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pdf2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP. DO NOT
DISPLAY. DATA EDITING ONLY.
(-8) DON'T KNOW
(-9) REFUSED
(01) HH4-PROFWORK
(02) HH18 - HHPRFRND
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND
(01) WORKS FOR ORGANIZATION
(02) WORKS FOR SELF
(-8) DON'T KNOW
(-9) REFUSED
(01) HH5-PROVIDER_HHPORG
(02) HH2-PROVIDER_HHP
(-8) HH2-PROVIDER_HHP
(-9) HH2-PROVIDER_HHP
HOME HEALTH UTILIZATION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C001, C002, C004, C005, C006, C007, C010) administer after IUQ.
SHOW CARD HH1
(At the time of the last interview, [you/(SP)] indicated that [you/(she/he)] had been helped at home by a health
or medical professional.)
HHPRPROF
HH1
yes/no
[(Since/since) (REFERENCE DATE/UTILDATE)/(Between/between) (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] helped at
home by any (other) health or medical professionals, such as those listed on this card? (This may include
health or medical professionals reported in prior interviews.)
[Health professionals include nurse (visiting nurse, private duty nurse, etc.), doctor, social worker, therapist,
hospice worker, home health aides, and those who provide homemaker services.]
PROFWORK
HH4
code one
Does this health or medical professional work for a place or organization?
[PROBE: Or does this health or medical professional work for himself/herself?]
What is the name of the home health place or organization who helped [you/(SP)] at home [since
(REFERENCE DATE/UTILDATE)/between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)]?
(01) CONTINUOUS ANSWER
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
ADD OR SELECT ONLY ONE PROVIDER.
2. [PROVIDER 2]
…
N. [PROVIDER N]
ENTER THE NAME OF THE PLACE OR ORGANIZATION RATHER THAN AN INDIVIDUAL PROVIDER.
N+1. ADD ANOTHER
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING N+2. NEED TO EDIT SPELLING OF EXISTING
AN EVENT WITH THAT PROVIDER.
PROVIDER
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
[DO NOT ADD A NEW ROSTER ENTRY IF A DIFFERENT PERSON CAME FROM AN ORGANIZATION
ALREADY LISTED ON THE ROSTER.]
[PROBE: Who would (you/SP) call if the home health provider did not show up?]
PROVIDER_HHPORG
HH5
roster
(01-N) BOX HH1AAA
(N+1) PROVNAME-HH5
(N+2) CHNGSPL-CHNGSPL
IF EXISTING PROVIDER SELECTED, GO TO BOX
HH1AAA.
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH5
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.
[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
ENTER THE NAME OF THE PLACE OR ORGANIZATION RATHER THAN AN INDIVIDUAL PROVIDER.
PROVNAME
HH5
verbatim
[DO NOT ADD A NEW ROSTER ENTRY IF A DIFFERENT PERSON CAME FROM AN ORGANIZATION
ALREADY LISTED ON THE ROSTER.]
BOX HH1AAA
YOU CAN CONSULT THE RESPONDENT’S STATEMENTS AND APPOINTMENT CARDS TO ENSURE THE
PROVIDER NAME IS ENTERED CORRECTLY.
NAME:
WHICH PROVIDER IS MISSPELLED?
CHNGSPL
CHNGSPL
roster
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
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 THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
CRCTSPL-CRCTSPL
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
Page 1 of 7
2021 MCBS Community Questionnaire
HHQ-HOME HEALTH UTILIZATION
Variable Name
MR Screen Name
Question Type
CRCTSPL
CRCTSPL
verbatim
Question Text/Description
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 "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]
Code List
Routing
(01) [Continuous Answer]
BOX HH1AAA
(01) CONTINUOUS ANSWER
(01-N) BOX HH1AAA
(N+1) PROVNAME-HH2
(N+2) CHNGSPL-CHNGSPL
NAME:
What is the name of the health professional who helped [you/(SP)] at home [since (REFERENCE
DATE/UTILDATE)/between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)]?
PROVIDER_HHP
HH2
roster
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF PLACE OR ORGANIZATION.
…
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING N. [PROVIDER N]
AN EVENT WITH THAT PROVIDER.
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
IF EXISTING PROVIDER SELECTED, GO TO BOX
HH1AAA
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH2
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.
[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF PLACE OR ORGANIZATION.
PROVNAME
HH2
verbatim
BOX HH1AAA
YOU CAN CONSULT THE RESPONDENT’S STATEMENTS AND APPOINTMENT CARDS TO ENSURE THE
PROVIDER NAME IS ENTERED CORRECTLY.
NAME:
WHICH PROVIDER IS MISSPELLED?
CHNGSPL
CHNGSPL
roster
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
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 THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
CRCTSPL-CRCTSPL
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?
CRCTSPL
CRCTSPL
verbatim
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]
(01) [Continuous Answer]
BOX HH1AAA
NAME:
BOX HH1AAA
routing
IF (HOME HEALTH PROVIDER WAS ADDED AT HH2 OR HH5) OR (AN EXISTING PROVIDER WAS
SELECTED AT HH2 OR HH5 THAT WAS NOT ASSOCIATED WITH A HOME HEALTH EVENT), GO TO HH3 PROVSPEC.
ELSE GO TO BOX HH1BBB.
Page 2 of 7
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
What kind of health professional [is (PROVIDER NAME)/did [you/(SP)] see from (PROVIDER NAME)]?
[SELECT THE RESPONSE CATEGORY FOR A GIVEN SPECIALTY ONLY IF THE RESPONDENT
SPECIFICALLY NAMES THE LISTED SPECIALTY OR MENTIONS THE WORDS OR INITIALS IN
PARENTHESES FOLLOWING THAT PROVIDER SPECIALTY. IF THE RESPONDENT NAMES A MEDICAL
SPECIALTY NOT LISTED BELOW, BUT LISTED ON MPQ JOB AID 1, SUCH AS ‘CARDIOLOGY,’ SELECT
'MEDICAL DOCTOR.']
PROVSPEC
HH3
code one
PROVSPOS
HH3
text
OTHER MEDICAL PROVIDER (SPECIFY)
BOX HH1AA
routing
IF HH4 -PROFWORK = 1/Works for Organization, SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE
HOME HEALTH ORGANIZATION SELECTED AT HH5, AND GO TO HH6 - HHPLACE.
ELSE SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE PROVIDER SELECTED AT HH2, HH19,
ST27 OR NS27, AND GO TO BOX HH1BB.
Code List
Routing
(01) DENTIST/DENTAL PROVIDER
(02) MEDICAL DOCTOR
(03) AUDIOLOGIST
(04) CHIROPRACTOR
(05) CLINICAL SOCIAL WORKER
(06) DIETITIAN-NUTRITIONIST
(07) HEARING THERAPIST
(08) HOME HEALTH/HEALTH AIDE
(09) HOMEMAKER
(10) HOSPICE WORKER
(11) I.V. THERAPIST
(12) NURSE (RN)
(13) NURSE PRACTITIONER
(14) NURSE'S AIDE
(15) OCCUPATIONAL THERAPIST (OT)
(16) OPTOMETRIST (OD)
(17) OSTEOPATH (DO)
(18) PARAMEDIC
(19) PHYSICAL THERAPIST (PT)
(01)-(34), (-8), (-9) BOX HH1AA
(20) PHYSICIAN'S ASSISTANT
(91) HH3 - PROVSPOS
(21) PODIATRIST (FOOT DOCTOR)
(22) PSYCHOLOGIST
(23) RESPIRATORY THERAPIST
(24) SOCIAL/CASE WORKER
(25) SPEECH THERAPIST
(26) THERAPIST (MENTAL HEALTH)
(27) X-RAY TECHNICIAN
(28) LICENSED PRACTICAL NURSE (LPN)
(29) ACUPUNCTURIST
(30) HOMEOPATH
(31) MASSAGE THERAPIST
(32) NATUROPATH
(33) LICENSED PROFESSIONAL COUNSELOR [LPC]
(34) LAB TECHNICIAN
(91) OTHER MEDICAL PROVIDER SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED
BOX HH1AA
HHPLACE
HH6
code one
PROVIDER NAME: (PROVIDER NAME)
What kind of place or organization is (PROVIDER NAME)?
(01) MANAGED CARE PLAN (SUCH AS HMO)
(02) MEAL PROGRAM (SUCH AS MEALS ON
WHEELS)
(03) VISITING NURSE ASSOCIATION
(04) HOME HEALTH AGENCY
(05) HOSPITAL
(06) PRIVATE PHYSICIAN/GROUP PRACTICE
(07) HOSPICE
(08) REHABILITATION OR SPORTS MEDICINE
THERAPY
(09) LOCAL GOVERNMENT ORGANIZATION
(10) CHURCH OR COMMUNITY ORGANIZATION
(11) ASSISTED LIVING/RETIREMENT HOME
(91) OTHER (SPECIFY)
(-8) DON'T KNOW
(-9) REFUSED
HHPLACOS
HH6
text
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
BOX HH1BBB
routing
SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE PROVIDER SELECTED AT HH2, HH5, OR HH19.
IF TYPE OF HOME HEALTH PROVIDER ORGANIZATION IS A MEAL PROGRAM, GO TO HH7 - OTHMEALS.
ELSE GO TO BOX HH1BB.
(01) BOX HH1BB
(02) BOX HH1BBB
(03) BOX HH1BB
(04) BOX HH1BB
(05) BOX HH1BB
(06) BOX HH1BB
(07) BOX HH1BB
(08) BOX HH1BB
(09) BOX HH1BB
(10) BOX HH1BB
(11) BOX HH1BB
(91) HH6 - HHPLACOS
(-8) BOX HH1BB
(-9) BOX HH1BB
Page 3 of 7
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HH1BB
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HH1A
HH7
yes/no
[Between (REFERENCE DATE/UTILDATE) and (today/DATE OF DEATH/ DATE OF
INSTITUTIONALIZATION/ENDUTILD)], did (PROVIDER NAME) provide any services to [you/(SP)] other than
delivering meals?
BOX HH1BB
routing
IF TYPE OF HOME HEALTH PROVIDER IS A MEAL PROGRAM THAT DID NOT PROVIDE ANY OTHER
SERVICES BESIDES MEALS, GO TO BOX HH3.
ELSE IF (HOME HEALTH PROVIDER IS A FRIEND OR RELATIVE) OR (TYPE OF HOME HEALTH
PROVIDER IS A LOCAL GOVERNMENT, CHURCH OR COMMUNITY ORGANIZATION), GO TO HH11-EVENT.
ELSE GO TO BOX HH1.
BOX HH1
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 HH8 VAPLACE.
ELSE GO TO BOX HH1A.
HH8
yes/no
Is [(PROVIDER NAME) associated with/(PROVIDER NAME)] a Department of Veterans Affairs, or V.A.,
facility?
BOX HH1A
routing
IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH A MANAGED CARE PLAN IS UNKNOWN), GO TO HH10A - HMOASSOC.
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND) AND
(THIS PROVIDER IS NOT ASSOCIATED WITH A MANAGED CARE PLAN), GO TO HH10B - HMOREFER.
ELSE GO TO HH11-EVENT.
HMOASSOC
HH10A
yes/no
Is (PROVIDER NAME) associated with [your/(SP’s)] [READ MANAGED CARE PLAN NAME(S) BELOW] plan?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HH11- EVENT
(02) HH10B - HMOREFER
(-8) HH10B - HMOREFER
(-9) HH10B - HMOREFER
HMOREFER
HH10B
yes/no
[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ MANAGED CARE PLAN NAME(S) BELOW]?
[INCLUDE REFERRALS BY THE RESPONDENT’S PRIMARY CARE PHYSICIAN (PCP).]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HH11 -EVENT
(01) [Continuous answer.]
HH12-HPADD
(01) ADD ANOTHER
(02) ALL DONE
(01) HH11 -EVENT
(02) HH13-NEEDNURS
(01) YES, AT LEAST ONE
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HH14 - NEEDMEAL
OTHMEALS
VAPLACE
When did [you/(SP)] see [(PROVIDER NAME)/(someone from (PROVIDER NAME))]? Please tell me all the
dates [since (REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)].
ENTER ALL DATES.
EVENT
HH11
roster
[IF THE RESPONDENT SAW THE SAME PROVIDER TWICE ON THE SAME DAY, ENTER THE DATE ONLY
ONCE.]
IF R HAD 5 OR MORE VISITS FROM THIS PROVIDER DURING THIS REFERENCE PERIOD, SELECT
"REPEAT VISITS" AND LEAVE THE DAY FIELD BLANK. ENTER EACH MONTH SEPARATELY.
HPADD
HH12
choose one
HAVE ALL DATES BEEN ENTERED?
[DISPLAY ALL EVENTS ASSOCIATED WITH THIS PROVIDER]
SHOW CARD HH2
NEEDNURS
HH13
yes/no
(Generally speaking, did/Generally speaking, does)[(PROVIDER NAME)/someone from (PROVIDER NAME)]
help [you/(SP)] by giving any medical or nursing treatment, such as the things shown on this card? ["MEDICAL
OR NURSING TREATMENT" MEANS SUCH THINGS AS APPLYING STERILE BANDAGES OR DRESSINGS,
GIVING MEDICATIONS, TAKING BLOOD PRESSURE, GIVING SHOTS OR INJECTIONS.]
[PROBE: We just need to know in general.]
Page 4 of 7
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
Code List
Routing
SHOW CARD HH3
NEEDMEAL
HH14
yes/no
(01) YES, AT LEAST ONE
(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)]
(02) NO
help with [your/(SP’s)] daily needs by doing things, such as the ones shown on this card? [HELP WITH DAILY
(-8) DON'T KNOW
NEEDS MEANS HELP IN USING THE TELEPHONE, DOING HOUSEWORK, PREPARING MEALS.]
(-9) REFUSED
HH15 - NEEDCARE
[PROBE: We just need to know in general.]
SHOW CARD HH4
NEEDCARE
HH15
yes/no
(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)]
help with [your/(SP’s)] personal care by doing things such as those shown on this card? [HELP WITH
PERSONAL CARE MEANS HELP WITH BATHING, SHOWERING, DRESSING, EATING, WALKING, USING
THE TOILET.]
(01) YES, AT LEAST ONE
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HH2
[PROBE: We just need to know in general.]
BOX HH2
routing
IF EXISTING PROVIDER SELECTED at HH2-PROVIDER_HHP, HH5-PROVIDER_HHPORG, HH19PROVIDER_HHF, or ST13-PROVIDER_STDATE, GO TO BOX HH3.
ELSE IF "ADD ANOTHER" SELECTED at HH2-PROVIDER_HHP, HH5-PROVIDER_HHPORG, HH19PROVIDER_HHF, or or ST13-PROVIDER_STDATE, GO TO HH15A-ATNDPHYS.
To be eligible for Medicare home health services, a beneficiary must be under the care of a physician who
decides home health services are necessary.
What is the complete name of the physician who determined that [you/SP] should receive home health
services?
ATNDPHYS
HH15A
text
[IF NEEDED: This physician can also be referred to as the attending physician.]
[IF THE RESPONDENT DOES NOT RECEIVE HOME HEALTH SERVICES THROUGH MEDICARE, SELECT
NOT APPLICABLE. IF THE RESPONDENT DOES NOT KNOW THE NAME OF THE PHYSICIAN, SELECT
DON'T KNOW.]
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT
CARD, ETC., FOR COMPLETE INFORMATION.]
HHPMORE
HHPOMORE
BOX HH3
routing
IF CURRENTLY ADMINISTERING ST, GO TO BOX ST23B.
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS33.
ELSE IF CURRENTLY ASKING ABOUT HOME HEALTH FRIENDS OR FAMILY, GO TO HH28-HHFMORE.
ELSE IF HOME HEALTH PROVIDER WORKED FOR SELF, GO TO HH16 - HHPMORE.
ELSE GO TO HH17 - HHPOMORE.
HH16
yes/no
[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] helped at home by any other
health professionals?
HH17
yes/no
Other than the persons who (have) visited [you/(SP)] from (PROVIDER NAME) [or from the other(s) we’ve
talked about], [have you been/has (SP) been/was (SP)] helped at home by any other health professionals
[since (REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)]?
[DON’T INCLUDE ANY OTHER PERSONS COMING FROM THE SAME ORG/ AGENCY LISTED BELOW]
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
(01) continuous answer
(996) NOT APPLICABLE/RESPONDENT DOES NOT
RECEIVE HOME HEALTH SERVICES THROUGH
MEDICARE
(-8) Don't Know
(-9) Refused
BOX HH3
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01)HH4 -PROFWORK
(02) HH18 - HHPRFRND
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HH4-PROFWORK
(02) HH18 - HHPRFRND
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND
Page 5 of 7
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP DO NOT
DISPLAY. DATA EDITING ONLY.
(-8) DON'T KNOW
(-9) REFUSED
(01) HH19 - PROVIDER_HHF
(02) BOX HH7
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) BOX HH7
(-9) BOX HH7
SHOW CARD HH5
(At the time of the last interview, [you/(SP)] indicated that, because of health problems, [you/(she/he)] had
received personal care or help at home with daily needs from a person who did not live with [you/(her/him)].)
HHPRFRND
HH18
yes/no
(Besides what you have already talked about, [(Since/since) (REFERENCE
DATE/UTILDATE)/(Between/between) (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], because of health problems [have you/has (SP)/did (SP)]
(received/receive) any personal care or help at home with daily needs from (any other) persons who (do/did)
not live with (you/him/her), including friends, neighbors, or relatives? (This may include friends, neighbors, or
relatives reported in prior interviews.)
(01) CONTINUOUS ANSWER
Who helped [you/(SP)]? What is the name of the person who helped (you/him/her)?
ENTER NAME OF PERSON WHO HELPED.
PROVIDER_HHF
HH19
roster
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
[SELECT OR ADD ONLY ONE PERSON. DO NOT ENTER A PERSON WHO LIVES WITH THE SP.]
2. [PROVIDER 2]
…
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING N. [PROVIDER N]
AN EVENT WITH THAT PROVIDER.
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
(01-N) BOX HH3AA
(N+1) PROVNAME-HH19
(N+2) CHNGSPL-CHNGSPL
IF EXISTING PROVIDER SELECTED, GO TO BOX
HH3AA
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH19
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.
[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
PROVNAME
HH19
verbatim
ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF THE PLACE OR
ORGANIZATION.
BOX HH3AA
NAME:
WHICH PROVIDER IS MISSPELLED?
CHNGSPL
CHNGSPL
roster
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
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 THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
CRCTSPL-CRCTSPL
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?
CRCTSPL
CRCTSPL
verbatim
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]
(01) [Continuous Answer]
BOX HH3AA
(01) FRIEND OR NEIGHBOR
(02) RELATIVE
(-8) DON'T KNOW
(-9) REFUSED
(01) BOX HH1AA
(02) HH21 - HHFRELAT
(-8) BOX HH1AA
(-9) BOX HH1AA
(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused
(02) BOX HH1AA
(56) BOX HH1AA
(58) BOX HH1AA
(59) BOX HH1AA
(60) BOX HH1AA
(61) BOX HH1AA
(91) HH21 - HHFRELOS
(-8) BOX HH1AA
(-9) BOX HH1AA
NAME:
HHFTYPE
HHFRELAT
BOX HH3AA
routing
IF (HOME HEALTH PROVIDER WAS ADDED AT HH19) OR (AN EXISTING PROVIDER WAS SELECTED AT
HH19 THAT WAS NOT ASSOCIATED WITH A HOME HEALTH EVENT), GO TO HH20 - HHFTYPE.
ELSE GO TO BOX HH1BBB.
HH20
code one
Is (PROVIDER NAME) a friend, neighbor, or a relative?
HH21
code one
How is (PROVIDER NAME) related to [you/(SP)]?
Page 6 of 7
2021 MCBS Community Questionnaire
HHQ-HOME HEALTH UTILIZATION
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
HHFRELOS
HH21
text
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
BOX HH1AA
HHFMORE
HH28
yes/no
[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you/has (SP)/did (SP)] (received/receive) personal care or help
at home with daily needs from any other persons who (do/did) not live with (you/him/her)?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HH19 - PROVIDER_HHF
(02) BOX HH7
(-8) BOX HH7
(-9) BOX HH7
BOX HH7
routing
GO TO MPQ.
Page 7 of 7
File Type | application/pdf |
File Title | Medicare Current Beneficiary Survey Section Specifications for HHQ |
Subject | Medicare beneficiaries, MCBS community questionnaire, 2021, Home health utilization and events, HHQ |
Author | NORC |
File Modified | 2021-08-12 |
File Created | 2021-08-03 |