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pdf2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
Code List
Routing
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
HHPRPROF
HH1
yes/no
(At the time of the last interview, [you/(SP)] indicated that [you/(SP)] had been helped at home by a health or medical
professional.)
(01) YES
(02) NO
[(Since/since) (REFERENCE DATE/UTILDATE)/(Between/between) (REFERENCE DATE) and (DATE OF
(03) INDICATED YES BY DATAPREP. DO NOT
DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] helped at home DISPLAY. DATA EDITING ONLY.
by any (other) health or medical professionals, such as those listed on this card? (This may include health or
(-8) DON'T KNOW
medical professionals reported in prior interviews.)
(-9) REFUSED
(01) HH4-PROFWORK
(02) HH18 - HHPRFRND
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND
[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)]?
[PROBE: Who would (you/SP) call if the home health provider did not show up?]
PROVIDER_HHP
HH5
ORG
roster
ADD OR SELECT ONLY ONE PROVIDER.
ENTER THE NAME OF THE PLACE OR ORGANIZATION RATHER THAN AN INDIVIDUAL PROVIDER.
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING
AN EVENT WITH THAT PROVIDER.
[DO NOT ADD A NEW ROSTER ENTRY IF A DIFFERENT PERSON CAME FROM AN ORGANIZATION
ALREADY LISTED ON THE ROSTER.]
(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
(01) CONTINUOUS ANSWER
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
N+1. ADD ANOTHER
N+2. NEED TO EDIT SPELLING OF EXISTING
PROVIDER
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
(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 CHNGSPL-CHNGSPL.
[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:
Page 1 of 7
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
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."
Code List
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
Routing
CRCTSPL-CRCTSPL
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
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
CRCTSPL
CRCTSPL
verbatim
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]
(01) [Continuous Answer]
BOX HH1AAA
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
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
AN EVENT WITH THAT PROVIDER.
(01) CONTINUOUS ANSWER
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
(01-N) BOX HH1AAA
(N+1) PROVNAME-HH2
(N+2) CHNGSPL-CHNGSPL
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 CHNGSPL-CHNGSPL.
[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."
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
CRCTSPL-CRCTSPL
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
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
Page 2 of 7
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
Code List
Routing
(01) [Continuous Answer]
BOX HH1AAA
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]
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.
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)
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.
BOX HH1AA
(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)
(20) PHYSICIAN'S ASSISTANT
(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
(01)-(34), (-8), (-9) BOX HH1AA
(91) HH3 - PROVSPOS
BOX HH1AA
Page 3 of 7
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
Code List
Routing
(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
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.
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?
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.
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.
OTHMEALS
HH7
BOX HH1BB
BOX HH1
VAPLACE
HH8
BOX HH1A
HMOASSOC
HH10A
yes/no
Is [(PROVIDER NAME) associated with/(PROVIDER NAME)] a Department of Veterans Affairs, or V.A., facility?
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.
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
BOX HH1BB
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HH1A
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HH11- EVENT
(02) HH10B - HMOREFER
(-8) HH10B - HMOREFER
(-9) HH10B - HMOREFER
Page 4 of 7
2023 MCBS Community Questionnaire
Variable Name
HMOREFER
MR Screen Name
HH10B
HHQ-HOME HEALTH UTILIZATION
Question Type
Question Text/Description
Code List
Routing
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
(01) YES, AT LEAST ONE
(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)] help
(02) NO
with [your/(SP’s)] daily needs by doing things, such as the ones shown on this card? [HELP WITH DAILY NEEDS
(-8) DON'T KNOW
MEANS HELP IN USING THE TELEPHONE, DOING HOUSEWORK, PREPARING MEALS.]
(-9) REFUSED
HH15 - NEEDCARE
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.]
SHOW CARD HH3
NEEDMEAL
HH14
yes/no
[PROBE: We just need to know in general.]
SHOW CARD HH4
NEEDCARE
HH15
yes/no
(01) YES, AT LEAST ONE
(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)] help
(02) NO
with [your/(SP’s)] personal care by doing things such as those shown on this card? [HELP WITH PERSONAL
(-8) DON'T KNOW
CARE MEANS HELP WITH BATHING, SHOWERING, DRESSING, EATING, WALKING, USING THE TOILET.]
(-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.
Page 5 of 7
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
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
(01) continuous answer
(996) NOT APPLICABLE/RESPONDENT DOES NOT
RECEIVE HOME HEALTH SERVICES THROUGH
[IF THE RESPONDENT DOES NOT RECEIVE HOME HEALTH SERVICES THROUGH MEDICARE, SELECT NOT
MEDICARE
APPLICABLE. IF THE RESPONDENT DOES NOT KNOW THE NAME OF THE PHYSICIAN, SELECT DON'T
(-8) Don't Know
KNOW.]
(-9) Refused
HHPMORE
HHPOMORE
HH16
HH17
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.
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?
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]
Routing
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
[IF NEEDED: This physician can also be referred to as the attending physician.]
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]
BOX HH3
Code List
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
SHOW CARD HH5
(At the time of the last interview, [you/(SP)] indicated that, because of health problems, [you/(SP)] had received
personal care or help at home with daily needs from a person who did not live with [you/(SP)].)
HHPRFRND
HH18
yes/no
(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP DO NOT
(Besides what you have already talked about, [(Since/since) (REFERENCE DATE/UTILDATE)/(Between/between) DISPLAY. DATA EDITING ONLY.
(REFERENCE DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)], because of health (-8) DON'T KNOW
problems [have you/has (SP)/did (SP)] (received/receive) any personal care or help at home with daily needs from (-9) REFUSED
(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/(SP)]?
ENTER NAME OF PERSON WHO HELPED.
PROVIDER_HHF
HH19
roster
[SELECT OR ADD ONLY ONE PERSON. DO NOT ENTER A PERSON WHO LIVES WITH THE SP.]
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING
AN EVENT WITH THAT PROVIDER.
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
(01) HH19 - PROVIDER_HHF
(02) BOX HH7
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) BOX HH7
(-9) BOX HH7
(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 CHNGSPL-CHNGSPL.
Page 6 of 7
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
HHQ-HOME HEALTH UTILIZATION
Question Text/Description
Code List
Routing
[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."
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]
CRCTSPL-CRCTSPL
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
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
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:
BOX HH3AA
HHFTYPE
HH20
routing
code one
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.
Is (PROVIDER NAME) a friend, neighbor, or a relative?
How is (PROVIDER NAME) related to [you/(SP)]?
HHFRELAT
HH21
code one
HHFRELOS
HH21
text
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
BOX HH1AA
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/SP)?
(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.
HHFMORE
Page 7 of 7
| File Type | application/pdf |
| File Title | Medicare Current Beneficiary Survey Section Specifications for HHQ |
| Subject | Medicare beneficiaries, MCBS community questionnaire, 2023, Home health utilization and events, HHQ |
| Author | NORC |
| File Modified | 2023-08-15 |
| File Created | 2023-08-11 |