CMS-P-0015A Usual Source of Care

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

USUAL SOURCE OF CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after KNQ.

PLACEPAR

US1

BOX USA

yes/no

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?

routing

IF (INTTYPE=7) AND SP ever reported speaking a language other than English in the home
(SAMPLE_PERSON.WHATLANG EQUALS 1-"SPANISH", 2-"FRENCH", 3-"GERMAN", OR 91-"Other, Specify")
AND P_ENGWELL=1, GO TO LEP6-LANGPROB.
ELSE GO TO US39 – NUSNOTSK.

PLACEKND

US2

code one

PLACEOS

US2

text

BOX USB

routing

US2A

yes/no

BOX USC

routing

CLNAME

US3A

verbatim text

USUALDOC

US4

yes/no

MDNAME

US5A

verbatim text

MDSEX

US5B

code one

PLACEMCP

(01) BOX USB
(02) BOX USB
(03) US3A - CLNAME
(04) US3A - CLNAME
(05) US3A - CLNAME
(06) US3A - CLNAME
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]
(07) US3A - CLNAME
health -- is that a managed care plan or HMO center, a clinic, a doctor or other health professional's office, a
(08) US3A - CLNAME
hospital, or some other place?
(09) US3A - CLNAME
(10) US5A - MDNAME
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
(11) US3A - CLNAME
IF SOME OTHER PLACE, ASK: Where is this?
(12) US3A - CLNAME
(13) US3A - CLNAME
(14) US3A - CLNAME
(91) US2 - PLACEOS
(-8) US3A - CLNAME
(-9) US3A - CLNAME
OTHER (SPECIFY)
US3A - CLNAME
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
BOX USC
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]?
US4 - USUALDOC
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
(01) US5A - MDNAME
Is there a particular doctor or other health professional [you usually see/(SP) usually sees] at this [place/managed
(02) US7-INNOVATE
care plan or HMO center/(US2 RESPONSE)]?
(-8) US7-INNOVATE
(-9) US7-INNOVATE
What is the complete name of that doctor or other health professional?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
Is (US5A PROVIDER NAME) a male or female?
SHOW CARD US1
What is (US5A PROVIDER NAME)'s specialty?

PVSPEC

US6A

code one

(01) US2 - PLACEKND
(02) BOX USA
(-8) BOX USA
(-9) BOX USA

[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'.]

MDSEX - US5B
US6A - PVSPEC

(01)- (43) US7-INNOVATE
(91) US6A - MDSPECOS
(-8) US7-INNOVATE
(-9) US7-INNOVATE

Page 1 of 8

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

OTHER DR SPECIALTY (SPECIFY)
MDSPECOS

US6A

text

INNOVATE

US7

yes/no

BOX USD

routing

LANGPREF

LEP1A

select one

LANGPFOS

LEP1B

verbatim text

LANGPRVD

LEP2

select one

LANGCOMM

LEP3

select one

BOX LEP1

routing

LEP4

select one

BOX LEP2

routing

LANGSYMP

LANGASST

LANGPROB

LEP5

LEP6

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
US7-INNOVATE
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'.]
Many health care providers are beginning to participate in innovative health care initiatives, programs, and payment
models. Is (US5A PROVIDER NAME)/(US3A PROVIDER NAME) associated with an innovative health care initiative
such as an accountable care organization or a patient centered medical home?
[IF NEEDED: Innovative health care initiatives are programs that test ways to improve the delivery of health care,
improve the quality of health care, lower health care costs, and reduce health disparities.]

BOX USD

IF THE RESPONDENT DOESN'T KNOW WHAT INNOVATIVE HEALTH CARE INITATIVES ARE OR HAS NEVER
HEARD OF INNOVATIVE HEALTH CARE INITIATIVES, SELECT 'DON'T KNOW'.
IF (INTTYPE=7) AND (SAMPLE_PERSON.WHATLANG EQUALS 1-"SPANISH", 2-"FRENCH", 3-"GERMAN", OR
91-"Other, Specify"), GO TO LEP1A-LANGPREF.
ELSE GO TO BOX US1.

(01) LEP4-LANGSYMP
(02) LEP2-LANGPRVD
(03) LEP2-LANGPRVD
In general, in what language [do you/does (SP)] prefer to receive [your/his/her] medical care?
(91) LEP1B-LANGPFOS
(-8) LEP2-LANGPRVD
(-9) LEP2-LANGPRVD
In general, in what language [do you/does (SP)] prefer to receive [your/his/her] medical care?
LEP2-LANGPRVD
(01) LEP3-LANGCOMM
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] speak [LANGUAGE SPOKEN AT (02) LEP4-LANGSYMP
HOME/LEP1B-LANGPFOS]?
(-8) LEP4-LANGSYMP
(-9) LEP4-LANGSYMP
SHOW CARD US2

How well can [you/(SP)] and [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] communicate BOX LEP1
in [LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS] about [your/his/her] symptoms? Very well, well, not well,
or not at all?
IF P_ENGWELL=1, GO TO LEP6-LANGPROB. ELSE GO TO BOX US1.
SHOW CARD US2
Without the aid of a translator, language assistant, or interpreter, how well can [you/(SP)] and [(US5A PROVIDER
NAME)/the providers at (US3A PROVIDER NAME)] communicate in English about [your/his/her] symptoms? Very
well, well, not well, or not at all?
IF P_ENGWELL=1, GO TO LEP5-LANGASST. ELSE GO TO BOX US1.
SHOW CARD US3

BOX LEP2

select all

Who helps [you/(SP)] communicate with [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] –
a professional interpreter, a staff person at [your/his/her] provider's office, a family member, a friend, [do you/does
LEP6-LANGPROB
(SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)] because [you have/(SP) has] no
trouble communicating in English?

select one

PROBE: Anyone else?
Have [you/(SP)] ever had a problem understanding a medical situation because it was not explained in [LANGAUGE
LEP7-LANGHELP
SPOKEN AT HOME/LEP1B-LANGPFOS]?
SHOW CARD US3
Now think about all of [your/(SP)'s] medical providers other than [your/his/her] usual provider.

LANGHELP

LEP7

BOX US1

select all

routing

Who helps [you/(SP)] communicate with medical providers who do not speak [LANGUAGE SPOKEN AT
HOME/LEP1B-LANGPFOS]– a professional interpreter, a staff person at [your/his/her] provider's office, a family
member, a friend, [do you/does (SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)]
because [you have/(SP) has] no trouble communicating in English?
PROBE: Anyone else?
IF US1 - PLACEPAR = NO, DK, or RF, GO TO US39 - NUSNOTSK.
ELSE IF US2 - PLACEKND = 10/AtHome, GO TO PP1A-PROVYR.
ELSE GO TO US8 - GETUSHOW.

How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)]?
GETUSHOW

US8

code one

[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by walking, driving, being driven by someone else, by
ambulance or other special vehicle for disabled people, by taxi, other public transportation, or some other way?]

BOX US1

(01) US9 - GETUSUNT
(02) US9 - GETUSUNT
(03) US9 - GETUSUNT
(04) US9 - GETUSUNT
(05) US9 - GETUSUNT
(06) US9 - GETUSUNT
(07) PP1A-PROVYR
(91) US8 - GETUSOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

Page 2 of 8

2023 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

GETUSOS

US8

verbatim text

SOME OTHER WAY (SPECIFY)

GETUSUNT

US9

code one

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

GETUSHRS

US9

numeric

HOURS:

GETUSMIN

US9

numeric

MINUTES:

ACCOMPUS

US10

yes/no

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

US9 - GETUSUNT
(01) US9 - GETUSHRS
(02) US9 - GETUSMIN
(03) US9 - GETUSHRS
(-8) US10 - ACCOMPUS
(-9) US10 - ACCOMPUS
If US9 GETUSUNT=3/HoursAndMinutes go to US9 GETUSMIN.
Else go to US10 - ACCOMPUS.
US10 - ACCOMPUS
(01) US11 - PERSON_USUALGO
(02) PP1A-PROVYR
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

PERSON_USUAL
US11
GO

roster

ROSTFNAM
ROSTLNAM

US11_NEW
US11_NEW

text
text

ROSTREL

US11_NEW

code one

ROSTREOS

US11_NEW

verbatim text

ACCREAS

US11AA

code all

ACCOTHOS

US11AA

verbatim text

PROVYR

PP1A

code one

REMINDAPPT

PP1

yes/no

PREAPPT

PP2

yes/no

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

Routing

(01-N) US11AA-ACCREAS
(N+1) US11_NEW-ROSTFNAM

IF EXISTING PERSON SELECTED, GO TO US11AAACCREAS.
ELSE IF "ADD ANOTHER" SELECTED, GO TO
US11_NEW-ROSTFNAM
[What is the name of the person and relationship to (SP)?]
US11_NEW - ROSTLNAM
[What is the name of the person and relationship to (SP)?]
US11_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) US11AA-ACCREAS
(56) US11AA-ACCREAS
(58) US11AA-ACCREAS
(59) US11AA-ACCREAS
[What is the name of the person and relationship to (SP)?]
(60) US11AA-ACCREAS
(61) US11AA-ACCREAS
(91) US11_NEW - ROSTREOS
(-8) US11AA-ACCREAS
(-9) US11AA-ACCREAS
[What is the name of the person and relationship to (SP)?]
US11AA-ACCREAS
(01) PP1A-PROVYR
(02) PP1A-PROVYR
(03) PP1A-PROVYR
(04) PP1A-PROVYR
What are the reasons [you accompany (SP)/this person accompanies you/this person accompanies this person] do?
(05) PP1A-PROVYR
(06) PP1A-PROVYR
[PROBE: Any other reason?]
(07) PP1A-PROVYR
(08)PP1A-PROVYR
CHECK ALL THAT APPLY.
(09) PP1A-PROVYR
(91) US11AA - ACCOTHOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR
OTHER (SPECIFY)
PP1A-PROVYR
(01) PP1-REMINDAPPT
[Have you/Has (SP)] seen [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)] in the last 12 months?
(02) US27-USCKEVRY
(-8) US27-USCKEVRY
INCLUDE TELEMEDICINE VISITS.
(-9) US27-USCKEVRY
The next questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)'S office/(US3A
(01) PP2- PREAPPT
PROVIDER NAME)].
(02) PP2- PREAPPT
(996) PP4-MISSAPPT
Some offices remind patients about appointments. Before [your/(SP)'s] most recent visit with [(US5A PROVIDER
(-8) PP2- PREAPPT
NAME)/(US3A PROVIDER NAME) ], did [you/he/she] get a reminder from [(US5A PROVIDER NAME)'S office
(-9) PP2- PREAPPT
/(US3A PROVIDER NAME)] about the appointment?
Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)], did
PP4-MISSAPPT
[you/he/she] get instructions telling [you/him/her] what to expect or how to prepare?
SELECT OR ADD ONLY ONE PERSON

SHOW CARD US4
MISSAPPT

PP4

code one

NEWAPPT

PP5

code one

(01) PP8-DOCHLTH
(02) PP5- NEWAPPT
Now I’m going to read you questions about the medical providers [you have/SP has] seen in the last twelve months,
(03) PP5-NEWAPPT
that is since {TODAY'S MONTH AND YEAR - 12 MONTHS}.
(04) PP5- NEWAPPT
(-8) PP8-DOCHLTH
People have busy lives and miss appointments for many reasons. Since (TODAY'S MONTH AND YEAR-12
(-9) PP8-DOCHLTH
MONTHS), how often did [you/(SP)] miss an appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER
NAME)]?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [ you/(SP)] missed an appointment with US5A
PROVIDER NAME/US3A PROVIDER NAME), how often did someone from [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)] contact [you/him/her] to make a new appointment?

PP8-DOCHLTH

Page 3 of 8

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US4
DOCHLTH

PP8

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] ask about things in [your/(SP)'s] work or life at home that affect
[your/(SP)'s] health?

PP9- DOCEASY

SHOW CARD US4
DOCEASY

PP9

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] explain things in a way that was easy [for (SP)] to understand?

PP10-DOCLSTN

SHOW CARD US4
DOCLSTN

PP10

code one

DOCRSPCT

PP11

code one

ENUFTIME

PP12

code one

HLTHIDEA

PP13

code one

STHLTHGL

PP15

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] listen carefully to [you/(SP)]?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] show respect for what [you/(SP)] had to say?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] spend enough time with [you/(SP)]?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 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?
SHOW CARD US5
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] talk with [you/(SP)] about setting goals for [your/his/her] health?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

PP11-DOCRSPCT

PP12- ENUFTIME

PP13- HLTHIDEA

PP15-STHLTHGL

(01) PP16- MTHLTHGL
(02) PP16- MTHLTHGL
(03) US27-USCKEVRY
(-8) US27-USCKEVRY
(-9) US27-USCKEVRY

SHOW CARD US5
MTHLTHGL

PP16

code one

Since (TODAY'S MONTH AND YEAR-12 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?

US27-USCKEVRY

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US6

USCKEVRY

US27

list

Now I am going to read some statements people have made about their health care. Think about the care [you
receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each statement, please tell
me whether you strongly agree, agree, disagree, or strongly disagree.

US27-USUNWRNG

[(US5A PROVIDER NAME) is/The doctors or other health professionals at (US3A PROVIDER NAME) are] very
careful to check everything when examining [you/him/her].
SHOW CARD US6
USUNWRNG

US27

list

BOX US4

routing

OTHRSTFF

PP17

yes/no

OSUPTODT

PP18

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other staff seem up-to-date about the care PP19- OSTLKCR
[you were/(SP) was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)]?
SHOW CARD US4

OSTLKCR

PP19

code one

Since (TODAY'S MONTH AND YEAR-12 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 US4

OSNOINFO

PP20

code one

BOX US4
[(US5A PROVIDER NAME) has/The doctors or other health professionals at (US3A PROVIDER NAME) have] a
complete understanding of the things that are wrong with [you/him/her].
IF PP1A-PROVYR= 01/YES, GO TO PP17 OTHRSTFF.
ELSE GO TO BOX US5.
People often get instructions about their health from more than one person in the same office, such as other medical
(01) PP18- OSUPTODT
providers, nurses, nutritionists, and social workers.
(02) PP21- ORDRTEST
(-8) PP21- ORDRTEST
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get any instructions about your health from any
(-9) PP21- ORDRTEST
other staff [in (US5A PROVIDER NAME)'s office/ at (US3A PROVIDER NAME)]?
SHOW CARD US4

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other staff seem to know the important
information about [your/(SP)'s] medical history?

PP20- OSNOINFO

PP21- ORDRTEST

Page 4 of 8

2023 MCBS Community Questionnaire

Variable Name

ORDRTEST

USQ-USUAL SOURCE OF CARE

MR Screen Name Question Type

Question Text/Description

PP21

The next set of questions ask about the care you received from [(US5A PROVIDER NAME)/the medical providers at
(01) PP22- TSTFLWUP
(US3A PROVIDER NAME)] or someone in [his/her/their] office.
(02) PP29-HLTHSRVC
(-8) PP29-HLTHSRVC
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(-9) PP29-HLTHSRVC
(US3A PROVIDER NAME)] or someone in [his/her/their] office order a blood test, x-ray, or other test for [you/(SP)]?

yes/no

Code List

Routing

SHOW CARD US4
TSTFLWUP

PP22

code one

RQSTRSLT

PP23

code one

RSLTEASY

PP24

code one

HLTHSRVC

PP29

yes/no

Since (TODAY'S MONTH AND YEAR-12 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?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [you/(SP)] have to request [your/his/her] test
results before [you/he/she] got them?
SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often were [your/(SP)'s] test results presented in a way
that was easy to understand?

PP23-RQSTRSLT

PP24- RSLTEASY

PP29-HLTHSRVC

(01) PP30- SRVCHELP
(02) PP31- GIVEINST
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need services at home to help [you/him/her] take
(-8) PP31- GIVEINST
care of [your/his/her] health?
(-9) PP31- GIVEINST
SHOW CARD US4

SRVCHELP

PP30

code one

Since (TODAY'S MONTH AND YEAR-12 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?

GIVEINST

PP31

yes/no

PP35-ANYRX
Since (TODAY'S MONTH AND YEAR-12 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?
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] take any prescription medicine?

PP31- GIVEINST

(01) PP36- TALKRX
(02) BOX US5
(-8) BOX US5
(-9) BOX US5

ANYRX

PP35

yes/no

TALKRX

PP36

code one

Since (TODAY'S MONTH AND YEAR-12 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 US4

PP37- ASPRSCBD

ASPRSCBD

PP37

code one

There are many reasons why people may not always be able to take their medicines as prescribed.
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often [were you/was (SP)] able to take [your/his/her]
medicine as prescribed?
SHOW CARD US4

PP38-BADRCTN

BADRCTN

PP38

code one

BOX US5

BOX US5

routing

Since (TODAY'S MONTH AND YEAR-12 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?
GO TO US37A CARESPCL.

[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK IF THE R HAD ANY
PRESCRIPTIONS FILLED]
SHOW CARD US4

SHOW CARD US1
CARESPCL

US37A

yes/no

Specialists are doctors or other health professionals who specialize in one area of health care. This card lists some
examples of specialists.
Since (TODAY'S MONTH AND YEAR-12 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)]?

(01) US37B - DRINFRMD
(02) PP50-HOSADMIT
(-8) PP50-HOSADMIT
(-9) PP50-HOSADMIT

SHOW CARD US4
DRINFRMD

US37B

code one

In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (US3A
PROVIDER NAME)] seem informed and up-to-date about the care [you get/(SP) gets] from specialists?

US37C - REMINDDR

SHOW CARD US4
REMINDDR

US37C

code one

In general, how often [do you/does(SP)] have to remind [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] about care [you receive/(SP) receives] from specialists?

US37D - STPMSPCL

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2023 MCBS Community Questionnaire

Variable Name
STPMSPCL

USQ-USUAL SOURCE OF CARE

MR Screen Name Question Type

Question Text/Description

Code List

US37D

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did any specialists outside the office of [(US5A PROVIDER
NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)] prescribe medicine for [you/(SP)]?

(01) US37E - TALKPMS
(02) US37E1 - NAMESPCL
(-8) US37E1 - NAMESPCL
(-9) US37E1 - NAMESPCL

yes/no

SHOW CARD US4
TALKPMS

US37E

code one

NAMESPCL

US37E1

verbatim text

SEXSPCL

US37E2

code one

In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (US3A
PROVIDER NAME)] talk with [you/(SP)] about the medicines prescribed by these specialists?
The next four questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the
last 12 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 since (TODAY'S MONTH AND YEAR-12
MONTHS)?
[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 since (TODAY'S MONTH AND YEAR-12
MONTHS)] a male or female?
SHOW CARD US5

Routing

US37E1 - NAMESPCL

US37E2 - SEXSPCL

US37F - KNOWSPCL

[IF NEEDED: This question is about the last twelve months, that is since (TODAY'S MONTH AND YEAR - 12
MONTHS).]
KNOWSPCL

US37F

code one

The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the last
twelve months outside the [office of (US5A PROVIDER NAME)/the doctors or other health professionals at (US3A
PROVIDER NAME)].

US37G - RPTINFO

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?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US4
RPTINFO

KNOWRSLT

US37G

PP49

code one

code one

When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do you/does (SP)] have to repeat
information that [you/he/she] [have/has] already given to [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)]?
SHOW CARD US4
The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often since
(TODAY'S MONTH AND YEAR-12 MONTHS) outside the [office of (US5A PROVIDER NAME)/the doctors or other
health professionals at (US3A PROVIDER NAME)].
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does [he/she/he or she] seem to know
[your/(SP)'s] important test results from other providers?

HOSADMIT

PP50

yes/no

HOSFLWUP

PP51

yes/no

HOSMED

PP52

yes/no

HOSFOLLOWUP

PP53

yes/no

HOSINSTU

PP54

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), [were you/was (SP)] admitted to a hospital overnight or
longer?

KNOWRSLT

PP50-HOSADMIT

(01) PP51- HOSFLWUP
(02) PP58- MNGCARE
(-8) PP58- MNGCARE
(-9) PP58- MNGCARE

After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office contact [you/him/her] to see how [you were/he was/she was] PP52- HOSMED
doing?
(01) PP53- HOSFOLLOWUP
(02) PP54- HOSINSTU
After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any medicines?
(-8) PP54- HOSINSTU
(-9) PP54- HOSINSTU
After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office contact [you/SP] to check if [you were/he was/she was ] able PP54- HOSINSTU
to follow instructions about any medicines [you were/he was/she was] prescribed?
(01) PP55- INSTUEASY
After (your/(SP)'s] most recent hospital stay, (were you/was he/was she] given instructions about caring for
(02) PP56- HOSINFO
[yourself/himself/herself] at home?
(-8) PP56- HOSINFO
(-9) PP56- HOSINFO
SHOW CARD US5

INSTUEASY

PP55

code one

After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP) was] given easy to understand?

PP56- HOSINFO

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

HOSINFO

PP56

code one

SHOW CARD US5
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?

PP58-MNGCARE

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

Page 6 of 8

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US7
People sometimes need to manage their medical care by making appointments with multiple providers, following
their instructions, and taking medicines as prescribed.
MNGCARE

PP58

code one

Using any number from 0 to 10, where 0 is hard and 10 is easy, what number would you use to rate how easy it was
for [you/(SP)] to manage [your/his/her] medical care since (TODAY'S MONTH AND YEAR-12 MONTHS)?

PP58A-DOCCARE

[IN SITUATIONS WHERE A PROXY OR SOMONE ELSE MANAGES THE RESPONDENT’S MEDICAL CARE FOR
OR WITH THEM, ANSWER BASED ON THEIR EXPERIENCE.]
DOCCARE

PP58A

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need help from [anyone in (US5A PROVIDER
NAME)'s office/the doctors or other health professionals at (US3A PROVIDER NAME)] to manage [your/his/her]
care among these different providers and services?
SHOW CARD US5

GETHELP

PP58B

code one

ONEDOC

PP59

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get the help [you/he/she] needed from [(US5A
PROVIDER NAME)'s office/the doctors or other health professionals at (US3A PROVIDER NAME)] to manage
[your/his/her] care among these different providers and services?
SHOW CARD US5
Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all [your/(SP)'s]
medical care needs?

(01) PP58B-GETHELP
(02) PP59-ONEDOC
(-8) PP59-ONEDOC
(-9) PP59-ONEDOC
PP59-ONEDOC

PP60- PRVNOMED

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US5
PRVNOMED

NOTAVAIL

COMPUSE

PP60

code one

BOX US7

routing

US37I

code one

BOX EHR1

routing

EHR2

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all the medicines [you
BOX US7
were/(SP) was] taking?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
GO TO US37I- NOTAVAIL
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when getting care for a medical problem, was there ever a
time when test results, medical records, or reasons for referrals were not available at the time of [your/(SP)’s]
scheduled doctor or other health professional appointment?
IF US1-PLACEPAR=1, GO TO EHR2-COMPUSE,
ELSE GO TO BOX USEND.
The next few questions will help us understand how [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] use(s) a computer during [your/(SP)'s] office visit. Please answer the
following questions based on where [you go/(SP) goes] for medical care most of the time.
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] use a computer during
[your/(SP)'s] office visit?
Many health care providers are beginning to use electronic or computer-based medical records instead of using
paper-based records. When [you visit/(SP) visits] [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] [does he or she/do they] generally enter [your/(SP)'s] health information
into a computer while [you are/(SP) is] present?

EMEDREC

US37K

yes/no

[IF SUPPORT STAFF (NURSES, MEDICAL ASSISTANTS) ENTER INFORMATION INTO THE ELECTRONIC
HEALTH RECORD DURING THEIR VISIT, SELECT “YES” AT THIS QUESTION.]

BOX EHR1

(01) US37K - EMEDREC
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

(01) EHR3-COMPSHW
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

[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.]
COMPSHW

EHR3

yes/no

COMPINFO

EHR4

yes/no

COMPREC

EHR5

yes/no

COMPRD

EHR6

yes/no

COMPINF

EHR7

yes/no

(01) EHR4-COMPINFO
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] use
(01) EHR5-COMPREC
the computer to show [you your/(SP) his/(SP) her] health information during [your/his/her] visit, such as trends in
(02) EHR6-COMPRD
blood pressure reading, height, weight and body mass index, previous lab results, x-rays/images, immunizations or (-8) EHR6-COMPRD
medications?
(-9) EHR6-COMPRD
Is the examination room set up so that [(US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)] can easily show [you/(SP)] information on the computer screen?

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] use
the computer to show [you/(SP)] recommendations for preventive health screenings or other medical services?
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] read
back to [you/(SP)] information that [you have/(SP) has] given during [your/(SP)'s] visit that is being put into
[your/(SP)'s] medical record?
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] send
[you/(SP)] health information electronically, such as information about [your/(SP)'s] medications, exercise plans,
dietary advice, etc.?

EHR6-COMPRD
EHR7-COMPINF
EHR8-COMPACC

Page 7 of 8

2023 MCBS Community Questionnaire

Variable Name
COMPACC

MR Screen Name Question Type
EHR8

yes/no

BOX EHR2

routing

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

[Does (US5A PROVIDER NAME)'s/Do the doctors or other health professionals at (US3A PROVIDER NAME)'s]
office give [you/(SP)] access through [your/(SP)'s] own computer or smart phone to parts or all of [your/(SP)'s]
BOX EHR2
electronic medical record (such as a list of [your/(SP)'s] medications, lab results, x-ray reports, office notes) through
a “patient portal” or other electronic system?
IF EHR2-COMPUSE=(01) YES, GO TO EHR9-COMPHLP,
ELSE GO TO BOX USEND
SHOW CARD US6

COMPHLP

EHR9

list

Now I am going to read some statements people have made about how their provider uses a computer. Think about
the care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each statement,
EHR9-COMPDIST
please tell me whether you strongly agree, agree, disagree, or strongly disagree.
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit is helpful to [me/(SP)].
SHOW CARD US6

COMPDIST

EHR9

list

COMPATT

EHR9

list

COMPTM

EHR10

code one

(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit distracts [him/her/them] from paying attention to [me/(SP)].
SHOW CARD US6
[(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME)] use of the
computer during [my/(SP)'s] visit distracts [me/(SP)] from paying attention to the clinician.
SHOW CARD US8
For the next statement, please tell me if it's much more than it should be, somewhat more than it should be, about
what it should be, somewhat less than it should be, much less than it should be, or no opinion?

EHR9-COMPATT

EHR10-COMPTM

BOX USEND

The amount of time during the visit that (US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME) spend(s) on the computer seems:
I am going to read some reasons that people have given for not having a usual source of health care. For each one,
please tell me whether or not it is a reason [you do/(SP) does] not have a usual place for health care.

NUSNOTSK

US39

list

NUSMOVIN

US39

list

[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not have a usual source of health
care?]

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?]

NUSAVAIL

US39

list

[Your/(SP’s)] usual source of health care in this area is no longer available. [Is that a reason [you do/(SP) does] not
have a usual source of health care?]

USWHYNAV

US42

code one

Why is [your/(SP’s)] usual source of health care no longer available?

USWHYNO1

US42

verbatim text

NUSDIFFP

US43

list

OTHER (SPECIFY)
Thinking about other possible reasons that people have for not having a usual source of health care, please tell me if
this statement applies to [you/(SP)]:

NUSTOOFR

US43

list

NUSTOOEX

US43

list

BOX USEND

routing

US39 - NUSMOVIN

US39 - NUSAVAIL
(01) US42 - USWHYNAV
(02) US43 - NUSDIFFP
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
(01) US43 - NUSDIFFP
(02) US43 - NUSDIFFP
(03) US43 - NUSDIFFP
(04) US43 - NUSDIFFP
(05) US43 - NUSDIFFP
(91) US42 - USWHYNO1
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
US43 - NUSDIFFP
US43 - NUSTOOFR

[You like/(SP) likes] to go to different places for different health care needs. [Is that a reason [you 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) does] not have
US43 - NUSTOOEX
a usual source of health care?]
The cost of health care is too expensive. [Is that a reason [you do/(SP) does] not have a usual source of health
BOX USEND
care?]
GO TO TLQ

Page 8 of 8