Attachment 3 MCBS Community Questionnaire Flow Diagrams_R76

Respondent Type Information
INTTYPE
C001
C002
C003
C004
C005
C006
C007
C008
C009
C010

Name
StandardHadPrev
NewFromFacility
NewFromSupplement
StandardSkippedPrev
LastRndFacSum
LastRndFacBase
SupSmp1stTimeUtil
ExitInterviewHadPrev
ExitInterviewSkippedPrev
SupSmp1stTimeUtilSkipped

Description
Standard Continuing SP. SP’s last interview was in the Community.
SP’s last interview was in a facility. SP has not had a community interview.
SP is in the Supplemental Sample (their 1st round in the study).
Standard Continuing SP. SP skipped the previous round.
SP’s last interview was in a facility. SP’s last community interview was 2 rounds ago.
SP’s last interview was in a facility. SP’s last community interview was 3 or more rounds ago.
SP’s 2nd interview. Utilization and cost data is collected for the 1st time.
SP’s last interview. SP is in the Exit Sample. SP’s last community interview was in the previous round.
SP’s last interview. SP is in the Exit Sample. SP’s last community interview was 2 rounds ago.
SP’s 2nd interview. SP skipped previous round. Utilization and cost data is collected for the 1st time.

Valid in round(s)
ALL
ALL
FALL ONLY
ALL
ALL
ALL
WINTER ONLY
SUMMER ONLY
SUMMER ONLY
SUMMER ONLY

Please note, proxy interviews for deceased respondents only get the sections highlighted in orange. Sections in white are not
administered for deceased SPs unless noted (INTTYPE C008, C009 is the single exception).

Standard Continuing Respondent, Interviews 3-11
(INTTYPE = C001, C004)

Introduction (INQ)

Address Verification (AVQ)

Fall

Housing Characteristics (HAQ)

Enumeration Summary (ENS)

Summer/Winter

Health Insurance Summary (HIS)

Health Insurance (HIQ)

Dental Utilization (DUQ)

Emergency Room Utilization (ERQ)

Inpatient Utilization (IPQ)

Outpatient Utilization (OPQ)

Institutional Utilization (IUQ)

Home Health Summary (HHS)

Home Health Utilization (HHQ)

Fall

Access to Care (ACQ)

Medical Provider Utilization (MPQ)

Summer/Winter

Other Medical Expenses (OMQ)

Prescribed Medicine Summary (PMS)

Prescribed Medicine Utilization (PMQ)

Statement Charge Series (STQ)

Post-Statement Charge (PSQ)

No Statement Charge (NSQ)

Charge Payment Summary (CPS)

Mobility of Beneficiaries (MBQ)

Fall

Health Status and Functioning
(HFQ)

Summer

Preventive Care (PVQ)

Winter

Income and Assets (IAQ)
Respondent is
Proxy

Respondent is SP

Nicotine and Alcohol Use (NAQ)
Beneficiary Knowledge (KNQ)

Patient Activation (PAQ)

Satisfaction with Care (SCQ)
Drug Coverage (RXQ)
Usual Source of Care/Patients
Perceptions of Integrated Care
(USQ/PPIC)
Closing (CLQ)

End (END)

New from Facility Respondent, Interviews 2-11
(INTTYPE = C002)

Introduction (INQ)

Fall

Housing Characteristics (HAQ)

Enumeration Summary (ENS)

Summer/Winter

Health Insurance (HIQ)

Dental Utilization (DUQ)

Emergency Room Utilization (ERQ)

Inpatient Utilization (IPQ)

Outpatient Utilization (OPQ)

Institutional Utilization (IUQ)

Home Health Utilization (HHQ)

Fall
Access to Care (ACQ)

Medical Provider Utilization (MPQ)

Summer/Winter

Other Medical Expenses (OMQ)

Prescribed Medicine Utilization (PMQ)

Statement Charge Series (STQ)

Post-Statement Charge (PSQ)

No Statement Charge (NSQ)

Mobility of Beneficiaries (MBQ)

Fall

Health Status and Functioning
(HFQ)

Summer

Preventive Care (PVQ)

Winter

Income and Assets (IAQ)
Respondent is
Proxy

Respondent is SP

Nicotine and Alcohol Use (NAQ)
Beneficiary Knowledge (KNQ)

Patient Activation (PAQ)

Satisfaction with Care (SCQ)
Drug Coverage (RXQ)
Usual Source of Care/Patients
Perceptions of Integrated Care
(USQ/PPIC)

Address Verification (AVQ)

Closing (CLQ)

End (END)

New Sampled Respondent, Interview 1
(INTTYPE = C003)
Introduction (INQ)

Enumeration Summary (ENS)

Housing Characteristics (HAQ)

Health Insurance (HIQ)

Mobility of Beneficiaries (MBQ)

Preventive Care (PVQ)

Access to Care (ACQ)

Health Status and Functioning (HFQ)

Nicotine and Alcohol Use (NAQ)

Satisfaction with Care (SCQ)
Usual Source of Care/Patients
Perceptions of Integrated Care
(USQ/PPIC)
Demographics and Income (DIQ)

Address Verification (AVQ)

Closing (CLQ)

End (END)

Old from Facility, Interviews 3-11
(INTTYPE = C005, C006)
Introduction (INQ)

Address Verification (AVQ)

Fall

Housing Characteristics (HAQ)

Enumeration Summary (ENS)

Summer/Winter

Health Insurance (HIQ)

Dental Utilization (DUQ)

Emergency Room Utilization (ERQ)

Inpatient Utilization (IPQ)

Outpatient Utilization (OPQ)

Institutional Utilization (IUQ)

Home Health Utilization (HHQ)

Fall

Access to Care (ACQ)

Medical Provider Utilization (MPQ)

Summer/Winter

Other Medical Expenses (OMQ)

Prescribed Medicine Utilization (PMQ)

Statement Charge Series (STQ)

Post-Statement Charge (PSQ)
1-2 Rounds since
Last Community
Interview

Charge Payment Summary (CPS)

No Statement Charge (NSQ)

3+ Rounds since
Last Community interview

Mobility of Beneficiaries (MBQ)

Fall

Health Status and Functioning
(HFQ)

Summer

Preventive Care (PVQ)

Winter

Income and Assets (IAQ)
Respondent is
Proxy

Respondent is SP

Nicotine and Alcohol Use (NAQ)
Beneficiary Knowledge (KNQ)

Patient Activation (PAQ)

Satisfaction with Care (SCQ)
Drug Coverage (RXQ)
Usual Source of Care/Patients
Perceptions of Integrated Care
(USQ/PPIC)
Closing (CLQ)

End (END)

First time Utilization, Interview 2 or 3
(INTTYPE = C007, C010)

Introduction (INQ)

Address Verification (AVQ)

Fall

Housing Characteristics (HAQ)

Enumeration Summary (ENS)

Summer/Winter

Health Insurance Summary (HIS)

Health Insurance (HIQ)

Dental Utilization (DUQ)

Emergency Room Utilization (ERQ)

Inpatient Utilization (IPQ)

Outpatient Utilization (OPQ)

Institutional Utilization (IUQ)

Home Health Utilization (HHQ)

Medical Provider Utilization (MPQ)

Other Medical Expenses (OMQ)

Prescribed Medicine Utilization (PMQ)

Statement Charge Series (STQ)

Post-Statement Charge (PSQ)

No Statement Charge (NSQ)

Mobility of Beneficiaries (MBQ)

Winter

Preventive Care (PVQ)

Summer

Income and Assets (IAQ)
Respondent is
Proxy

Respondent is SP

Beneficiary Knowledge (KNQ)
Patient Activation (PAQ)

Drug Coverage (RXQ)

Closing (CLQ)

End (END)

Exit Interview, Interview 12
(INTTYPE = C008)

Exit Interview, Interview 12
(INTTYPE = C009)

Introduction (INQ)

Introduction (INQ)

Had an Ongoing
IP Event

Enumeration Summary (ENS)

Inpatient Utilization (IPQ)

Health Insurance Summary (HIS)

Mobility of Beneficiaries (MBQ)

Health Insurance (HIQ)

Preventive Care (PVQ)

Dental Utilization (DUQ)

Income and Assets (IAQ)

Emergency Room Utilization (ERQ)

Respondent is SP

Inpatient Utilization (IPQ)

Patient Activation (PAQ)

Outpatient Utilization (OPQ)

No Ongoing
IP Events

Respondent is
Proxy

SP Alive

Institutional Utilization (IUQ)

SP Deceased

Exit Interview (EXQ)

Home Health Summary (HHS)

Closing (CLQ)

Home Health Utilization (HHQ)

End (END)

Medical Provider Utilization (MPQ)

Other Medical Expenses (OMQ)

Prescribed Medicine Summary(PMS)

Prescribed Medicine Utilization (PMQ)

Statement Charge Series (STQ)

Post-Statement Charge (PSQ)

No Statement Charge (NSQ)

Charge Payment Summary (CPS)

Mobility of Beneficiaries (MBQ)

Preventive Care (PVQ)

Income and Assets (IAQ)
Respondent is
Proxy

Respondent is SP

Patient Activation (PAQ)

Drug Coverage (RXQ)
SP Alive

SP Deceased

Exit Interview (EXQ)

Closing (CLQ)

End (END)