A BACHELORS DEGREE SHOULD BE
CODED AS 4. IF THE RESPONDENT DESCRIBES NON-ACADEMIC
TRAINING, SUCH AS TRADE SCHOOL, PROBE TO FIND OUT IF
THE FAMILY MEMBER HAS A HIGH SCHOOL DIPLOMA AND
CODE 2 OR 3, AS APPROPRIATE.
Q42
Was your family member of Hispanic, Latino, or Spanish origin or
descent?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
YES
<1> NO
MISSING/DK
IF YES: Would you say you are (READ ALL RESPONSE CHOICES)
<2> Puerto Rican,
<3> Mexican, Mexican American, Chicano/a,
<4> Cuban, or
<5> Other Spanish/Hispanic/Latino?
MISSING/DK
18
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
[FOR TELEPHONE INTERVIEWING, QUESTION 43 IS BROKEN INTO PARTS AE]
READ ALL RACE CATEGORIES PAUSING AT EACH RACE
CATEGORY TO ALLOW PATIENT TO REPLY TO EACH RACE
CATEGORY.
IF THE RESPONDENT REPLIES, “WHY ARE YOU ASKING ABOUT
MY FAMILY MEMBER’S RACE?:” We ask about your family
member’s race for demographic purposes. We want to makes sure that the
people we include accurately represent the racial diversity in this country.
IF THE RESPONDENT REPLIES, “I ALREADY TOLD YOU ABOUT
MY FAMILY MEMBER’S RACE”:
I understand, however the survey requires me to ask about all races so
results can include people who are multiracial. If the race does not apply
to your family member please answer no. Thanks for your patience.
Q43
When I read the following, please tell me if the category describes your
family member’s race. I am required to read all five categories. Please
answer yes or no to each of the categories.
Q43A
Was your family member White?
<1> YES/WHITE
<2> NO/NOT WHITE
MISSING/DK
Q43B
Was your family member Black or African American?
<1> YES/BLACK OR AFRICAN AMERICAN
<2> NO/NOT BLACK OR AFRICAN AMERICAN
MISSING/DK
Q43C
Was your family member Asian?
<1> YES/ASIAN
<2> NO/NOT ASIAN
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19
Q43D
Was your family member Native Hawaiian or other Pacific Islander?
<1> YES/NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
<2> NO/NOT NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
MISSING/DK
Q43E
Was your family member American Indian or Alaska Native?
<1> YES/AMERICAN INDIAN OR ALASKA NATIVE
<2> NO/NOT AMERICAN INDIAN OR ALASKA NATIVE
MISSING/DK
Q44_INTRO The next questions are about you.
Q44
What is your age?
READ ANSWER CHOICES ONLY IF NECESSARY
<1> 18 to 24
<2> 25 to 34
<3> 35 to 44
<4> 45 to 54
<5> 55 to 64
<6> 65 to 74
<7> 75 to 84
<8> 85 or older
MISSING/DK
Q45
INTERVIEWER ASK ONLY IF NEEDED: Are you male or female?
<1> MALE
<2> FEMALE
MISSING/DK
20
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q46
What is the highest grade or level of school that you have completed? Did
you…
READ ANSWER CHOICES ONLY IF NECESSARY
<1> Complete 8th grade or less,
<2> Complete some high school, but did not graduate,
<3> Graduate from high school or earn a GED,
<4> Complete some college or earn a 2-year degree,
<5> Graduate from a 4-year college, or
<6> Complete more than 4-year college degree?
MISSING/DK
ACADEMIC TRAINING BEYOND A HIGH SCHOOL DIPLOMA
THAT DOES NOT LEAD TO A BACHELORS DEGREE SHOULD BE
CODED AS 4. IF THE RESPONDENT DESCRIBES NON-ACADEMIC
TRAINING, SUCH AS TRADE SCHOOL, PROBE TO FIND OUT IF
SHE/HE HAS A HIGH SCHOOL DIPLOMA AND CODE 2 OR 3, AS
APPROPRIATE.
Q47
What language do you mainly speak at home? Please listen to all three
response choices before you answer. Would you say that you mainly
speak…
<1> English,
<2> Spanish,
<3> Chinese, or
<4> Some other language?
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO Q47A]
MISSING/DK
[GO TO END]
IF THE PATIENT REPLIES WITH MULTIPLE LANGUAGES,
PROBE:
Would you say that you mainly speak [LANGUAGE A] or [LANGUAGE
B]?
IF THE PATIENT REPLIES THAT THEY SPEAK AMERICAN
PLEASE CODE AS 1-ENGLISH.
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21
Q47A
What other language do you mainly speak at home?
[NOTE: PLEASE DOCUMENT THE OTHER LANGUAGE AND
MAINTAIN IN YOUR INTERNAL RECORDS]
END
Those are all the questions I have. Thank you for your time. [OPTIONAL:
Should you like the number for bereavement support at [HOSPICE
NAME], I can provide that to you now.]
INTERVIEWER: PROVIDE CONTACT INFORMATION AS NEEDED
Have a good (day/evening). [END CALL]
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Appendix P
CAHPS® Hospice Survey
Telephone Script (Spanish)
Appendix P
CAHPS® Hospice Survey
Telephone Script (Spanish)
Overview
This telephone interview script is provided to assist interviewers while attempting to reach the
caregiver of the sampled decedent. The script explains the purpose of the survey and confirms
necessary information about the caregiver and decedent.
General Interviewing Conventions and Instructions
• The telephone introduction script must be read verbatim
• All text that appears in lowercase letters must be read out loud
• Text in UPPERCASE letters must not be read out loud, however, YES and NO response
options are to be read if necessary
• All questions and all answer categories must be read exactly as they are worded
• No changes are permitted to the order of the question and answer categories for the
“Core”, “About Your Family” and “About You” CAHPS Hospice Survey questions
o The first forty “Core” questions must remain together
o The next three “About Your Family” questions must remain together and the
last four questions “About You” questions must remain together
• All transitional statements must be read
• Text that is underlined must be emphasized
• Characters in <> must not be read
• [Square brackets] are used to show programming instructions that must not actually
appear on electronic telephone interviewing system screens
• Only one language (i.e., English or Spanish) must appear on the electronic
interviewing system screen
• MISSING/DON’T KNOW (DK) is a valid response option for each item in the electronic
telephone interviewing system scripts. This allows the telephone interviewer to go to the
next question if a patient is unable to provide a response for a given question (or refuses
to provide a response). In the survey file layouts, a value of MISSING/DK is coded as
“M – Missing/Don't know.”
• Skip patterns should be programmed into the electronic telephone interviewing system
o Appropriately skipped questions should be coded as “88 - Not applicable.” For
example, if a patient answers “No” to Question 4 of the CAHPS Hospice Survey, the
program should skip Question 5, and go to Question 6. Question 5 must then be
coded as “88 - Not applicable.” Coding may be done automatically by the telephone
interviewing system or later during data preparation.
o When a response to a screener question is not obtained, the screener question and any
questions in the skip pattern should be coded as “M - Missing/Don't know.” For
example, if the patient does not provide an answer to Question 4 of the CAHPS
Hospice Survey and the interviewer selects “M – Missing/Don’t Know” to Question 4,
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1
then the telephone interviewing system should be programmed to skip Question 5,
and go to Question 6. Question 5 must then be coded as “M - Missing/Don't know.”
Coding may be done automatically by the telephone interviewing system or later
during data preparation.
INICIANDO CONTACTO
INICIO: Buenos(as) días(tardes/noches), ¿podría hablar con [SAMPLED CAREGIVER
NAME]?
<1>
SÍ [GO TO INTRO]
<2>
PROXY IDENTIFICADO – [COLLECT PROXY INFORMATION
THEN RETURN TO INTRO]
<3>
NO, NEGATIVA [GO TO REFUSAL]
<4>
NO, NO ESTÁ DISPONIBLE EN ESTE MOMENTO [SET
CALLBACK]
<5>
YA HA VUELTO ENCUESTAS POR CORREO [GO TO MAILED]
<6>
PACIENTE NO RECIBIÓ ATENCIÓN EN EL HOSPICIO NOMBRADO
[GO TO DISAVOWAL]
SI LE PREGUNTAN QUIÉN LLAMA:
Soy [INTERVIEWER NAME] de [VENDOR NAME].Estamos trabajando con
[HOSPICE NAME] y con el Departamento de Salud y Servicios Humanos de los
Estados Unidos para realizar un estudio sobre los cuidados de hospicio.
SI EL CUIDADOR/PERSONA ENCARGADA DEL CUIDADO DEL PACIENTE
NO ESTÁ O NO PUEDE ATENDER LA LLAMADA:
¿Puede decirme a qué hora es conveniente llamar para hablar con él/ella?
SI EL CUIDADOR MUESTRA O DICE QUE NO ES UN BUEN MOMENTO:
Si usted no tiene tiempo ahora, ¿cuándo es más conveniente que vuelva a
llamarle?
SI CONTESTA EL TELÉFONO ALGUIEN QUE NO SEA EL CUIDADOR/PERSONA
QUE CUIDA DE PACIENTE, CUANDO ÉSTE TOME LA LLAMADA, CONFIRME QUE
EFECTIVAMENTE USTED ESTÁ HABLANDO CON LA PERSONA INDICADA.
******
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INICIANDOCONTACTO CON UN ENTREVISTADO PROXY
INICIO: Buenos(as) días (tardes/noches), ¿podría hablar con [PROXY CAREGIVER
NAME]?
<1>
SÍ [GO TO INTRO]
<2>
NO [GO TO REFUSAL]
<3>
NO, NO ESTÁ DISPONIBLE EN ESTE MOMENTO [SET
CALLBACK]
SI LE PREGUNTAN QUIÉN LLAMA:
Soy [INTERVIEWER NAME] de [VENDOR NAME]. Estamos trabajando con
[HOSPICE NAME] y con el Departamento de Salud y Servicios Humanos de los
Estados Unidos para realizar un estudio sobre los cuidados de hospicio.
SI EL CUIDADOR PROXYNO ESTÁ O NO PUEDE ATENDER LA
LLAMADA:
¿Puede decirme a qué hora es conveniente llamar para hablar con él(ella)?
SI EL CUIDADOR PROXY DICE QUE NO ES UN BUEN MOMENTO:
Si usted no tiene tiempo ahora, ¿cuándo es más conveniente que vuelva a
llamarle?
SI CONTESTA EL TELÉFONO ALGUIEN QUE NO SEA EL CUIDADOR PROXY,
CUANDO ÉSTE TOME LA LLAMADA, CONFIRME QUE EFECTIVAMENTE USTED
ESTÁ HABLANDO CON EL CUIDADOR PROXY.
******
NUEVA LLAMADA PARA TERMINAR LA ENCUESTA INICIADA
ANTERIORMENTE
INICIO: Buenos(as) días(tardes/noches), ¿podría hablar con [SAMPLED CAREGIVER
NAME/PROXY CAREGIVER NAME]?
<1>
SÍ [GO TO CONFIRM RESPONDENT]
<2>
NO [REFUSAL]
<3>
NO, NO ESTÁ DISPONIBLE EN ESTE MOMENTO [SET
CALLBACK]
SI LE PREGUNTAN QUIÉN LLAMA: Soy [INTERVIEWER NAME], y llamo de
[VENDOR NAME]. ¿Puedo hablar con [SAMPLED CAREGIVER
NAME/PROXY CAREGIVER NAME] para terminar una encuesta que empecé
con él(ella) hace poco?
CONFIRMAR QUE ES EL ENTREVISTADO: Antes de continuar con la encuesta,
quisiera confirmar que efectivamente estoy hablando con [SAMPLED CAREGIVER
NAME/PROXY CAREGIVER NAME].
CONTINUAR CON LA ENCUESTA DONDE SE DEJÓ.
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3
******
HABLANDO CON EL CUIDADOR
INTRODUCCIÓN — Buenos(as) días(tardes/noches); soy [INTERVIEWER NAME], y llamo
de [VENDOR NAME].
[HOSPICE NAME] está llevando a cabo una encuesta sobre los servicios que
reciben los pacientes y sus familias en el hospicio. Esta encuesta es parte de una
iniciativa nacional patrocinada por el Departamento de Salud y Servicios Humanos
de los Estados Unidos (HHS, por sus siglas en inglés) para evaluar la calidad de la
atención en los hospicios. Estamos conscientes de que éste debe de ser un momento
difícil para usted, pero esperamos que nos dedique unos minutos para ayudarnos a
conocer la calidad de la atención que usted y su familiar o amigo recibieron en el
hospicio.
Su participación es voluntaria y no afectará los beneficios o la atención médica que
usted recibe. La entrevista durará [FILL: aproximadamente 10 minutos /OR
SURVEY VENDOR SPECIFY]. Sus respuestas se combinarán con las de otros
encuestados y, en conjunto, se compartirán con el hospicio con el fin de
mejoramiento de la calidad.
SI LE PREGUNTAN SI OTRA PERSONA PUEDE SERVIR DE PROXY DEL
CUIDADOR MUESTRA:
Para este estudio, tenemos que hablar con la persona de su hogar que esté más
enterada, UNA VEZ QUE LE DEN EL NOMBRE DE LA PERSONA QUE
ESTÁ MÁS AL TANTO: ¿Puede decirme si es él(ella OR usted) la persona que
está más enterada y al tanto de los cuidados paliativos/de hospicio que recibió
[DECEDENT NAME]?
SI ES NECESARIO, Y HABLA CON EL CUIDADOR MUESTRA: Nos dieron
su nombre en el [HOSPICE NAME] porque usted aparecía en sus registros
como la persona encargada del cuidado de [DECEDENT NAME].
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SI ES NECESARIO, Y HABLA CON EL PROXY DEL CUIDADOR
MUESTRA: Nos dió su nombre [SAMPLED CAREGIVER] porque nos dijo
que usted está al tanto de los cuidados paliativos/de hospicio que recibió
[DECEDENT NAME].
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<8>
<9>
SÍ - [GO TO CONTINUE]
PROXY IDENTIFICADO - [COLLECT PROXY INFORMATION
THEN RETURN TO PROXY INTRO]
NO, VA A ENVIARÁ LA ENCUESTA LLENADA POR CORREO [GO TO CALLBACK]
NO, VOLVER A LLAMAR - [GO TO CALLBACK]
NO, R NO ESTÁ DISPONIBLE DURANTE PERÍODO DE CAMPO [GO TO ITEM TO CODE ILL, ETC.]
NEGATIVA - [GO TO REFUSAL]
YA ENVIÓ LA ENCUESTA POR CORREO [GO TO MAILED]
NO PARTICIPÓ EN EL CUIDADO Y NO SE IDENTIFICÓ AL PROXY
[GO TO INELIGIBLE]
EL PACIENTE NO RECIBIÓ CUIDADOS EN EL HOSPICIO
MENCIONADO [GO TO DISAVOWAL]
*************
CONTINUAR — Esta llamada puede ser monitoreada [OPTIONAL: y/o grabada] con fines de
control de calidad. ¿Podemos empezar?
<1>
<2>
<3>
SÍ -[BEGIN SURVEY]
NO, VOLVER A LLAMAR - [GO TO CALLBACK]
REHUSA - [GO TO REFUSAL]
*************
ENCUESTA ENVIADA POR CORREO — Muchas gracias por contestar la encuesta por
correo. Quizá no la hayamos recibido todavía, pero que voy a revisar nuestros
registros de nuevo. Es posible que tengamos que comunicarnos de nuevo con usted
en caso de que aún no lo hayamos recibido. [END CALL]
*************
INELEGIBLE4 — Lo siento, para este proyecto, sólo hablamos con los familiares o amigos que
supervisaron o participaron en los cuidados de hospicio de su familiar. Gracias por
su tiempo. Que tenga un(una/-) buen(buena/buenas) día(tarde/noches). FINALICE
LA LLAMADA [END CALL]
*************
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DESCONOCIDO — Debe de haber un error en nuestros registros. Gracias por su tiempo. Que
tenga un(una/-) buen(buena/buenas) día(tarde/noches). FINALICE LA LLAMADA
[END CALL]
EMPIECE CON LAS PREGUNTAS CAHPS SOBRE EL HOSPICIO
Q1_INTRO Responda a todas las preguntas de esta encuesta sobre la atención recibida por el
paciente en [HOSPICE NAME]. Cuando piense en sus respuestas, no incluya
ninguna estancia en ningún otro hospicio.
ESTÉ PREPARADO/A PARA TANTEAR EN CASO DE QUE EL
ENTREVISTADO DÉ UNA RESPUESTA FUERA DE LAS CATEGORÍAS DE
RESPUESTA PROVISTAS. TANTEE REPITIENDO SÓLO LAS CATEGORÍAS
DE RESPUESTA; NO TRATE DE INTERPRETAR LO QUE DIGA EL
ENTREVISTADO.
Q1
Q1A
¿Cuál es su parentesco o relación con [DECEDENT NAME]?
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<8>
<9>
MI CÓNYUGE O PAREJA
MI MADRE O PADRE
MI SUEGRA O SUEGRO
MI ABUELA O ABUELO
MI TÍA O TÍO
MI HERMANA O HERMANO
MI HIJA O HIJO
AMIGA O AMIGO
OTRO (POR FAVOR, ESPECIFIQUE)
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q2]
[GO TO Q1A]
MISSING/DK
[GO TO Q2]
¿Cuál es su relación con [DECEDENT NAME]?
[NOTA: POR FAVOR DOCUMENTE EL DATO DE PARENTESCO O RELACIÓN Y
CONSÉRVELO EN SU ARCHIVO.]
Q2
Para este estudio, la palabra “familiar” se refiere a [DECEDENT NAME]. ¿En qué
lugar o lugares recibió cuidados de [HOSPICE NAME] su familiar? Por favor,
responda sí o no para cada una de las categorías.
Q2A
¿En casa?
<1> SÍ
<0> NO
MISSING/DK
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Q2B
¿ En un hogar de asistencia parcial?
<1> SÍ
<0> NO
MISSING/DK
Q2C
¿En un hogar de ancianos?
<1> SÍ
<0> NO
MISSING/DK
Q2D
¿En un hospital?
<1> SÍ
<0> NO
MISSING/DK
Q2E
¿En un hospicio o casa hospicio?
<1> SÍ
<0> NO
MISSING/DK
Q2F
¿En algún otro lugar?
<1> SÍ [GO TO Q2F]
<0> NO [GO TO Q3]
MISSING/DK [GO TO Q3]
Q2G
¿Dónde recibió cuidados su familiar?
[NOTA: POR FAVOR DOCUMENTE EL DATO DEL OTRO LUGAR Y CONSÉRVELO EN
SU ARCHIVO]
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Q3
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia
participó usted en dichos cuidados o los supervisó? ¿Diría usted que...
<1> Nunca, [GO TO Q41_INTRO]
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
MISSING/DK
Q4_INTRO Mientras conteste el resto de las preguntas de esta encuesta, por favor piense
únicamente en la experiencia de su familiar con [HOSPICE NAME]
Q4
Para este estudio, el equipo del hospicio incluye a todas las enfermeras, médicos,
trabajadores sociales, sacerdotes y otras personas que le proporcionaron cuidados
paliativos/de hospicio a su familiar.
Mientras su familiar estaba bajo los cuidados del hospicio, ¿necesitó usted ponerse
en contacto con el equipo del hospicio durante la noche, en fin de semana o en día
festivo porque tenía alguna duda o necesitaba ayuda para el cuidado de su familiar?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q6]
[<88> NOT APLICABLE]
MISSING/DK [GO TO Q6]
Q5
¿Con qué frecuencia obtuvo la ayuda que necesitaba del equipo del hospicio
durante la noche, en fin de semana o en día festivo? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APLICABLE]
MISSING/DK
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Q6
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
equipo del hospicio lo(a) mantuvo a usted informado(a) de cuando iban a llegar a
cuidar a su familiar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q7
Mientras su familiar estaba bajo los cuidados del hospicio, cuando usted o alguno
de sus familiares le pedían ayuda al equipo del hospicio, ¿con qué frecuencia
obtenían la ayuda tan pronto como la necesitaban? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q8
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
equipo del hospicio explicaba las cosas de un modo fácil de entender? ¿Diría usted
que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q9
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
equipo del hospicio lo(a) mantenía a usted informado(a) sobre el estado de su
familiar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
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Q10
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia
alguien del equipo del hospicio le dio a usted informes contradictorios o confusos
sobre el estado o los cuidados de su familiar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q11
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
equipo del hospicio trataba a su familiar con dignidad y respeto? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q12
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia
sintió usted que al equipo del hospicio le importaba realmente su familiar? ¿Diría
usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q13
Mientras su familiar estaba bajo los cuidados del hospicio, ¿habló usted con el
equipo del hospicio sobre algún problema relacionado con la atención o el cuidado
de su familiar?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q15]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q15]
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Q14
¿Con qué frecuencia el equipo del hospicio lo(a) escuchó con atención cuando
usted les habló sobre algún problema relacionado con la atención o el cuidado de su
familiar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q15
Mientras su familiar estaba bajo los cuidados del hospicio, ¿tuvo él(ella) algún tipo
de dolor?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q17]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q17]
Q16
¿Recibió su familiar toda la ayuda que necesitaba para aliviar el dolor? ¿Diría usted
que...
<1> Sí, definitivamente,
<2> Sí, más o menos, o
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q17
Mientras su familiar estaba bajo los cuidados del hospicio, ¿le dieron a él(ella)
algún medicamento contra el dolor?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q21]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q21]
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Q18
Entre los efectos secundarios de la medicina contra el dolor está la somnolencia.
¿El equipo del hospicio habló con usted o con su familiar sobre los efectos
secundarios del medicamento contra el dolor? ¿Diría usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos, o
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q19
¿El equipo del hospicio le dio la capacitación o información que usted necesitaba
para saber de qué efectos secundarios del medicamento contra el dolor tenía usted
que estar pendiente? ¿Diría usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos, o
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q20
¿El equipo del hospicio le dio a usted la capacitación o información que usted
necesitaba para saber si tenía que darle más medicamento contra el dolor a su
familiar y, si sí, cuándo dárselo? ¿Diría usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos,
<3> No, o
<4> No tuve necesidad de darle a mi familiar medicina para el dolor.
[<88> NOT APPLICABLE]
MISSING/DK
Q21
Mientras su familiar estaba bajo los cuidados del hospicio, ¿en algún momento tuvo
él(ella) dificultad para respirar o recibió tratamiento para su dificultad para respirar?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q24]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q24]
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Q22
¿Con qué frecuencia su familiar recibió la ayuda que necesitaba para su dificultad
para respirar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q23
¿El equipo del hospicio le dio a usted la capacitación que usted necesitaba para
saber cómo ayudar a su familiar si él(ella) tenía problemas para respirar? ¿Diría
usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos,
<3> No, o
<4> No tuve necesidad de ayudar a mi familiar con alguna dificultad para respirar.
[<88> NOT APPLICABLE]
MISSING/DK
Q24
Mientras su familiar estaba bajo los cuidados del hospicio, ¿en algún momento tuvo
él(ella) problemas de estreñimiento?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q26]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q26]
Q25
¿Con qué frecuencia su familiar recibió la ayuda que necesitaba para sus problemas
de estreñimiento? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
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Q26
Mientras su familiar estaba bajo los cuidados del hospicio, ¿en algún momento
él(ella) mostró ansiedad o tristeza?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q28]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q28]
Q27
¿Con qué frecuencia su familiar recibió del equipo del hospicio la ayuda que
necesitaba para su ansiedad o tristeza? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q28
Mientras su familiar estaba bajo los cuidados del hospicio, ¿en algún momento
estuvo su familiar inquieto o agitado?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO P30]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO P30]
Q29
¿El equipo del hospicio le dio a usted la capacitación que usted necesitaba para
saber qué hacer si su familiar estaba inquieto o agitado? ¿Diría usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos, o
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
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Q30
Mover a su familiar incluye acciones como ayudarlo(a) a darse la vuelta en la cama,
o meterse y salir de la cama o sentarse y levantarse de una silla de ruedas.
¿El equipo del hospicio le dio a usted la capacitación que usted necesitaba para
saber cómo mover a su familiar de manera segura? ¿Diría usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos,
<3> No, o
<4> No tuve necesidad de mover a mi familiar.
[<88> NOT APPLICABLE]
MISSING/DK
Q31
¿El equipo del hospicio le dio a usted tanta información como usted quería sobre
qué acontecimientos esperar mientras su familiar estuviera muriéndose? ¿Diría
usted que...
<1> Sí, definitivamente,
<2> Sí, más o menos, o
<3> No?
[<88> NOT APPLICABLE]
MISSING/DK
Q32
Algunas personas reciben cuidados paliativos/de hospicio mientras viven en un
hogar de ancianos.
¿Su familiar recibió cuidados de este hospicio mientras él(ella) estaba viviendo en
un hogar de ancianos?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO [GO TO Q35]
[<88> NOT APPLICABLE]
MISSING/DK [GO TO Q35]
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Q33
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
personal del hogar de ancianos y el equipo del hospicio se pusieron de acuerdo y
acoplaron bien para proporcionarle los cuidados a su familiar? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q34
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia los
informes que el personal del hogar de ancianos le daba sobre su familiar eran
diferentes de los informes que le daba el equipo del hospicio? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
Q35_INTRO El siguiente grupo de preguntas es sobre usted.
Q35
Mientras su familiar estaba bajo los cuidados del hospicio, ¿con qué frecuencia el
equipo del hospicio lo(a) escuchó a usted? ¿Diría usted que...
<1> Nunca,
<2> A veces,
<3> La mayoría de las veces, o
<4> Siempre?
[<88> NOT APPLICABLE]
MISSING/DK
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Q36
El apoyo respecto a sus creencias religiosas o espirituales incluye hablar, rezar,
tener momentos de recogimiento, u otras maneras de satisfacer sus necesidades
religiosas o espirituales.
Mientras su familiar estaba bajo los cuidados del hospicio, ¿cuánto apoyo recibió
usted respecto a sus creencias religiosas y espirituales por parte del equipo del
hospicio? ¿Diría usted que...
<1> Demasiado poco,
<2> Justo el necesario, o
<3> Demasiado?
[<88> NOT APPLICABLE]
MISSING/DK
Q37
Mientras su familiar estaba bajo los cuidados del hospicio, ¿cuánto apoyo
emocional recibió usted del equipo del hospicio? ¿Diría usted que...
<1> Demasiado poco,
<2> Justo el necesario, o
<3> Demasiado?
[<88> NOT APPLICABLE]
MISSING/DK
Q38
Durante las semanas posteriores a la muerte de su familiar, ¿recibió usted todo el
apoyo emocional que usted quería por parte del equipo del hospicio? ¿Diría usted
que...
<1> Demasiado poco,
<2> Justo el necesario, o
<3> Demasiado?
[<88> NOT APPLICABLE]
MISSING/DK
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Q39
Por favor conteste las siguientes preguntas sobre los cuidados paliativos/de hospicio
que su familiar recibió de [HOSPICE NAME]. No incluya ningún cuidado
proporcionado por otros hospicios.
Utilizando un número del 0 al 10, siendo 0 los peores cuidados paliativos/de
hospicio posibles y 10 los mejores cuidados paliativos/de hospicio posibles, ¿qué
número usaría para calificar los cuidados paliativos/de hospicio que recibió su
familiar?
SI EL ENTREVISTADO NO DA UNA RESPUESTA ADECUADA, INTENTE
DE NUEVO Y REPITA LA PREGUNTA: Utilizando un número del 0 al 10,
siendo 0 los peores cuidados paliativos/de hospicio posibles y 10 los mejores
cuidados paliativos/de hospicio posibles, ¿qué número usaría para calificar los
cuidados paliativos/de hospicio que recibió su familiar?
<0> 0
<1> 1
<2> 2
<3> 3
<4> 4
<5> 5
<6> 6
<7> 7
<8> 8
<9> 9
<10> 10
[<88> NOT APPLICABLE]
MISSING/DK
Q40
¿Le recomendaría este hospicio a sus amigos y familiares? ¿Diría usted que...
<1> Definitivamente no,
<2> Probablemente no,
<3> Probablemente sí, o
<4> Definitivamente sí?
[<88> NOT APPLICABLE]
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
Q41_INTRO Las siguientes preguntas son sobre su familiar.
Q41
¿Cuál es el grado o nivel escolar más alto que terminó su familiar?
¿Él(ella)...
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> Terminó ocho años de escuela o menos,
<2> Terminó el bachillerato o la preparatoria, pero sin graduarse,
<3> Obtuvo el diploma de bachillerato, preparatoria, o su equivalente (o GED),
<4> Terminó algunos cursos universitarios u obtuvo un título universitario de un
programa de 2 años,
<5> Obtuvo un título universitario de 4 años, o
<6> Terminó estudios universitarios o superiores de más de 4 años
<7> El entrevistado indica que no sabe el nivel escolar de su familiar
MISSING/DK
CUALQUIER FORMACIÓN ACADÉMICA MÁS ALLÁ DE UN DIPLOMA DE
BACHILLERATO, PREPARATORIA O HIGH SCHOOL, QUE NO SEA UNA
LICENCIATURA DEBERÁ CODIFICASE COMO 4. SI EL ENTREVISTADO
MENCIONA UNA FORMACIÓN NO ACADÉMICA, COMO UNA ESCUELA
DE COMERCIO, TRATE DE AVERIGUAR SI SU FAMILIAR TIENE UN
DIPLOMA DE BACHILLERATO, PREPARATORIA O HIGH SCHOOL Y
ASIGNE EL CÓDIGO 2 O EL 3, SEGÚN CORRESPONDA.
Q42
¿Su familiar era de ascendencia u origen hispano, latino o español?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> SÍ
<2> NO
MISSING/DK
SI LA RESPUESTA ES SÍ:
¿Diría usted que su familiar era...
(LEA TODAS OPCIONES DE RESPUESTA)
<2> Puertorriqueño(a),
<3> Mexicano(a), estadounidense de origen mexicano, chicano(a),
<4> Cubano(a), o
<5> De otro origen español, hispano o latino?
MISSING/DK
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
19
PARA LA ENTREVISTA TELEFÓNICA, LA PREGUNTA 43 SE DIVIDE EN
PARTES, DE LA “A” A LA “E”
LEER TODAS CATEGORÍAS DE RAZA HACIENDO UNA PAUSA EN CADA
CATEGORÍA RACIAL PARA PERMITIRLE AL ENTREVISTADO
RESPONDER A CADA CATEGORÍA RACIAL.
SI EL ENTREVISTADO PREGUNTA: “¿POR QUÉ ME PREGUNTA LA RAZA
DE MI FAMILIAR?”: Le preguntamos la raza de su familiar para fines
demográficos. Queremos estar seguros de que las personas a las que incluimos en el
estudio representan efectivamente la diversidad racial de este país.
SI EL ENTREVISTADO RESPONDE: “YA LE DIJE LA RAZA DE MI
FAMILIAR”: Sí, ya lo sé; sin embargo, el estudio me obliga a preguntar sobre
todas las razas para que en los resultados se pueda incluir a personas que son
multirraciales. Si la raza que yo mencione no corresponde al miembro de su familia
por favor conteste NO. Gracias por su paciencia.
Q43
Q43A
Cuando le lea lo siguiente, por favor, dígame si la categoría describe la raza de su
familiar. Estoy obligado a leer las cinco categorías. Por favor, responda SÍ o NO a
cada una de las categorías.
¿Su familiar era blanco(a)?
<1> SÍ/ ERA BLANCO(A)
<2> NO/NO ERA BLANCO(A)
MISSING/DK
Q43B
¿Su familiar era negro(a) o afroamericano(a)?
<1> SÍ/ ERA NEGRO(A)/AFROAMERICANO(A)
<2> NO/NO ERA NEGRO(A) NI AFROAMERICANO(A)
MISSING/DK
Q43C
¿Su familiar era asiático(a)?
<1> SÍ/ ERA ASIÁTICO(A)
<2> NO/NO ERA ASIÁTICO(A)
MISSING/DK
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Q43D
¿Su familiar era nativo(a) de Hawai o de otras islas del Pacífico?
<1> SÍ/ERA NATIVO(A) DE HAWAI/DE OTRAS ISLAS DEL PACÍFICO
<2> NO/NO ERA NATIVO(A) DE HAWAI NI DE OTRAS ISLAS DEL
PACÍFICO
MISSING/DK
Q43E
¿Su familiar era Indio(a) Americano(a) o nativo(a) de Alaska?
<1> SÍ/ERA INDIO(A) AMERICANO(A)/NATIVO(A) DE ALASKA
<2> NO/NO ERA INDIO(A) AMERICANO(A) NI NATIVO(A) DE ALASKA
MISSING/DK
Q44_INTRO Las siguientes preguntas son sobre usted.
Q44
¿Qué edad tiene usted?
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> de 18 a 24 años
<2> de 25 a 34 años
<3> de 35 a 44 años
<4> de 45 a 54 años
<5> de 55 a 64 años
<6> de 65 a 74 años
<7> de 75 a 84 años
<8> 85 años o más
MISSING/DK
Q45
ENTREVISTADOR, PREGUNTE SÓLO SI ES NECESARIO:
¿Es usted hombre o mujer?
<1> HOMBRE
<2> MUJER
MISSING/DK
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Q46
¿Cuál es el grado o nivel escolar más alto que terminó? ¿Usted...
LEA LAS OPCIONES DE RESPUESTA SÍ/NO SÓLO SI ES NECESARIO
<1> Terminó ocho años de escuela o menos,
<2> Terminó el bachillerato o la preparatoria, pero sin graduarse,
<3> Obtuvo el diploma de bachillerato, preparatoria, o su equivalente (o GED),
<4> Terminó algunos cursos universitarios u obtuvo un título universitario de un
programa de 2 años,
<5> Obtuvo un título universitario de 4 años, o
<6> Terminó estudios universitarios o superiores de más de 4 años
MISSING/DK
CUALQUIER FORMACIÓN ACADÉMICA MÁS ALLÁ DE UN DIPLOMA DE
BACHILLERATO, PREPARATORIA O HIGH SCHOOL, QUE NO SEA UNA
LICENCIATURA DEBERÁ CODIFICASE COMO 4. SI EL ENTREVISTADO
MENCIONA UNA FORMACIÓN NO ACADÉMICA, COMO UNA ESCUELA
DE COMERCIO, TRATE DE AVERIGUAR SI SU FAMILIAR TIENE UN
DIPLOMA DE BACHILLERATO, PREPARATORIA O HIGH SCHOOL Y
ASIGNE EL CÓDIGO 2 O EL 3, SEGÚN CORRESPONDA.
Q47
¿Qué idioma habla usted principalmente en su casa? Por favor, escuche las tres
opciones de respuesta antes de contestar. ¿Diría usted que usted habla
principalmente...
<1> Inglés,
<2> Español,
<3> Chino, o
<4> Algún otro idioma?
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO Q47A]
MISSING/DK
[GO TO END]
SI LA RESPUESTA DEL ENTREVISTADO COMPRENDE VARIOS IDIOMAS,
INTENTE PREGUNTÁNDOLE:
¿Diría usted que usted habla sobre todo (IDIOMA A) o (IDIOMA B)?
SI EL ENTREVISTADO CONTESTA QUE HABLA AMERICANO, POR
FAVOR ASIGNE EL CÓDIGO 1-INGLÉS.
Q47A
¿Qué otro idioma habla usted mayormente en su casa?
[NOTA: POR FAVOR DOCUMENTE EL DATO DEL OTRO IDIOMA Y CONSÉRVELO EN
SU ARCHIVO]
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END
Esas son todas las preguntas que tengo. Gracias por su tiempo. (OPCIONAL: Si
quiere ayuda para sobrellevar su duelo puedo darle ahora el número de apoyo en el
[HOSPICE NAME].
ENTREVISTADOR: PROPORCIONE LA INFORMACIÓN DE CONTACTO
SEGÚN SEA NECESARIO
Que tenga un(una/-) buen(buena/buenas) día(tarde/noches).
FINALICE LA LLAMADA
[END CALL]
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CAHPS Hospice Survey Quality Assurance Guidelines V1.0
| File Type | application/pdf |
| File Title | CAHPS Hospice Survey QAG V1.0 August 2014 |
| Subject | CAHPS Hospice Survey QAG V1.0 August 2014 |
| Author | CMS |
| File Modified | 2014-08-28 |
| File Created | 2014-08-27 |