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pdf2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
IUQ - INSTITUTIONAL UTILIZATION
Question Type
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP
(-8) Don't Know
(-9) Refused
(01) IU2 - PROVIDER_IU
(02) BOX IU3
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) BOX IU3
(-9) BOX IU3
INSTITUTIONAL UTILIZATION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after OPQ.
SHOW CARD IU1
IUPROBE
IU1
yes/no
[Since (REFERENCE DATE/UTILDATE), [have you/has (SP)] been/Between (REFERENCE DATE) and (DATE OF
DEATH/ENDUTILD), was (SP)/Other than the current institutional stay that started on (DATE OF
INSTITUTIONALIZATION), between (REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION) was (SP)] a
patient in (a/another) nursing home or any similar place that provides long-term care -- such as the places shown on this
card?
LONG-TERM CARE PLACES INCLUDE SKILLED NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD
AND CARE HOMES, NURSING HOME UNITS IN HOSPITALS, FACILITIES FOR THE INTELLECTUALLY DISABLED,
PSYCHIATRIC FACILITIES AND GROUP HOMES.
[ENTER A STAY AT A DRUG AND REHABILITATION CENTER AS AN IP EVENT, NOT AN IU EVENT.]
Where [were you/was (SP)] a patient -- in which nursing home?
SELECT OR ADD ONLY ONE FACILITY.
PROVIDER_IU
IU2
roster
[PROBE TO OBTAIN THE COMPLETE AND FORMAL NAME OF THE INSTITUTION.]
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING AN
EVENT WITH THAT PROVIDER
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
N+1. ADD ANOTHER
N+2. NEED TO EDIT SPELLING OF EXISTING
PROVIDER
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE
PROVNUM>02.
(01-N) BOX IU1
(N+1) IU2-PROVNAME
(N+2) CHNGSPL-CHNGSPL
IF EXISTING PROVIDER SELECTED, GO TO BOX
IU1.
ELSE IF "ADD ANOTHER" SELECTED, GO TO IU2PROVNAME
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.
(01) continuous answer
ENTER THE NAME OF THE PROVIDER AND THE BILLING/GROUP OR PRACTICE NAME BELOW.
[PROVE TO OBTAIN THE COMPLETE AND FORMAL NAME OF THE HOSPITAL]
PROVNAME
IU2
verbatim
YOU MUST ENTER A PROVIDER NAME IN THE ‘NAME’ FIELD. IF THE PROVIDER IS AN INDIVIDUAL BUT YOU
DO NOT KNOW THE PROVIDER’S NAME, OR IF THE PROVIDER IS AN ORGANIZATION, ENTER THE GROUP OR
PRACTICE NAME IN THE ‘NAME’ FIELD AND LEAVE THE ‘GROUP’ FIELD BLANK.
IU2-GROUPNAM
YOU CAN CONSULT THE RESPONDENT’S STATEMENTS AND APPOINTMENT CARDS TO ENSURE THE
PROVIDER NAME IS ENTERED CORRECTLY.
NAME:
[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
GROUPNAM
IU2
GROUP:
BOX IU1
roster
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND SELECT 2. [PROVIDER 2]
"ADD ANOTHER."
…
N. [PROVIDER N]
ONLY SELECT A PROVIDER IF YOU ARE CURRENTLY ENTERING AN EVENT WITH THAT PROVIDER. IF YOU
ARE NOT CURRENTLY ENTERING AN EVENT WITH A MISSPELLED PROVIDER, BACK UP TO SELECT OR ADD DISPLAY PROVIDER NAME, SPECIALITY, GROUP
THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE
PROVNUM>02.
CRCTSPL-CRCTSPL
verbatim
WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND SELECT
(01) [Continuous Answer]
"ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]
BOX IU1
WHICH PROVIDER IS MISSPELLED?
CHNGSPL
CRCTSPL
CHNGSPL
CRCTSPL
Page 1 of 2
2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
BOX IU1
IUQ - INSTITUTIONAL UTILIZATION
Question Type
routing
Question Text/Description
Code List
Routing
IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A. IN THE CURRENT ROUND OR ANY
PREVIOUS ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO IU3 - VAPLACE.
ELSE TO IU4 - EVBEGMM.
Is (FACILITY NAME) a Department of Veterans Affairs, or V.A., facility?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) continuous answer
(-8) Don't Know
(-9) Refused
VAPLACE
IU3
yes/no
EVBEGMM
IU4
date
EVBEGDD
IU4
date
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IU4 - EVBEGYY
EVBEGYY
IU4
date
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IU4 - EVENDMM
EVENDMM
IU4
date
(01) continuous answer
(-8) Don't Know
(-9) Refused
IU4 - EVENDDD
EVENDDD
IU4
date
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IU4 - EVENDYY
EVENDYY
IU4
date
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IU4 - STLLINST
STLLINST
IU4
date
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
(01) SP IS STILL IN FACILITY
(-7) Empty
IU4B-IUADD
IUADD
IU4B
choose one
(01) ADD ANOTHER
(02) ALL DONE
(01) IU4-EVBEGMM
(02) IU7-IUMORE
(01) YES
(02) NO
(-8) Don't know
(-9) Refused
(01) IU2 - PROVIDER_IU
(02) BOX IU3
(-8) BOX IU3
(-9) BOX IU3
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
Admission Date:
When [were you/was (SP)] admitted to and discharged from (FACILITY NAME)?
Discharge Date:
HAVE ALL DATES BEEN ENTERED?
[DISPLAY ALL EVENTS ASSOCIATED WITH THIS PROVIDER]
IF RESPONDENT HAS ALREADY MENTIONED ANOTHER STAY AT A NURSING HOME, ENTER “YES” WITHOUT
ASKING. OTHERWISE, ASK:
IUMORE
IU7
yes/no
[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you had/has (SP) had/did (SP) have] any other stays in this or any other
nursing home or similar place that provides long-term care?
IU4 - EVBEGMM
IU4 - EVBEGDD
[ENTER A STAY AT A DRUG AND REHABILITATION CENTER AS AN IP EVENT, NOT AN IU EVENT.]
BOX IU3
routing
IF INTTYPE in(C001, C004), GO TO HHS.
IF INTTYPE in(C002, C005, C006, C007, C010), GO TO HHQ.
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |