Crosswalk - Hospital Survey

Crosswalk for Changes to

Evaluation of the CMS Network of Quality Improvement and Innovation Contractors Program (NQIIC) (CMS-10769)

Appendix B Hospital Survey Questions

Old #	New #	Question Used in Pretest	Recommendation/Decision	Reason	Recommended Revised Question
S1	S1	Are you the best person at [FACILITY NAME] to complete this survey?   Yes  No   DK   Refused   [IF S1 = NO, ASK S2; IF S1 = Yes, PROCEED TO S4]	Skip logic adjusted to reflect DK and Refused options	As recommended by the pretest.	Are you the best person at [FACILITY NAME] to complete this survey?  a. Yes  b. No  c. DK  d. Refused  [IF S1 = NO, DK, or Refused, ASK S2; IF S1 = Yes, PROCEED TO S4]
S2	S2	Can you provide us the name of the person most responsible for improving quality in your hospital?  a. Yes  b. No  c. DK  d. Refused  Record Name  Record Title  Record phone number  [IF S2 = No or DK, ASK S3]	Skip logic adjusted to reflect Refused option	As recommended by the pretest.	Can you provide us the name of the person most responsible for improving quality in your hospital?  a. Yes  b. No  c. DK  d. Refused  Record Name  Record Title  Record phone number  [IF S2 = No, DK, or Refused, ASK S3]
S6	S6	How long have you been in this role?   [Record years and months]  Not sure (approximately how long?)	Added ‘at this hospital’ Programing note removed “Not sure” removed	As recommended by the pretest.	How long have you been in this role at this hospital?
S7	S7	New question	Add question to ensure permission to record responses	As recommended by the pretest.	This survey includes closed-ended questions with specific answer choices, as well as longer open-ended response questions. In order to help the survey go faster, I would like to record your answers to some questions where you may have longer responses. Do I have your permission to record these answers? Yes No
1	1	Over the last 6 months, did your facility work on improving processes or protocols used to increase the quality and safety of patient care with either of these two aims? Select all that apply Responding to the opioid crisis Reducing hospital acquired conditions, infections, or adverse events, such as infections caused by urinary catheters or central lines Neither of these	Changed timeframe Changed question to focus on supportiveness of leadership when a change was made, rather than if a change was made Removed specific aims (opioid and hospital acquired conditions) from question and response options Add response options on a scale	Adjusting to reflect post-Covid years and to better assess general quality improvement culture As recommended by the pretest	In the last 12 months, when your facility tried to improve quality of care, how supportive was your leadership? Please give a response on a scale from 1 to 5, with 1 being very unsupportive and 5 being very supportive. How would you rate your leadership? 1- Very unsupportive 2 3 4 5- Very supportive Prefer not to answer [DON’T READ]
1.1		[IF Q1a AND Q1b = NO OR Q1c = YES] Over the last 6 months, did you work on other quality improvements for your hospital? [Open ended] [DO NOT READ BUT RECORD RESPONSES. ANY RESPONSES THAT ARE CONSIDERED A HAC SHOULD FOLLOW THE SKIP PATTERN FOR 1B] COVID-19 NA. No other quality improvements were worked on	Remove question	Avoid duplication of data from other data source	None.
2		Does your hospital post its patient safety record or the number of patients who experience harmful events on its website? Yes No	Remove question	Question no longer necessary for data needs	None.
	2	New question	Add question to assess staff willingness to adopt new practices or policies for quality improvement	Added to better assess general quality improvement culture	In the last 12 months, when your facility tried to improve quality of care, how willing was your staff to adopt new practices or policies? Please give a response on a scale from 1 to 5, with 1 being very unwilling and 5 being very willing. How would you rate your staff? 1- Very unwilling to adopt 2 3 4 5- Very willing to adopt Prefer not to answer [DON’T READ]
3		Now I’m going to read a list of programs, policies, agencies, or resources that you may have used in improving the quality of care at your facility. As I read each one, please tell me if you recall working with or using this resource over the last 6 months. Select all that apply Resources from the Hospital Quality Improvement Contractor Program or [INSERT HQIC NAME FOR HOSPITAL] CMS COVID-19 StAT Learning Series for Hospitals NHSN Report HHS Protect [INSERT STATE] hospital association-sponsored effort National Association of Public Hospitals (NAPH) or America’s Essential Hospitals (AEH) Other regional, state, or local initiative (specify) Programs, policies, and resources from your own hospital system Peers and/or other hospitals None of the above [DO NOT READ]	Remove question	Question no longer necessary for data needs, remove to reduce burden	None.
3.1		Are there any other sources of information you used when working on improving the quality of care at your facility? [PROBE TO SEE WHAT SPECIFIC RESOURCES WERE USED FOR EACH SOURCE] Record answer choice #1 Record answer choice #2 Record answer choice #3	Remove question	Question no longer necessary for data needs, remove to reduce burden	None.
	3	New question	Add question to assess facility priorities	Per change in CMS priorities	Now we want to better understand your facility’s priorities for quality improvement. I’m going to read a list of care topics that you may have addressed to improve the quality of care for patients at your facility. In the last 12 months, please tell me if your facility has changed or developed new processes or protocols to improve this topic… [Respond Yes or No] Health equity, meaning reducing disparities in health and health care…for those patients with a greater social risk factor burden Adopting a patient-centered approach Increasing patient safety Opioid misuse Preventing or controlling Covid-19 infection Other infection control (not Covid-19) Emergency preparedness Care transitions Patient Family Engagement Other Prefer not to answer [DON’T READ]
	3A	New question.	Add question to understand what might be preventing changes for quality improvement within an organization	As recommended by the pretest.	3A. [Asked if any a-i = No] With regard to the care topics that you have not addressed, namely [insert responses selected ‘no’ above (do not include the full definition for Health Equity)], which of these statements best describe the reasons why your facility didn’t change any processes or protocols? [Select all that apply] Our processes and protocols were already effective Other goals were of higher priority to our facility We didn’t have the resources needed to make changes We were not aware of best practices for quality improvement Other [Open ended] Prefer not to answer [DON’T READ]
4	4	What would you consider the sources of information, guidance or assistance that had the most impact on your facility’s effort to INSERT GOAL 1a ‘address the opioid crisis; GOAL 1b ‘reduce hospital acquired conditions, infections, and adverse events’; GOAL 1c ‘work on this quality improvement’ [Open ended]	Add time period Remove specific insertion of goals Adjust wording to reflect top sources influence on general quality improvement	As recommended by the pretest.	The next question will be an open-response question. In the last 12 months, what were the top three sources of influence on your facility’s ability to improve the quality of services for patients (e.g. organizations, professional associations, federal programs, websites, podcasts, etc.)? [Open ended]
5	5	Before this survey, had you ever heard of the Hospital Quality Improvement Contractor Program, otherwise referred to as HQIC? Yes No	Add time period Remove program name, and add programming for specific HQIC name or contact person	As recommended by the pretest.	In the last 12 months, do you recall working with [HQIC name or HQIC contact person] or using any resources provided by this organization? Yes No Prefer not to answer [DON’T READ]
	5A	New question	Add question to understand what might be preventing a working relationship with the HQIC organization	As recommended by the pretest.	[Asked if Q5= b] Which best describes the reason(s) why your facility did not work with [HQIC name or HQIC contact person] or use resources provided by this organization since in the last 12 months? [Select all that apply] We were not aware of this organization and its resources No such opportunity presented itself  We had all the support needed within this facility  The resources offered seemed redundant with other efforts we are involved in We didn’t have enough time to participate in another effort We had already received support from another government program The assistance available didn’t seem to be helpful or worth the effort  The quality of resources or assistance from [HQIC name or HQIC contact person] was sub-optimal  The scheduling was not convenient Other Prefer not to answer [DON’T READ]
	5B	New question	Add question to confirm if providers know how to contact the HQIC organization	As recommended by the pretest	[Asked if Q5= b] Do you know how to contact [HQIC name or HQIC contact person] if you want help or advice from them on improving quality at your facility? Yes No Prefer not to answer [DON’T READ]
6		The name of your HQIC is [HQIC Name OR HQIC Contact Person if available], have you ever heard of them? [CONFIRM CONTACT PERSON IS INCLUDED IN CONTACT LIST] Yes No	Removed question	Redundant based on change to question 5 Reduce burden of survey
7	6	How would you describe your facility’s level of engagement with [INSERT HQIC ID FOR HOSPITAL] for work on [INSERT FOR GOAL 1a ‘addressing the opioid crisis’; FOR GOAL 1b ‘reducing hospital acquired conditions, infections, and adverse events’; GOAL 1c ‘Insert open ended answer’]? Would you say you were… Fully engaged [INSERT HQIC NAME FOR HOSPITAL] Moderately engaged [INSERT HQIC NAME FOR HOSPITAL] Minimally engaged [INSERT HQIC NAME FOR HOSPITAL] Not at all engaged [INSERT HQIC NAME FOR HOSPITAL]	Add time period Remove insertion of specific goals in order to assess general engagement Simplify response options	Assessment of specific goals no longer priority for CMS As recommended by the pretest	In the last 12 months, how would you describe your level of engagement with [HQIC name or HQIC contact person]? Would you say you were... Highly engaged Moderately engaged Minimally engaged   Not at all engaged Prefer not to answer [DON’T READ]
	6A	New question	Add question to understand engagement over time	As recommended by the pretest.	[Asked if Q6= c or d] You said you were [insert answer from Q6], was there a period before the last 12 months when you were more engaged with [HQIC name or HQIC contact person]? Yes No Prefer not to answer [DON’T READ]
7.1		You said before you were not working with [HQIC Name] but answered that you were engaged with them. Do you want to change your response that you are working with them? Yes [Set Q3a = YES] No	Remove question	Question irrelevant due to previous question deletions	None
8	6B	Which of these statements describe the reasons why this hospital was not fully engaged with the [INSERT HQIC ID FOR HOSPITAL] for work on [INSERT GOAL 1a ‘addressing the opioid crisis; GOAL 1b ‘reducing hospital acquired conditions, infections, and adverse events’; GOAL 1c ‘this quality improvement’]? Select all that apply. [FOR GOAL 1a] The population served by our hospital did not have issues with opioid misuse [FOR GOAL 1a] The hospital did not need to improve the way it addressed opioids because there were already effective protocols in place [FOR GOAL 1b] No improvement was needed because the hospital sustains zero rates of harm We were overwhelmed by the COVID-19 pandemic and did not have resources for improvements in other areas [HIDE IF 1.1a=TRUE] The hospital did not need the support of [INSERT HQIC NAME FOR HOSPITAL] We had all the improvement support needed within this hospital or health system We preferred to work with another organization outside the hospital My hospital made a management decision not to participate The quality of resources or programming provided by [INSERT HQIC NAME FOR HOSPITAL] was sub-optimal Learning events scheduled by [INSERT HQIC NAME FOR HOSPITAL] were inconvenient My hospital has not been in the program long enough to assess work with [INSERT HQIC NAME FOR HOSPITAL] (SHOW IF enrollment <= 4 months) Other [specify]:	Add time period Remove insertion of specific goals to in order to assess reason for limited engagement, generally Simplify and refine language in response options	As recommended by the pretest.	[Asked if Q6= c or d] In the last 12 months, which of the following options best describe the reasons why this facility was not more fully engaged with [HQIC name or HQIC contact person]? [Select all that apply] No such opportunity presented itself We had all the support needed within this facility  The resources seemed redundant with other efforts we were involved in  We didn’t have enough time to participate in another effort We had already received support from another government program The assistance provided didn’t seem to be helpful or worth the effort  The quality of resources or assistance from [HQIC name or HQIC contact person] was sub-optimal The scheduling was not convenient Other [Open ended] Prefer not to answer [DON’T READ]
	6C	New Question	Added to understand if providers turn to HQICs when they need additional assistance	Adjusted to better represent data priorities for survey	[Asked if Q6= d] When you needed additional support or advice for improving quality of care at your facility, did you contact [HQIC name or HQIC contact person]? Yes No Prefer not to answer [DON’T READ]
9	6D	Do you know how to contact someone at [HQIC NAME FOR HOSPITAL] if you wanted help or advice from them on improving quality at your facility? Yes No	Simplify language	Adjusted to align with changes of question 6C, per the survey data priorities	[Asked if Q6C= b] Do you know how to contact [HQIC name or HQIC contact person]? Yes No Prefer not to answer [DON’T READ]
	7	New question	Added to understand provider outreach	Added to meet data priorities	Does your facility engage in community outreach or with other service providers? Yes No Prefer not to answer [DON’T READ]
	7A	New question	Added to understand provider outreach	Added to meet data priorities	[Asked if Q7= a] In the last 12 months, what types of outreach has your facility used to engage with partners in the communities you serve? I’m going to read you a list of possible ways; please tell me if this applies to your facility: [Select all that apply] Community advisory groups Conducting focus groups Patient Family Engagement committees Collaboration with community service partners Newsletters Webinars or Free Talks Social Media Other [Open ended] Prefer not to answer [DON’T READ]
	8	New question	Added to understand HQIC influence on providers’ quality improvement efforts	Added to meet data priorities	In the last 12 months, were there any changes to the processes or protocols in your facility as a result of your interactions with [HQIC name or HQIC contact person] or its resources? Yes No I’m not sure Prefer not to answer [DON’T READ]
	8A	New question	Added to understand HQIC influence on providers’ quality improvement efforts	Added to meet data priorities	[Asked if Q8 = a] Please identify what processes or protocols changed as a result of the interactions with [HQIC name or HQIC contact person] [Only include response options where respondent answered ‘Yes’ in Q3.] [Respond Yes or No] Adopting a patient-centered approach Increasing patient safety Opioid misuse Preventing or controlling Covid-19 infection Other infection control (not Covid-19) Emergency preparedness Care transitions Patient Family Engagement Other [Open ended] Prefer not to answer [DON’T READ]
	8B	New question	Added to understand barriers to HQIC influence on providers’ quality improvement efforts	Added to meet data priorities	[Asked if Q8 = b] You said that working with [HQIC name or HQIC contact person] did not result in any changes to your facility’s procedures or protocols. Which responses best describe why that was the case? Would you say it was because... [Select all that apply] Our facility already made changes needed before we began working with [HQIC name or HQIC contact person] We had all the support needed within this facility The resources offered seemed redundant with other efforts we were using We had already received support from another government program The assistance provided didn’t seem to be helpful or worth the effort We didn’t have time to implement the changes the [HQIC name or HQIC contact person] recommended The quality of resources or assistance from [HQIC name or HQIC contact person] was sub-optimal The scheduling was inconvenient Other [Open ended] Prefer not to answer [DON’T READ]
10		If I asked you to describe in just a few words, the CMS Quality Improvement Program, or the HQIC Program, also known as [HQIC NAME FOR HOSPITAL], what’s the first thing that comes to mind? [Open ended]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
11		[If > year; “In the last twelve months” If < year; “Since [INSERT DATE]” how satisfied are you with the amount of contact between your facility and [HQIC NAME FOR HOSPITAL]? Would you say you are …  Very Satisfied  Somewhat Satisfied  Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
12		Have you or someone in your facility ever had occasion to initiate the interaction with [HQIC NAME FOR HOSPITAL], such as when you needed questions answered or assistance with an issue? Yes No [GO TO Q14]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
13		[IF Q12 = Y] Overall, how satisfied are you with the timeliness of [HQIC NAME FOR HOSPITAL]’s response to your questions or requests for assistance? Would you say you are... Very Satisfied  Somewhat Satisfied  Neither Satisfied or Dissatisfied  Somewhat Dissatisfied  Very Dissatisfied  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
14	9	Thinking about all interactions with [HQIC NAME FOR HOSPITAL], overall, how satisfied are you with your relationship with [HQIC NAME FOR HOSPITAL]?  Would you say you are…  Very Satisfied  Somewhat Satisfied  Neither Satisfied or Dissatisfied  Somewhat Dissatisfied  Very Dissatisfied  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Moved word “overall” for better flow Adjusted last two response options to one: “prefer not to answer”	As recommended by pretest.	Thinking about all interactions with [HQIC name or HQIC contact person,] how satisfied are you with your relationship overall? Would you say you are…? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Prefer not to answer [DON’T READ]
18	9A	[If Q13, Q14, Q15, Q16 OR Q17 = d or e] Please tell me what [HQIC NAME FOR HOSPITAL] could have done better. [Open ended]	Moved this question up to a sub-question of the general satisfaction question Adjusted skip-logic accordingly	Better flow; as recommended by pretest	[Asked if Q9= c, d e, or f] Please tell me what [HQIC name or HQIC contact person] could have done better. [Open ended]
	9B	New question	Added to understand how the HQICs have been most helpful	Accommodating updated data priorities for the survey.	[Asked if Q9= a, b, c, or f] Please tell me in what ways [HQIC name or HQIC contact person] has been most helpful. [Open ended]
15	10	The assistance we received from [HQIC NAME FOR HOSPITAL] was key to the efficient implementation of our quality improvement projects. Would you say you… Strongly Agree Somewhat Agree Neither Agree or Disagree  Somewhat Disagree  Strongly Disagree  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Added introduction to statement Changed word ‘key’ to ‘significant’ Adjusted question focus from general implementation to focus on health equity efforts Simplified last two response options to ‘prefer not to answer’	Question no longer reflects data priorities; removed to reduce burden	Please indicate your level of agreement with the following statement about health equity and the information and assistance provided by the [HQIC name or HQIC contact person]: 10. The assistance we received from [HQIC name or HQIC contact person] was significant to our facility’s efforts to improve health equity in the care setting, meaning the facility’s efforts to reduce disparities in health and health care…for those patients with a greater social risk factor burden. Would you... Strongly agree Somewhat agree   Neither agree nor disagree   Somewhat disagree   Strongly disagree Prefer not to answer [DON’T READ]
16		The service we received from [HQIC NAME FOR HOSPITAL] was worth the time or effort required on the part of our staff. Would you say you…  Strongly Agree Somewhat Agree Neither Agree or Disagree  Somewhat Disagree  Strongly Disagree  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
17		Our organization has benefited from having received services from [HQIC NAME FOR HOSPITAL]. Would you say you… Strongly Agree Somewhat Agree Neither Agree or Disagree  Somewhat Disagree  Strongly Disagree  Don’t Know/Not Sure [DO NOT READ] Decline to answer [DO NOT READ]	Question removed	Question no longer reflects data priorities; removed to reduce burden	None.
19	11	At this point, what quality improvement areas are you most in need of for additional assistance? [Open ended] NA. No quality improvement areas are in need of additional assistance	Adjust wording at the beginning of the question	As recommended by pretest.	[All respondents] Finally, what quality improvement areas are you most in need of additional assistance? [Open ended]

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