CMS-P-0015A Satisfaction Care

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

SCQ - SATISFACATION WITH CARE

Question Type

Question Text/Description

Code List

Routing

SATISFACTION WITH CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY until BOX PA1
Other: N/A
PLACEMENT
Administer after NAQ.
NOTE: In R79 the PAQ was incorporated into the SCQ. Until BOX PA1 the section is administered if the R is SP
or Proxy. At BOX PA1, the routing only asks the PAQ questions if the R is SP.

SHOW CARD SC1

MCQUALTY

SC1

code 1

(01) VERY SATISFIED
We’re interested in how you feel about the health care [you have/(SP) has] received [over the past year/since
(02) SATISFIED
(TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)] from doctors and hospitals. Please tell me how satisfied (03) DISSATISFIED
or dissatisfied you have been with the following:
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The overall quality of the health care [you have /(SP) has] received [over the past year/since (TODAY'S DATE - (-8) Don't Know
12 MONTHS)]. Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied?
(-9) Refused

SC2 - MCAVAIL

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC3 - MCEASE

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC4 - MCCOSTS

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC5 - MCINFO

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC7-MCCONCRN

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC8 - MCSAMLOC

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC8A - MCSPECAR

SHOW CARD SC1
MCAVAIL

SC2

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of health care at night and on weekends.

SHOW CARD SC1
MCEASE

SC3

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease and convenience of getting to a doctor or other health professional from where [you/(SP)] [live/lives].

SHOW CARD SC1
MCCOSTS

SC4

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The out-of-pocket costs [you/(SP)] paid for health care.

SHOW CARD SC1
MCINFO

SC5

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The information given to [you/you or (SP)] about what was wrong with [you/(SP)].

SHOW CARD SC1
MCCONCRN

SC7

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The concern of doctors or other health professionals for [your/(SP’s)] overall health rather than just for an
isolated symptom or disease.

MCSAMLOC

SC8

code 1

SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
Getting all [your/(SP’s)] health care needs taken care of at the same location.

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2019 MCBS Community Questionnaire

Variable Name

MCSPECAR

MR Screen Name

SC8A

SCQ - SATISFACATION WITH CARE

Question Type

code 1

Question Text/Description

SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of care by specialists when [you/(SP)] (feel/feels) (you/he/she) (need/needs) it.

SHOW CARD SC1
MCTELANS

SC8B

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease of obtaining answers to questions over the telephone about [your/(SP’s)] treatment or prescriptions.

MDISSFY

SC9

verbatim text

Please think about all of the health care services [you/(SP)] [receive/receives], including services provided by
doctors or other health professionals, hospitals and pharmacies.
What things, if anything, about the health care services [you/(SP)] [receive/receives] are you dissatisfied with?

MCDISVB

SC9

verbatim text

[Please think about all of the health care services [you/(SP)] (receive/receives), including services provided by
doctors or other health professionals, hospitals and pharmacies.

Code List

Routing

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC8B - MCTELANS

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SC9-MDISSFY

(01) RESPONDENT IS NOT DISSATISFIED WITH
ANYTHING
(91) RESPONDENT IS DISSATISFIED (RECORD
VERBATIM IN THE NEXT SCREEN)
(-8) Don't Know
(-9) Refused

(01) SC10A - MCWORRY
(91) SC9 - MCDISVB
(-8) SC10A - MCWORRY
(-9) SC10A - MCWORRY

(01) [Continuous answer.]

SC10A - MCWORRY

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCAVOID

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCSICK

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCDRSOON

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

BOX PA1

What things, if anything, about the health care services [you/(SP)] (receive/receives) are you dissatisfied with?]

Please tell me whether each of the following statements is true or false.
MCWORRY

SC10A

list

[You/(SP)] (worry/worries) about (your/his/her) health more than other people (your/his/her) age.
[Is this statement true or false?]

MCAVOID

MCSICK

SC10A

SC10A

list

list

[Please tell me whether each of the following statements is true or false.]
[You/(SP)] will do just about anything to avoid going to the doctor.

[Please tell me whether each of the following statements is true or false.]
When [you/(SP)] [are/is] sick, [you/he/she] [try/tries] to keep it to [yourself/himself/herself].
[Please tell me whether each of the following statements is true or false.]

MCDRSOON

SC10A

list

BOX PA1

PAINTRO

PAINSTRC

PAINTRO

PA3

Usually, [you/(SP)] (go/goes) to the doctor or other health professional as soon as (you/he/she) (start/starts) to
feel bad.
IF IN4-SPPROXY=1/SP then go to PAINTRO- PAINTRO. ELSE GO TO BOX SCEND

no entry

code 1

Now I have some questions about how you make health care decisions. Answers to questions like these will
help Medicare better understand how people use medical services.
Please keep in mind that there are no right or wrong answers to these questions. Your opinions and
experiences are important to us.

SHOW CARD SC2
Doctors often give instructions about how you should care for yourself at home, like changing a bandage, taking
medicines on schedule, or applying ice packs. How confident are you that you can follow instructions to care for
yourself at home?

(01) CONTINUE
(-7) Empty

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

PA3 - PAINSTRC

PA4 - PAMEDREC

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2019 MCBS Community Questionnaire

Variable Name

PAMEDREC

PACHGDRS

PADISAGR

MR Screen Name

PA4

PA5

PA6

SCQ - SATISFACATION WITH CARE

Question Type

Question Text/Description

Code List

Routing

code 1

SHOW CARD SC2
Doctors also often give instructions about changing your habits or lifestyle, such as changing your diet, stopping
smoking, or getting regular exercise. How confident are you that you can follow this kind of instruction, to
change your habits or lifestyle?

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

PA5 - PACHGDRS

(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused

PA6-PADISAGR

(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused

PA10-PARXINFO

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

PA11-PADRQUEX

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

PA12-PAANSWR

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

PA13-PALISTRX

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

PA14-PATRSLT

code 1

code 1

SHOW CARD SC3
Please use this card to respond to the following statements.
How likely are you to change doctors or other health professionals if you are dissatisfied with the way you and
your doctor or other health professional communicate?

SHOW CARD SC3
How likely are you to tell your doctor or other health professional when you disagree with him or her?

SHOW CARD SC4
PARXINFO

PA10

code 1

These next questions are about practices sometimes associated with receiving medical care. Please tell me if
you always, usually, sometimes, or never do the following:
Do you always, usually, sometimes, or never read information about a new prescription, such as side effects
and precautions?

PADRQUEX

PAANSWR

PALISTRX

PA11

PA12

PA13

code 1

code 1

code 1

SHOW CARD SC4
Do you always, usually, sometimes, or never...
Bring with you to your doctor or other health professional visits a list of questions or concerns you want to
cover?
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Leave your doctor or other health professional's office feeling that all of your concerns or questions have been
fully answered?

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Take a list of all of your prescribed medicines to your doctor or other health professional visits?

PATRSLT

PAOPTION

PADVICE

PA14

PA15

PA21

code 1

code 1

code 1

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
Make sure you understand the results of any medical test or procedure such as an x-ray, blood test, or EKG for
(-8) Don't Know
heart conditions?
(-9) Refused
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Talk with your doctor or other health professional about your options if you need tests, follow-up care, or a
referral for care by a medical specialist?

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Contact your doctor or other health professional's office to get medical advice when you need it.

BOX SCEND

routing

PA15-PAOPTION

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

PA21-PADVICE

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

BOX SCEND

IF INTTYPE in(C001, C002, C004, C005, C006), GO TO END.
IF INTTYPE in(C003), GO TO DIQ.

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