Form 2 Attachment B: Child HCAHPS Database Data Use Agreement

The CAHPS Database CAHPS®
Child Hospital Survey Database Data
Use Agreement
Instructions
1. All organizations that want to participate in the Child Hospital CAHPS Survey Database must submit a
signed Data Use Agreement (DUA) and provide the organization name (hereinafter termed “Participating
Organization”), and the Participating Organization’s point of contact.
Data collection vendors may not sign this DUA on behalf of a hospital or health system organization
(even if they have been given permission by the hospital or health system organization to handle the
actual submission of data). Only a duly appointed representative from the hospital or health system
organization may sign this DUA.
2. AHRQ’s Contractor, Westat, has pre-signed this Data Use Agreement (DUA) in its current form. Any
changes or modifications to the DUA or the Authorization Form other than those required to complete the
DUA, such as contact information, will require review and execution, by both parties, of a new DUA or
addendum.
3. Upload Upload a scanned copy of the signed DUA and Authorization Form at
https://www.cahpsdatabase.ahrq.gov
4. Please retain a copy of the fully signed and executed DUA and Authorization Form for your records.

If you have any questions or require any additional information please contact the CAHPS Database
at 888-808-7108 or by email to [email protected].

Form Approved
OMB No.
Exp. Date

The CAHPS Database
Child Hospital CAHPS Survey
Database
Data Use Agreement

1. This Data Use Agreement (DUA) is made by and between the Agency for Healthcare Research and Quality (AHRQ),
AHRQ’s contractor, Westat, and the organization named below (hereinafter termed “Participating Organization”)
which includes any hospital listed under item 13 on page 3 of this Data Use Agreement.

Name of Participating Organization (Hospital or Corporate Office/Health System if more than one
hospital is included in this DUA)

Street Address of Participating Organization

City

State

Zip Code

VERY IMPORTANT: Type or write in the name of the Participating Organization above. If more than one hospital is
represented, list the name of the health system organization above, and under item 13, page 3 of this Data Use
Agreement, IDENTIFY EACH INDIVIDUAL HOSPITAL for which data will be submitted.

2.

AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Database is a central repository of data
on hospital, medical group, clinician, and health care facility performance as measured by a selected set of CAHPS
surveys. This DUA specifies the terms and conditions of Participating Organization’s submission of its Child Hospital
CAHPS Survey data to Westat for participation in the Child Hospital CAHPS Survey Database (hereinafter termed the
“Database”).

3. The Database is populated with Child Hospital CAHPS survey data through the voluntary participation of organizations
that have administered the Child Hospital CAHPS Survey and are willing to submit their Child Hospital CAHPS survey
data to AHRQ for inclusion in the Database. Because participating organizations (e.g., hospitals, health system)
voluntarily submit data to the CAHPS Database, the Data do not constitute a nationally representative sample.
The Database is funded by the Agency for Healthcare Research and Quality (AHRQ) and managed and administered by
AHRQ’s contractor, Westat (hereinafter termed the “Contractor”). AHRQ’s Contractor will operate the Database to
comply with the provisions in this DUA.
4.

Participating Organizations will provide their Child Hospital CAHPS survey data to the Database for AHRQ’s research,
analysis and reporting programs according to the terms specified in this DUA. By agreeing to participate in the Database,
each Participating Organization agrees to make every good faith effort to provide data for inclusion in the Database, as
specified by the data specifications outlined below. The data provided for inclusion in the Database is collectively
referred to as the “Data”. Participating Organization’s Data include:
a) A copy of the final Child Hospital CAHPS survey instrument(s) administered, including copies of paper and/or webbased versions as applicable, for each surveyed population for which data will be submitted to the Database showing
all survey instructions and items administered. If more than one version of the Child Hospital CAHPS survey was
administered, a copy of each Child Hospital CAHPS survey instrument administered must be provided with the
corresponding results for each version of the survey instrument for which data is submitted;
b) Respondent-level Child Hospital CAHPS survey data that are de-identified to prevent identification of any individual
in the database. Participating Organization submit its final, de-identified respondent-level Child Hospital CAHPS
survey data, as collected by the Participating Organization itself or by a survey data collection vendor, according to
the data specifications outlined for the Database; and
c) Selected organizational characteristics data (e.g., ownership, bed size, dates of administration, sample size, response
rate, etc.).
Public reporting burden for this collection of information is estimated to average 3 minutes per response, the estimated time
required to complete the form. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer
Attention: PRA, Paperwork Reduction Project (0935-0218) AHRQ, 5600 Fishers Lane, Rockville, MD 20857.

Data Use Agreement – Child HCAHPS Survey Database

Last Updated May 25, 2018

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5.

The CAHPS Database
Child Hospital CAHPS Survey
Database
Data Use Agreement

Form Approved
OMB No.
Exp. Date

AHRQ’s Contractor agrees to establish appropriate and necessary administrative, technical, and physical procedures and
safeguards including limiting access to the Data and providing appropriate staff training to protect the confidentiality of
the Data and to prevent the unauthorized use of it or access to it. Only AHRQ’s Contractor and duly authorized
representatives appointed by AHRQ will have access to the identifiable source Data provided by Participating
Organization.

6. Participating Organization’s Data will be accepted into the Database provided that the version of the Child Hospital
CAHPS survey administered is deemed acceptable by AHRQ’s Contractor, (i.e., not modified from the original Child
Hospital CAHPS survey instructions and items) and the Data submitted by Participating Organization are deemed
acceptable. AHRQ’s Contractor will promptly notify the Participating Organization of any problem with the survey
version(s) administered or with the Data submitted. If the survey version administered is acceptable but the Data
submitted are problematic, AHRQ’s Contractor will make a good faith effort to work with the Participating Organization
to complete or correct the data submission, but reserves the right to not include incompatible or flawed Data in the
Database.
7. Participating Organization’s Data will be used for AHRQ’s research, analysis, and reporting programs, and the Data will
be aggregated along with other Participating Organizations’ Data in the Database. AHRQ will report aggregated statistics
on Child Hospital CAHPS survey composite scores and items that include all Participating Organizations and present
statistics by various organizational characteristics (e.g., ownership, bed size,etc.). Results will not publicly identify
individual Participating Organizations by name. Only aggregated data will be reported, and only when there are sufficient
data so that such aggregation will not permit the identification of Participating Organizations by other Participating
Organizations or the public. Results will be made available publicly at no charge.
8.

AHRQ’s Contractor conducts analyses of the Data to examine its distributional properties (variability, missing data,
skewness), to assess the factor structure and reliability of the items and composites, and examine relationships of the Data
with organizational characteristics. In any data analysis reports that may be produced, such reports will not identify
individual Participating Organizations by name and results will only be reported in a manner that will not permit the
identification of Participating Organizations.

9.

AHRQ and its Contractor, Westat, agree to use the Data submitted by Participating Organization only for the purposes
stated in this DUA.

10. Researcher Access to Participating Organization’s Data. The AHRQ confidentiality statute, Section 944(c) of the
Public Health Service Act (42 U.S.C. 299c-3(c)), requires that data collected by AHRQ or one of its contractors
(including Westat) that identify establishments be used only for the purposes for which the data were supplied. AHRQ
may grant researchers access to Participating Organizations’ de-identified Data according to the following provisions:
a) Access to respondent and organization level data files that do not identify or permit re-identification of individual
respondents or Participating Organizations may be granted by AHRQ without the specific authorization of
Participating Organizations whose Data are included as part of the data files. Individuals requesting de-identified
Child Hospital CAHPS data (hereinafter termed “Data Requesters”) must submit a Research Abstract Form detailing
the research purpose, hypotheses and methodology for analyzing the Data. AHRQ will review all Research Abstract
Forms and approve or deny the requests. The de-identified data files may include organizational characteristics (e.g.,
product type and region), provided the characteristics do not permit re-identification of individual respondents or
Participating Organizations. Data Requesters must also sign a Data Release Agreement in which they agree with the
following requirements. Data Requesters agree that they: 1) will not use, and will prohibit others from using or
disclosing, the de-identified Data except for the purposes specified in their Research Abstract Form; 2) will ensure
that the de-identified Data are kept in a secured environment and that only authorized users will have access to it; and
3) will limit the use of the de-identified Data to the individuals who require access in order to perform activities for
the purposes specified in the Research Abstract Form.
b) Access to data files specific to an identifiable Participating Organization may be approved only with the express
written authorization of the Participating Organization whose data files are requested. Results containing any
identifying information, may not be released, disclosed or made public without the express written authorization of
any Participating Organizations that may be identified in the published research analysis.
Data Use Agreement – Child HCAHPS Survey Database

Last Updated May 25, 2018

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The CAHPS Database
Child Hospital CAHPS Survey
Database
Data Use Agreement

Form Approved
OMB No.
Exp. Date

c) Valid purposes for the use of Child Hospital CAHPS de-identifiable or identifiable Data do not include the use of
Datafor public reporting, proprietary, commercial or competitive purposes involving those Participating Organizations, or
to determine the rights, benefits, or privileges of Participating Organizations.

11. AHRQ’s Contractor, Westat, has signed this DUA in its current form. Any changes or modifications to the DUA other
than those required to complete the DUA, such as contact information, will require review and execution, by both parties,
of a new DUA or addendum.
12. Participating Organization may change or revoke this consent by sending written notification to the CAHPS Database,
Westat, 1600 Research Boulevard, Rockville, MD 20850. Requests for changes or revocations must be received within 2
weeks of the current year’s data submission deadline to be excluded from the current year’s database and all reporting for
that year. The request for revocation will not apply to Data already authorized and released prior to receipt of your written
request to revoke consent.
13. If Participating Organization represents more than one hospital, use the space below to TYPE OR WRITE THE
NAME OF EACH INDIVIDUAL HOSPITAL AND ITS ADDRESS, INCLUDING CITY AND STATE, which is
represented by the Participating Organization and therefore covered under this Data Use Agreement.
Attach additional sheet if necessary.
Add
health
plans

NAME OF HOSPITAL REPRESENTED

Data Use Agreement – Child HCAHPS Survey Database

ADDRESS, CITY AND STATE

Last Updated May 25, 2018

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The CAHPS Database
Child Hospital CAHPS Survey
Database
Data Use Agreement

Form Approved
OMB No.
Exp. Date

14. PLEASE COMPLETE THE INFORMATION BELOW, SIGN, AND RETURN ALL PAGES OF THIS DATA
USE AGREEMENT TO WESTAT.
The undersigned individual hereby attests that he/she is duly authorized to represent the Participating Organization and
all hospitals listed under item 13 and in so doing, enters into this Data Use Agreement on behalf of the Participating
Organization and the hospitals listed under item 13 and agrees to all the terms specified herein.
Complete
all
information

Name:
Title:
Address:

Phone number:
Fax number:
Email address:
Sign and
date

(Signature)

(Date)

15. NAME AND ADDRESS OF PARTICIPATING ORGANIZATION CONTACT (if different from above):
Name and address of person from Participating Organization who is the point of contact for this completed DUA.
Complete
as needed

Name of contact:
Title:
Address:

Phone number:
Email address:

The undersigned individual hereby attests that he/she is duly authorized to represent Westat, AHRQ’s Contractor, and, in so
doing, enters into this Data Use Agreement on behalf of Westat and agrees to all the terms specified herein.

David M. Maklan
Senior Vice President, Westat
Data Use Agreement – Child HCAHPS Survey Database

Last Updated May 25, 2018

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