Attachment F R80 USQ revisions (Feb 2017 non-sub change request)

Usual Source of Care (USQ): moved from Fall Round to Winter Round
Variable Name
MR Screen Name
Question text/description
PLACEPAR
US1
Is there a particular doctor or other health professional, or a clinic [you/(SP)] usually [go/goes] to
when [you are/he is/she is] sick or for advice about [your/his/her] health?

PLACEKND

US2

What kind of place [do you/does (SP)] usually go to when [you are/he is/she is] sick or for advice
about [your/his/her] health -- is that a managed care plan or HMO center, a clinic, a doctor or other
health professional's office, a hospital, or some other place?
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
IF SOME OTHER PLACE, ASK: Where is this?

PLACEOS

US2
BOX USB

PLACEMCP

US2A

BOX USC
CLNAME

US3A

OTHER (SPECIFY)
IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
US2A - PLACEMCP.
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
Is this [doctor or other health professional/medical clinic] associated with [your/his/her] [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?

IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
What is the complete name of the [place/managed care plan or HMO center/(US2 RESPONSE)] that
[you go to/(SP) goes to]?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
Is there a particular doctor or other health professional [you usually see/(SP) usually sees] at this
[place/managed care plan or HMO center/(US2 RESPONSE)]?

USUALDOC

US4

MDNAME

US5A

What is the complete name of that doctor or other health professional?

US5B

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
Is (US5A PROVIDER NAME) a male or female?

MDSEX

Code List
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) DOCTOR'S OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
(05) FREESTANDING SURGICAL CENTER
(06) RURAL HEALTH CLINIC
(07) COMPANY CLINIC
(08) OTHER CLINIC
(09) WALK-IN URGENT CENTER
(10) DOCTOR COMES TO SP'S HOME
(11) HOSPITAL EMERGENCY ROOM
(12) HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
(13) VA FACILITY
(14) MENTAL HEALTH CENTER
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUOUS ANSWER

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) continuous answer

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUOUS ANSWER

(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED

MDSPEC

US6A

SHOW CARD AC1
What is (US5A PROVIDER NAME)'s specialty?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]

MDSPECOS

US6A

OTHER DR SPECIALTY (SPECIFY)

LANGPREF

LEP1A

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]
IF PWHTLANG= 1, GO TO LEP1-LANGPREF.
IF PWHTLANG=0, GO TO BOX US1.
In general, in what language do you prefer to receive your medical care?

LANGPFOS
LANGPRVD

LEP1B
LEP2

In general, in what language do you prefer to receive your medical care?
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] speak [PWHTLANG]?

BOX USD

(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(06) EMERGENCY ROOM PHYSICIAN
(07) ENDOCRINOLOGY/ METABOLISM (DIABETES, THYROID)
(08) FAMILY PRACTICE
(09) GASTROENTEROLOGY
(10) GENERAL PRACTICE
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(15) HOSPITAL RESIDENCE
(16) INTERNAL MEDICINE (INTERNIST)
(17) NEPHROLOGY (KIDNEYS)
(18) NEUROLOGY
(19) NUCLEAR MEDICINE
(20) ONCOLOGY (TUMORS, CANCER)
(21) OPHTHALMOLOGY (EYES)
(22) ORTHOPEDICS
(24) OSTEOPATHY (DO)
(25) OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT)
(26) PATHOLOGY
(27) PHYS MED/REHAB
(28) PLASTIC SURGERY
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(01) CONTINUOUS ANSWER

(01) English
(02) [PWHTLANG], or
(03) Both English and [PWHTLANG] equally
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

LANGCOMM

LEP3

How well can you and [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)]
communicate in [PWHTLANG] about your symptoms? Very well, well, not well, or not at all?

LANGSYMP

BOX LEP1
LEP4

IF PNTWELL=1, GO TO LEP6-LANGPROB. ELSE GO TO BOX US1.
Without the aid of a translator, language assistant, or interpreter, how well can you and [(US5A
PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] communicate in English about your
symptoms? Very well, well, not well, or not at all?

LANGASST

BOX LEP2
LEP5

IF LEP PNTWELL=1, GO TO LEP5-LANGASST. ELSE GO TO BOX US1.
Who helps you communicate with [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER
NAME)] – a professional interpreter, a staff person at your provider's office, a family member, a
friend, or do you do the best that you can in English?

LANGPROB

LEP6

LANGHELP

LEP7

BOX US1
GETUSHOW

US8

GETUSOS

US8

(01) VERY WELL
(02) WELL
(03) NOT WELL
(04) NOT AT ALL
(-8) DON’T KNOW
(-9) REFUSED
(01) VERY WELL
(02) WELL
(03) NOT WELL
(04) NOT AT ALL
(-8) DON’T KNOW
(-9) REFUSED

(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S OFFICE
(03) FAMILY MEMBER
(04) FRIEND
PROBE: Anyone else?
(05) SOMEONE ELSE
(06) DOES BEST THAT CAN IN ENGLISH
(-8) DON’T KNOW
(-9) REFUSED
Have you ever had a problem understanding a medical situation because it was not explained in
(01) YES
[PWHTLANG]?
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
Now think about all of your medical providers other than your usual provider.
(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S OFFICE
Who helps you communicate with medical providers who do not speak [PWHTLANG]– a professional (03) FAMILY MEMBER
interpreter, a staff person at your provider's office, a family member, a friend, or do you do the best (04) FRIEND
that you can in English?
(05) SOMEONE ELSE
(06) DOES BEST THAT CAN IN ENGLISH
PROBE: Anyone else?
(07) DOES NOT SEE A MEDICAL PROVIDER
(-8) DON’T KNOW
(-9) REFUSED
IF US2 - PLACEKND = 10/AtHome, PP1A-PROVYR.
ELSE GO TO US8 - GETUSHOW.
How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)]?
(01) WALKING
(02) DRIVING
[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by walking, driving, being driven by someone (03) BEING DRIVEN
else, by ambulance or other special vehicle for disabled people, by taxi, other public transportation, (04) AMBULANCE OR OTHER SPECIAL VEHICLE
or some other way?]
(05) TAXI
(06) OTHER PUBLIC TRANSPORTATION
(07) DR. USUALLY COMES TO HOME
(08) SeniorCitizenVan DO NOT DISPLAY.
(91) SOME OTHER WAY
(-8) DON'T KNOW
(-9) REFUSED
SOME OTHER WAY (SPECIFY)
(01) continuous answer

GETUSUNT

US9

About how long does it usually take for [you/(SP)] to get there?

GETUSHRS
GETUSMIN
ACCOMPUS

US9
US9
US10

HOURS:
MINUTES:
[Do you/Does (SP)] usually have someone accompany [you/him/her] there?

PERSON_USUALGO

US11

Who usually goes with [you/(SP)]?

PERSWITH

US11A1

SELECT OR ADD ONLY ONE PERSON
How often [are you/is that person] with [you/(SP)] while [you/(SP)] [see/sees] the doctor or other
health professional? Would you say always, sometimes, or never?

ACCREAS

US11AA

What are the reasons [you accompany (SP)/this person accompanies you/this person
accompaniD25:E35s this person] do?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

ACCOTHOS
USHOWLNG

US11AA
US15

OTHER (SPECIFY)
SHOW CARD US1
How long [have you/has (SP)] been [seeing (US5A PROVIDER NAME)/going to (US3A PROVIDER
NAME)]?

PREVMEDC

US17

Before [you/(SP)] started [seeing (US5A PROVIDER NAME)/going to (US3A PROVIDER NAME)], had
[you/(SP)] usually been going to some other place or seeing some other doctor or other health
professional for medical care?

PROVYR

PP1A

Have you seen [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)] in the last 12 months?

(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUOUS ANSWER

(01) ALWAYS
(02) SOMETIMES
(03) NEVER
(-8) DON'T KNOW
(-9) REFUSED
(01) WRITES DOWN WHAT DOCTOR SAYS/RECORDS
INSTRUCTIONS/TAKES NOTES/REMEMBERS
(02) GIVES INFORMATION/EXPLAINS SP'S MEDICAL CONDITION OR
NEEDS TO THE DOCTOR
(03) EXPLAINS DOCTOR’S INSTRUCTIONS TO SP
(04) ASKS QUESTIONS
(05) TRANSLATES LANGUAGE
(06) SCHEDULES APPOINTMENTS
(07) NOTHING/KEEPS SP COMPANY/SITS WITH SP/MORAL SUPPORT
(08) TRANSPORTATION
(09) SP NEEDS PHYSICAL ASSISTANCE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(01) LESS THAN 1 YEAR
(02) 1 YEAR TO LESS THAN 3 YEARS
(03) 3 YEARS TO LESS THAN 5 YEARS
(04) 5 YEARS TO LESS THAN 10 YEARS
(05) 10 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED

REMINDAPPT

PP1

PREPARE

PP2

APPTMISS

PP4

APPTNEW

PP5

DOCLIFE

PP8

EXPLAINEASY

PP9

PPLISTEN

PP10

PPRESPECT

PP11

The next questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)].

(01) YES
(02) NO
(-8) DON'T KNOW
Some offices remind patients about appointments. Before [your/(SP)'s] most recent visit with [(US5A (-9) REFUSED
PROVIDER NAME)/(US3A PROVIDER NAME) ], did [you/he/she] get a reminder from [(US5A
PROVIDER NAME)'S office /(US3A PROVIDER NAME)] about the appointment?
Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)], did
(01) YES
[you/he/she] get instructions telling [you/him/her] what to expect or how to prepare?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Now I’m going to read you questions about the medical providers [you have/SP has] seen in the last (01) NEVER
six months, that is since {CurrentMonth – 6}.
(02) SOMETIMES
(03) USUALLY
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(04) ALWAYS
(-8) Don't Know
People have busy lives and miss appointments for many reasons. In the last six months, how often did (-9) Refused
[you/(SP)] miss an appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)]?
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, when [ you/(SP)] missed an appointment with US5A PROVIDER NAME/US3A
(-8) Don't Know
PROVIDER NAME), how often did someone from [(US5A PROVIDER NAME)'S office/(US3A PROVIDER (-9) Refused
NAME)] contact [you/him/her] to make a new appointment?
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
(-8) Don't Know
PROVIDER NAME)] ask about things in [your/(SP)'s] work or life at home that affect [your/(SP)'s]
(-9) Refused
health?
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
(-8) Don't Know
PROVIDER NAME)] explain things in a way that was easy [for (SP)] to understand?
(-9) Refused
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
(-8) Don't Know
PROVIDER NAME)] listen carefully to [you/(SP)]?
(-9) Refused
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
(-8) Don't Know
PROVIDER NAME)] show respect for what [you/(SP)] had to say?
(-9) Refused

ENOUGHTIME

PP12

SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

PPIDEAS

PP13

In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] spend enough time with [you/(SP)]?
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

SETGOAL

PP15

In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] ask whether [you/(SP)] had ideas about how to improve [your/his/her] health?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)] talk with [you/(SP)] about setting goals for [your/his/her] health?

MEETGOAL

PP16

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did the care [you/(SP)] received from [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] help [you/(SP)] meet [your/his/her] goals?

USCKEVRY

US27

USCOMPET

US27

USUNHIST

US27

USUNWRNG

US27

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US3

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) STRONGLY AGREE
(02) AGREE
Now I am going to read some statements people have made about their health care. Think about the (03) DISAGREE
care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each
(04) STRONGLY DISAGREE
statement, please tell me whether you strongly agree, agree, disagree, or strongly disagree.
(05) NOT APPLICABLE
(-8) Don't Know
[(US5A PROVIDER NAME) is/The doctors or other health professionals at (US3A PROVIDER NAME) are] (-9) Refused
very careful to check everything when examining [you/him/her].
SHOW CARD US3
(01) STRONGLY AGREE
(02) AGREE
[(US5A PROVIDER NAME) is/The doctors or other health professionals at (US3A PROVIDER NAME) are] (03) DISAGREE
competent and well-trained.
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SHOW CARD US3
(01) STRONGLY AGREE
(02) AGREE
[(US5A PROVIDER NAME) has/The doctors or other health professionals at (US3A PROVIDER NAME) (03) DISAGREE
have] a good understanding of [your/his/her] medical history.
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SHOW CARD US3
(01) STRONGLY AGREE
(02) AGREE
[(US5A PROVIDER NAME) has/The doctors or other health professionals at (US3A PROVIDER NAME) (03) DISAGREE
have] a complete understanding of the things that are wrong with [you/him/her].
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

USHURRY

US27

SHOW CARD US3
[(US5A PROVIDER NAME) often seems/The doctors or other health professionals at (US3A PROVIDER
NAME) often seem] to be in a hurry.

USEXPPRB

US32

SHOW CARD US3
[Think about the care [you/(SP)] [receive/receives] from [(US5A PROVIDER NAME)/(US3A PROVIDER
NAME)].]

USDISCUS

US32

[(US5A PROVIDER NAME) often does/The doctors or other health professionals at (US3A PROVIDER
NAME) often do] not explain [your/his/her] medical problems to [you/him/her].
SHOW CARD US3
[You/(SP)] often [have/has] health problems that should be discussed but are not.

USFAVOR

US32

SHOW CARD US3
[(US5A PROVIDER NAME) often acts/The doctors or other health professionals at (US3A PROVIDER
NAME) often act] as though [(he/she) was/they were] doing [you/(SP)] a favor by talking to
[you/him/her].

USTELALL

US32

SHOW CARD US3
[(US5A PROVIDER NAME) tells/The doctors or other health professionals at (US3A PROVIDER NAME)
tell] [you/him/her] all [you want/he wants/she wants] to know about [your/his/her] condition and
treatment.

USANSQUX

US32

SHOW CARD US3
[(US5A PROVIDER NAME) answers/The doctors or other health professionals at (US3A PROVIDER
NAME) answer] all [your/his/her] questions.

USCONFID

US37

SHOW CARD US3
[Think about the care [you/(SP)] [receive/receives] from (US5A PROVIDER NAME/US3A PROVIDER
NAME).]
[You have/(SP) has] great confidence in [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)].

(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

USDEPEND

US37

OSTAFF

PP17

SHOW CARD US3

(01) STRONGLY AGREE
(02) AGREE
[You depend/(SP) depends] on [(US5A PROVIDER NAME)/the doctors or other health professionals at (03) DISAGREE
(US3A PROVIDER NAME)] in order to feel better both physically and emotionally.
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
People often get instructions about their health from more than one person in the same office, such (01) YES
as other medical providers, nurses, nutritionists, and social workers.
(02) NO
(-8) DON'T KNOW
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(-9) REFUSED

OSAWARE

PP18

In the last six months, did [you/(SP)] get any instructions about your health from any other staff [in
(US5A PROVIDER NAME)'s office/ at (US3A PROVIDER NAME)]?
SHOW CARD US2

OSCARE

PP19

SHOW CARD US2

(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did these other staff seem up-to-date about the care [you were/(SP) (-8) Don't Know
was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)]?
(-9) Refused

[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

OSINFO

PP20

OSTEST

PP21

OSFOLLOWUP

PP22

In the last six months, how often did these other staff talk with [you/(SP)] about care [you/he/she]
[were/was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)]?
SHOW CARD US2

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
In the last six months, how often did these other staff seem to know the important information about (-8) Don't Know
[your/(SP)'s] medical history?
(-9) Refused
The next set of questions ask about the care you received from [(US5A PROVIDER NAME)/the medical (01) YES
providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office.
(02) NO
(-8) DON'T KNOW
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(-9) REFUSED
In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)] or someone in [his/her/their] office order a blood test, x-ray, or other test for [you/(SP)]?
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, when [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)] or someone from [his/her/their] office ordered a blood test, x-ray, or other test for
[you/(SP)], how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)] or someone from [his/her/their] office follow up to give [you/(SP)] those results?

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

REQUEST

PP23

[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, how often did [you/(SP)] have to request [your/his/her] test results before
[you/he/she] got them?

TESTCLEAR

PP24

SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

PPSERVICES

HELPGET

PP29

In the last six months, how often were [your/(SP)'s] test results presented in a way that was easy to
understand?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

PP30

In the last six months, did [you/(SP)] need services at home to help [you/him/her] take care of
[your/his/her] health?
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

PPINSTRUCTIONS

PPMED

PP31

In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office help [you/(SP)] get these services at home to
take care of [your/his/her] health?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

PP35

In the last six months, did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)] or someone in [his/her/their] office give [you/(SP)] instructions about how to take care of
[your/his/her] health?
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
In the last six months, did [you/(SP)] take any prescription medicine?

HOWMED

PP36

[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK IF THE R HAD ANY
PRESCRIPTIONS FILLED]
SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

ASPRESCRIBED

PP37

In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about how [you were/he
was/she was] supposed to take [your/his/her] medicine?
SHOW CARD US2

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

(01) NEVER
(02) SOMETIMES
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(03) USUALLY
(04) ALWAYS
There are many reasons why people may not always be able to take their medicines as prescribed. In (-8) Don't Know
the last six months, how often [were you/was (SP)] able to take [your/his/her] medicine as
(-9) Refused
prescribed?

REACTION

PP38

SHOW CARD US2
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

SPCLCARE

US37A

In the last six months, how often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about what to do if [you
have/he has/she has] a bad reaction to [your/his/her] medicine?
SHOW CARD AC1
Specialists are doctors or other health professionals who specialize in one area of health care. This
card lists some examples of specialists.

DRINFRMD

US37B

REMINDDR

US37C

SPCLSTPM

US37D

TALKPMS

US37E

SPCLNAME

US37E1

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

In the last 6 months, did [you/(SP)] receive care from any specialists outside the office of [(US5A
PROVIDER NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)]?
SHOW CARD US2

(01) NEVER
(02) SOMETIMES
In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (03) USUALLY
(US3A PROVIDER NAME)] seem informed and up-to-date about the care [you get/(SP) gets] from
(04) ALWAYS
specialists?
(-8) Don't Know
(-9) Refused
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
In general, how often [do you/does(SP)] have to remind [(US5A PROVIDER NAME)/the doctors or
(03) USUALLY
other health professionals at (US3A PROVIDER NAME)] about care [you receive/(SP) receives] from
(04) ALWAYS
specialists?
(-8) Don't Know
(-9) Refused
In the last 6 months, did any specialists outside the office of [(US5A PROVIDER NAME)/the doctors or (01) YES
other health professionals at (US3A PROVIDER NAME)] prescribe medicine for [you/(SP)]?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (03) USUALLY
(US3A PROVIDER NAME)] talk with [you/(SP)] about the medicines prescribed by these specialists?
(04) ALWAYS
(-8) Don't Know
(-9) Refused
The next four questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most (01) continuous answer
often in the last 6 months outside the office of [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)].
First, what is the name of the specialist [you/(SP)] saw most often in the last 6 months?

SPCLSEX

US37E2

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
Is [(US37E1 PROVIDER NAME)/the specialist you saw most often in the last six months] a male or
female?

(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED

SPCLKNOW

US37F

[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most
(03) NO
often in the last six months outside the [office of (US5A PROVIDER NAME)/the doctors or other health (-8) Don't Know
professionals at (US3A PROVIDER NAME)].
(-9) Refused
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], does [he/she/he or she] seem to
know enough information about [your/his/her] medical history?

RPTINFO

US37G

KNOWTEST

US37H

SPLKNTEST

PP49

ADMITHOS

PP50

HOSFLWUP

PP51

HOSMED

PP52

HOSFOLLOWUP

PP53

HOSINSTU

PP54

INSTUEASY

PP55

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US2

(01) NEVER
(02) SOMETIMES
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do you/does (SP)] have to (03) USUALLY
repeat information that [you/he/she] [have/has] already given to [(US5A PROVIDER NAME)/the
(04) ALWAYS
doctors or other health professionals at (US3A PROVIDER NAME)]?
(-8) Don't Know
(-9) Refused
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does this [he/she/he or
(03) USUALLY
she] seem to know all of [your/his/her] test results from other providers?
(04) ALWAYS
(-8) Don't Know
(-9) Refused
SHOW CARD US2
(01) NEVER
(02) SOMETIMES
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does [he/she/he or she]
(03) USUALLY
seem to know [your/(SP)'s] important test results from other providers?
(04) ALWAYS
(-8) Don't Know
(-9) Refused
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(01) YES
(02) NO
In the last six months, [were you/was (SP)] admitted to a hospital overnight or longer?
(-8) DON'T KNOW
(-9) REFUSED
After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (01) YES
(US3A PROVIDER NAME)] or someone in [his/her/their] office contact [you/him/her] to see how [you (02) NO
were/he was/she was] doing?
(-8) DON'T KNOW
(-9) REFUSED
After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any medicines?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (01) YES
(US3A PROVIDER NAME)] or someone in [his/her/their] office contact [you/SP] to check if [you
(02) NO
were/he was/she was ] able to follow instructions about any medicines [you were/he was/she was] (-8) DON'T KNOW
prescribed?
(-9) REFUSED
After (your/(SP)'s] most recent hospital stay, (were you/was he/was she] given instructions about
(01) YES
caring for [yourself/himself/herself] at home?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP) was] given easy to (01) YES, DEFINITELY
understand?
(02) YES, SOMEWHAT
(03) NO
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(-8) DON'T KNOW
(-9) REFUSED

HOSINFO

PP56

RATEMANAGE

PP58

DOCKNOWALL

PP59

KNOWMEDS

PP60

RECORDNA

US37I

UNMEDTST

US37J

EMEDREC

US37K

NUSNOTSK

US39

After (your/(SP)'s) most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] seem to know the important information about this hospital stay?

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD PP2
(00) 0 HARD TO MANAGE
(01) 1
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(02) 2
(03) 3
People sometimes need to manage their medical care by making appointments with multiple
(04) 4
providers, following their instructions, and taking medicines as prescribed.
(05) 5
(06) 6
Using any number from 0 to 10, where 0 is hard and 10 is easy, what number would you use to rate (07) 7
how easy it was for [you/(SP)] to manage [your/his/her] medical care in the last six months?
(08) 8
(09) 9
(10) 10 EASY TO MANAGE
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
In the last six months, was there one provider who knew about all [your/(SP)'s] medical care needs? (03) NO
(-8) DON'T KNOW
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
(-9) REFUSED
[IF NEEDED: This question is about the last six months, that is since {CurrentMonth – 6}.]
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
In the last six months, was there one provider who knew about all the medicines [you were/(SP) was] (03) NO
taking?
(-8) DON'T KNOW
(-9) REFUSED
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
Now I’m going to ask you two questions about all the doctors or other health professionals [you
(01) YES
have/(SP) has] seen in the past two years.
(02) NO
(03) NOT APPLICABLE
In the past two years (REFERENCE PERIOD), when getting care for a medical problem, was there ever (04) NOT SURE
a time when test results, medical records, or reasons for referrals were not available at the time of
(-9) Refused
[your/(SP)’s] scheduled doctor or other health professional appointment?
In the past 2 years, when getting care for a medical problem, was there ever a time when doctors or (01) YES
other health professionals ordered a medical test that [you/(SP)] felt was unnecessary because the
(02) NO
test had already been done?
(03) NOT APPLICABLE
(04) NOT SURE
(-9) Refused
Many health care providers are beginning to use electronic or computer-based medical records
(01) YES
instead of using paper-based records. When [you visit/(SP) visits] [(US5A PROVIDER NAME)/the
(02) NO
doctors or other health professionals at (US3A PROVIDER NAME)] [does he or she/do they] generally (-8) Don't Know
enter [your/(SP)'s] health information into a computer while [you are/(SP) is] present?
(-9) Refused
[EXPLAIN IF NECESSARY: An “electronic health record” is an electronic version of a patient’s medical
history maintained by a provider over time. It automates the way in which doctors can access patient
health information. "Health Information" includes information such as symptoms, vital signs, test
results, or prescribed medicines.]
I am going to read some reasons that people have given for not having a usual source of health care. (01) YES
For each one, please tell me whether or not it is a reason [you do/(SP) does] not have a usual place
(02) NO
for health care.
(-8) DON'T KNOW
(-9) REFUSED
There is no reason to have a usual source of health care because [you/(SP)] seldom or never
[get/gets] sick. [Is that a reason [you do/(SP) does] not have a usual source of health care?]

NUSMOVIN

US39

NUSAVAIL

US39

USWHYNAV

US42

USWHYNO1
NUSDIFFP

US42
US43

NUSTOOFR

US43

NUSTOOEX

US43

[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not have a usual source (01) YES
of health care?]
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Your/(SP’s)] usual source of health care in this area is no longer available. [Is that a reason [you
(01) YES
do/(SP) does] not have a usual source of health care?]
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Why is [your/(SP’s)] usual source of health care no longer available?
(01) PREVIOUS DOCTOR RETIRED
(02) PREVIOUS DOCTOR DIED
(03) PREVIOUS DOCTOR MOVED
(04) SP MOVED
(05) PREVIOUS DR/PLACE TOO FAR AWAY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
Thinking about other possible reasons that people have for not having a usual source of health,
(01) YES
please tell me if this statement applies to [you/(SP)]:
(02) NO
(-8) DON'T KNOW
[You like/(SP) likes] to go to different places for different health care needs. [Is that a reason [you
(-9) REFUSED
do/(SP) does] not have a usual source of health care?]
The places where [you/(SP)] can receive health care are too far away. [Is that a reason [you do/(SP) (01) YES
does] not have a usual source of health care?]
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
The cost of health care is too expensive. [Is that a reason [you do/(SP) does] not have a usual source (01) YES
of health care?]
(02) NO
(-8) DON'T KNOW
(-9) REFUSED