CMS-10102 HCAHPS Survey Instrument (AVIR Script)

OMB Control Number 0938-0981 (Expires: TBD)

HCAHPS
Active Interactive Voice Response Script (English)
Overview
This active interactive voice response (IVR) interview script is provided to assist operators while
attempting to reach the patient. The script explains the purpose of the survey and confirms
necessary information about the patient before the patient is connected to the IVR system.
Operators must not conduct the survey with a proxy.
Note: No proxy respondents are permitted in the administration of the HCAHPS Survey.
However, an individual may assist the patient by repeating questions-- but only the patient may
provide answers to the survey.
General Interviewing Conventions and Instructions
 It is optional to include the day of the week, e.g., Monday, with the discharge date
(mm/dd/yyyy)
 All text that appears in lowercase letters must be read out loud
 Text in UPPERCASE letters must not be read out loud
 All questions and all answer categories must be read exactly as they are worded
o During the course of the survey, use of neutral acknowledgment words such as the
following is permitted:
 Thank you
 Alright
 Okay
 I understand, or I see
 Yes, Ma’am
 Yes, Sir
 Read the scripts from the interviewer screens (reciting the survey from memory can lead
to unnecessary errors and missed updates to the scripts)
 Adjust the pace of the HCAHPS Survey interview to be conducive to the needs of the
respondent
 No changes are permitted in the order of the question and answer categories for the core
and “About You” HCAHPS questions
 The Core HCAHPS questions (Questions 1-22) must remain together
 The seven “About You” HCAHPS 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 IVR screens
 Only one language (i.e. English, Spanish, Chinese, or Russian) must appear on the
electronic interviewing system screen

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Each question must be programmed so that the patient can go to the next question in
cases where they do not know the answer or refuse to answer
Each question must have the option for the respondent to be connected to a live operator
at any time during the survey
MISSING/DON’T KNOW (DK) is a valid response option for each item in the IVR
script, however this option must not be read out loud to the patient. MISSING/DK
response options allow the IVR system 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 IVR system.
o Appropriately skipped questions should be coded as “8 - Not applicable.” For
example, if a patient answers “No” to Question 10 of the HCAHPS survey, the
program should skip Question 11, and go to Question 12. Question 11 must then be
coded as “8 - Not applicable.” Coding may be done automatically by the IVR 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 10 of the HCAHPS
survey, then the IVR system should be programmed to skip Question 11, and go to
Question 12. Question 11 must then be coded as “M - Missing/Don't know.” Coding
may be done automatically by the IVR system or later during data preparation.

NOTE: SEE INTERVIEWING GUIDELINES IN APPENDIX M FOR GUIDELINES
ON HOW TO HANDLE DIFFICULT TO REACH PATIENTS.
INITIATING CONTACT
START Hello, may I please speak to [SAMPLED PATIENT NAME]?
OPTIONAL START
Hello, my name is [INTERVIEWER NAME], may I speak to
[SAMPLED PATIENT NAME]?
<1> YES [GO TO INTRO]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING:
This is [OPERATOR NAME] calling from [DATA COLLECTION
CONTRACTOR] on behalf of [HOSPITAL NAME]. We are conducting a survey
about healthcare. Is [SAMPLED PATIENT NAME] available?
IF ASKED WHETHER PERSON CAN SERVE AS PROXY FOR SAMPLED
PATIENT:
For this survey, we need to speak directly to [SAMPLED PATIENT NAME]. Is
[SAMPLED PATIENT NAME] available?
IF THE SAMPLED PATIENT IS NOT AVAILABLE:
Can you tell me a convenient time to call back to speak with (him/her)?
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IF THE SAMPLED PATIENT 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 ASKED IF YOU WOULD LIKE TO SPEAK TO “SR.” OR “JR”:
I would like to speak with [PATIENT NAME] who is approximately [AGE
RANGE].
IF SOMEONE OTHER THAN THE SAMPLED PATIENT ANSWERS THE PHONE
RECONFIRM THAT YOU ARE SPEAKING WITH THE SAMPLED PATIENT WHEN HE
OR SHE PICKS UP.
CALL BACK TO COMPLETE A PREVIOUSLY STARTED SURVEY
START: Hello, may I please speak to [SAMPLED PATIENT NAME]?
<1> YES [GO TO CONFIRM PATIENT]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING: This is [INTERVIEWER NAME] calling from [DATA
COLLECTION CONTRACTOR] on behalf of [HOSPITAL NAME]. Is [SAMPLED
PATIENT NAME] available to complete a survey that [HE/SHE] started at an earlier date?
CONFIRM PATIENT: This is [INTERVIEWER NAME] calling from [DATA
COLLECTION CONTRACTOR] on behalf of [HOSPITAL NAME]. I would like to confirm
that I am speaking with [SAMPLED PATIENT NAME]. I am calling to continue the survey
started on an earlier date. CONTINUE SURVEY WHERE PREVIOUSLY LEFT OFF.
SPEAKING WITH SAMPLED PATIENT
INTRO

Hi, this is [OPERATOR NAME], calling (OPTIONAL TO STATE: from [DATA
COLLECTION CONTRACTOR]) on behalf of [HOSPITAL NAME].
[HOSPITAL NAME] is participating in a survey about the care people receive in
the hospital. This survey is part of a national initiative to measure the quality of
care in hospitals. Survey results can be used by people to choose a hospital. Your
answers may be shared with the hospital for purposes of quality improvement.
Participation in the survey is completely voluntary and will not affect your health
care or your benefits. It should take about 7 minutes [OR VENDOR SPECIFY] to
answer.
This call may be monitored [recorded] for quality improvement purposes.
OPTIONAL QUESTION TO INCLUDE:
I’d like to begin the survey now, is this a good time for us to continue?

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NOTE: THE STATED NUMBER OF MINUTES TO COMPLETE THE SURVEY
MUST BE AT LEAST 7 MINUTES. IF SUPPLEMENTAL ITEMS ARE ADDED
TO THE SURVEY, THIS NUMBER SHOULD BE INCREASED ACCORDINGLY.
S1:

Our records show that you were discharged from [HOSPITAL NAME] on or
about [DISCHARGE DATE (mm/dd/yyyy)]. Is that right?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>
<3>
<4>

S2:

YES
NO
DON’T KNOW
REFUSAL

[GO TO S2]
[GO TO INEL1]
[GO TO INEL1]
[GO TO INEL1]

Thank you. You will now be connected to an automated interviewing system. If at
any time you would like to speak with a live operator, please press [VENDOR
SPECIFY] to be connected with someone.
CONFIRMING INELIGIBLE RESPONDENTS

INEL1:

Were you ever at this hospital?
<1> YES [GO TO INEL2]
<2> NO
[GO TO INEL_END]

INEL2:

Were you a patient at this hospital in the last year?
<1> YES [GO TO INEL3]
<2> NO
[GO TO INEL_END]

INEL3:

When was this?
IF ANY DATE WAS WITHIN TWO WEEKS OF [DISCHARGE DATE
(mm/dd/yyyy)], GO TO S2; OTHERWISE, GO TO INEL_END.

INEL_END: Thank you for your time. It looks like we made a mistake. Have a good
(day/evening).
BEGIN HCAHPS QUESTIONS
MESSAGE 1: You have been successfully connected to the automated interviewing system. The
survey will now begin. You may enter [VENDOR SPECIFY] at any time to
return to the telephone operator. If you cannot choose one of the response options
after a particular question, please wait for further instruction.
Q1_INTRO

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Please answer the questions in this survey about your stay at [HOSPITAL
NAME]. When thinking about your answers, do not include any other hospital
stays. The first questions are about the care you received from nurses during this
hospital stay.

Q1

During this hospital stay, how often did nurses treat you with courtesy and
respect? Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q2

During this hospital stay, how often did nurses listen carefully to you? Would you
say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q3

During this hospital stay, how often did nurses explain things in a way you could
understand? Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q4

During this hospital stay, after you pressed the call button, how often did you get
help as soon as you wanted it? Would you say never, sometimes, usually, always,
or I never pressed the call button?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
For “I never pressed the call button,” press '9'
MISSING/DK

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Q5_INTRO

The next questions are about the care you received from doctors during this
hospital stay.

Q5

During this hospital stay, how often did doctors treat you with courtesy and
respect? Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q6

During this hospital stay, how often did doctors listen carefully to you? Would
you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q7

During this hospital stay, how often did doctors explain things in a way you could
understand? Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q8_INTRO

The next set of questions is about the hospital environment.

Q8

During this hospital stay, how often were your room and bathroom kept clean?
Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

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Q9

During this hospital stay, how often was the area around your room quiet at night?
Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
MISSING/DK

Q10_INTRO The next questions are about your experiences in this hospital.
Q10

During this hospital stay, did you need help from nurses or other hospital staff in
getting to the bathroom or in using a bedpan?
For “Yes,” press '1'
For “No,” press '2' [GO TO Q12]
MISSING/DK

Q11

[GO TO Q12]

How often did you get help in getting to the bathroom or in using a bedpan as
soon as you wanted? Would you say never, sometimes, usually, or always?
For "Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
<8> NOT APPLICABLE
MISSING/DK
[NOTE: IF Q10 = “2 - NO” THEN Q11 = “8 - NOT APPLICABLE” OR IF Q10
= “M - MISSING/DK” THEN Q11 = “M - MISSING/DK”]

Q12

During this hospital stay, were you given any medicine that you had not taken
before?
For “Yes,” press '1'
For “No,” press '2' [GO TO Q15_INTRO]
MISSING/DK [GO TO Q15_INTRO]

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Q13

Before giving you any new medicine, how often did hospital staff tell you what
the medicine was for? Would you say never, sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
<8> NOT APPLICABLE
MISSING/DK
[NOTE: IF Q12 = “2 - NO” THEN Q13 = “8 - NOT APPLICABLE” OR IF Q12
= “M - MISSING/DK” THEN Q13 = “M - MISSING/DK”]

Q14

Before giving you any new medicine, how often did hospital staff describe
possible side effects in a way you could understand? Would you say never,
sometimes, usually, or always?
For “Never,” press '1'
For “Sometimes,” press '2'
For “Usually,” press '3'
For “Always,” press '4'
<8> NOT APPLICABLE
MISSING/DK
[NOTE: IF Q12 = “2 - NO” THEN Q14 = “8 - NOT APPLICABLE” OR IF Q12
= “M - MISSING/DK” THEN Q14 = “M - MISSING/DK”]

Q15_INTRO The next questions are about when you left the hospital.
Q15

After you left the hospital, did you go directly to your own home, to someone
else’s home, or to another health facility?
For “Own home,” press '1'
For “Someone else's home,” press '2'
For “Another health facility,” press '3' [GO TO Q18]
MISSING/DK [GO TO Q18]

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Q16

During this hospital stay, did doctors, nurses or other hospital staff talk with you
about whether you would have the help you needed when you left the hospital?
For “Yes,” press '1'
For “No,” press '2'
<8> NOT APPLICABLE
MISSING/DK
[NOTE: IF Q15 = “3 - ANOTHER HEALTH FACILITY” THEN Q16 = “8 NOT APPLICABLE” IF Q15 = “M - MISSING/DK” THEN Q16 = “M MISSING/DK”]

Q17

During this hospital stay, did you get information in writing about what symptoms
or health problems to look out for after you left the hospital?
For “Yes,” press '1'
For “No,” press '2'
<8> NOT APPLICABLE
MISSING/DK
[NOTE: IF Q15 = “3 - ANOTHER HEALTH FACILITY” THEN Q17 = “8 NOT APPLICABLE” IF Q15 = “M - MISSING/DK” THEN Q17 = “M MISSING/DK”]

Q18

We want to know your overall rating of your stay at [FACILITY NAME]. This is
the stay that ended around [DISCHARGE DATE (mm/dd/yyyy)]. Please do not
include any other hospital stays in your answer.
Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is
the best hospital possible, what number would you use to rate this hospital during
your stay?
[VENDOR SPECIFIES HOW TO ENTER BOTH “0” AND “10” INTO THEIR
SYSTEM.] Please press this number now.

Q19

Would you recommend this hospital to your friends and family? Would you say
definitely no, probably no, probably yes, or definitely yes?
For “Definitely no,” press '1'
For “Probably no,” press '2'
For “Probably yes,” press '3'
For “Definitely yes,” press '4'

MISSING/DK

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Q20_INTRO We have a few more questions about this hospital stay.
Q20

During this hospital stay, staff took my preferences and those of my family or
caregiver into account in deciding what my health care needs would be when I
left. Would you say strongly disagree, disagree, agree, or strongly agree?
For “Strongly disagree,” press '1'
For “Disagree,” press '2'
For “Agree,” press '3'
For “Strongly agree,” press '4'
MISSING/DK

Q21

When I left the hospital, I had a good understanding of the things I was
responsible for in managing my health. Would you say strongly disagree,
disagree, agree, or strongly agree?
For “Strongly disagree,” press '1'
For “Disagree,” press '2'
For “Agree,” press '3'
For “Strongly agree,” press '4'
MISSING/DK

Q22

When I left the hospital, I clearly understood the purpose for taking each of my
medications. Would you say strongly disagree, disagree, agree, strongly agree, or
I was not given any medication when I left the hospital?
For “Strongly disagree,” press '1'
For “Disagree,” press '2'
For “Agree,” press '3'
For “Strongly agree,” press '4'
For “I was not given any medication when I left the hospital,” press '5'
MISSING/DK

Q23_INTRO This next set of questions is about you.
Q23

During this hospital stay, were you admitted to this hospital through the
Emergency Room?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

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Q24

In general, how would you rate your overall health? Would you say that it is
excellent, very good, good, fair, or poor?
For “Excellent,” press '1'
For “Very good,” press '2'
For “Good,” press '3'
For “Fair,” press '4'
For “Poor,” press '5’
MISSING/DK

Q25

In general, how would you rate your overall mental or emotional health? Would
you say it is excellent, very good, good, fair, or poor?
For “Excellent,” press '1'
For “Very good,” press '2'
For “Good,” press '3'
For “Fair,” press '4'
For “Poor,” press '5’
MISSING/DK

Q26

What is the highest grade or level of school that you have completed? Did you
complete the 8th grade or less, complete some high school but did not graduate,
graduate from high school or earn a GED, complete some college or earn a 2-year
degree, graduate from a 4-year college, or complete more than a 4-year college
degree?
For “Completed the 8th grade or less,” press '1'
For “Completed some high school, but did not graduate,” press '2'
For “Graduated from high school or earned a GED,” press '3'
For “Completed some college or earned a 2-year degree,” press '4'
For “Graduated from a 4-year college,” press '5'
For “Completed more than a 4-year college degree,” press '6'
MISSING/DK

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Q27

Are you of Spanish, Hispanic or Latino origin or descent? Would you say “No,
not Spanish/Hispanic/Latino”; “Yes, Puerto Rican”; “Yes, Mexican, Mexican
American, Chicano”; “Yes, Cuban”; or “Yes, other Spanish/ Hispanic/Latino”?
For “No, not Spanish/Hispanic/Latino,” press '1'
For “Yes, Puerto Rican,” press '2'
For “Yes, Mexican, Mexican American, Chicano,” press '3'
For “Yes, Cuban,” press '4'
For “Yes, other Spanish/Hispanic/Latino,” press '5'
MISSING/DK

[FOR IVR, QUESTION 28 IS BROKEN INTO PARTS A-E]
Q28

When I read the following, please tell me if the category describes your race.
Please answer “Yes” or “No” to each of the categories.

Q28A

Are you White?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

Q28B

Are you Black or AfricanAmerican?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

Q28C

Are you Asian?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

Q28D

Are you Native Hawaiian or other Pacific Islander?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

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Q28E

Are you American Indian or Alaska Native?
For “Yes,” press '1'
For “No,” press '2'
MISSING/DK

NOTE: “1” and “2” SHOULD BE CONVERTED TO “1” AND “0”, RESPECTIVELY IN
THE DATA FILE. FOR VALID VALUES, REFER TO APPENDIX P - DATA FILE
STRUCTURE.
Q29

What language do you mainly speak at home? Would you say that you mainly
speak English, Spanish, Chinese, Russian, Vietnamese, Portuguese, or some other
language?
For “English,” press '1'
For “Spanish,” press '2'
For “Chinese,” press '3'
For “Russian,” press '4'
For “Vietnamese,” press '5'
For “Portuguese,” press '6'
For “Some other language,” press '9'
MISSING/DK

END

Those are all the questions I have. Thank you for your time. Have a good
(day/evening).

< THIS ITEM IS NOT TO BE PROGRAMMED. THE NOTE BELOW MUST APPEAR ON ALL PUBLISHED
MATERIALS CONTAINING THIS IVR SCRIPT.>

< THIS ITEM IS NOT TO BE PROGRAMMED. THE NOTE BELOW MUST APPEAR ON ALL PUBLISHED
MATERIALS CONTAINING THIS CATI SCRIPT>

“According to the Paperwork Reduction Act of 1995, no persons are required to respond to
a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0938-0981. The time required to complete
this information collected is estimated to average 7 minutes for questions 1-22 on the
survey, including the time to review instructions, search existing data resources, gather the
data needed, and complete and review the information collection. If you have any
comments concerning the accuracy of the time estimate(s) or suggestions for improving
this form, please write to: Centers for Medicare & Medicaid Services, 7500 Security
Boulevard, C1-25-05, Baltimore, MD 21244-1850.”
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