Form 2 Attachment B- Child CAHPS Database DUA

The Child HCAHPS Survey Database
Data Use Agreement
Instructions
1.

All organizations that want to participate in AHRQ’s Child HCAHPS 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 and submit this DUA on behalf of a hospital or health system (even if they
have been given permission by the hospital or health system to handle the actual submission of data). Only a duly
appointed representative from a hospital or health system 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 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.

Please sign and upload a copy of the signed DUA by logging into the Child HCAHPS Survey Database submission
system at https://cahpsdatabase.ahrq.gov/CHDSS/login.aspx and selecting the DUA tab. The DUA may be signed
electronically using a Digital ID (recommended) or may be printed and scanned.

4.

Please retain a copy of the fully signed and executed DUA 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 at [email protected].

Form Approved: OMB No.: 0935-0243
Exp. Date: 1/31/2029

The Child HCAHPS 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
hospitals listed under item 13 on page 4 of this DUA.
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 (Hospital or Corporate Office/Health System)

City

State

Zip Code

VERY IMPORTANT: Type or write in the name of the Participating Organization above. If more than one
hospital location is represented, list the name of the corporate office or overall health system above, and
under item 13, page 4 of this DUA, IDENTIFY EACH INDIVIDUAL HOSPITAL LOCATION 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
health plan, hospital, health care facility, state agency, and program 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 HCAHPS Survey
data to Westat for participation in the Child HCAHPS Survey Database (hereinafter termed the “Database”).

3.

The Database is populated with Child HCAHPS Survey data through the voluntary participation of organizations that have
administered the Child HCAHPS Survey and are willing to submit their Child HCAHPS Survey data to AHRQ for inclusion in the
Database. Because participating organizations (e.g., health systems, hospitals) voluntarily submit data to the CAHPS
Database, the data included in the Database 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 HCAHPS 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 are collectively referred to as the
“Data.” Participating Organization’s Data include:
a) A copy of the final Child HCAHPS Survey instrument(s) administered, including copies of paper, phone 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 HCAHPS Survey was administered, a
copy of each Child HCAHPS Survey instrument administered must be provided with the corresponding results for each
version of the survey instrument for which data are submitted;

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 (0935-0165) AHRQ, 5600 Fishers Lane, Rockville, MD 20857.

Data Use Agreement – Child HCAHPS Survey Database

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b)

Respondent-level Child HCAHPS Survey data that are de-identified to prevent identification of any individual in the
Database. Participating Organization will submit its final, de-identified respondent-level Child HCAHPS 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 survey administration and organizational characteristics data (e.g., location, mode of survey administration,
dates of administration, sample size, response rates, etc.).

5.

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 HCAHPS Survey
administered is deemed acceptable by AHRQ’s Contractor, (i.e., not modified from the original Child HCAHPS Survey
instructions and items in a manner that will make the Data incompatible for inclusion in the Database) 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 publicly report aggregated statistics
overall for the Child HCAHPS Survey composite scores and items, and present statistics by various organizational
characteristics (e.g., region, bed size, teaching status), using data from Participating Organizations. Only aggregated data will
be publicly reported, and only when there are sufficient data so that such aggregation will not permit the identification of
individual respondents or hospitals 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 organizations 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:
10.1 Release of De-Identified Hospital Data: 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 HCAHPS Survey 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. Data requesters must also sign a Data Release
Agreement in which they agree that they: 1) will not use, and will prohibit others from using or disclosing, the deidentified 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
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the de-identified Data to the individuals who require access in order to perform activities for the purposes specified in
the Research Abstract Form. The de-identified Data files may include organizational characteristics (e.g., region, bed
size, teaching status, etc.), provided the characteristics do not permit re-identification of individual respondents or
Participating Organizations.
Valid purposes for the use of de-identifiable Child HCAHPS Survey Data do not include the use of Data for public
reporting, proprietary, commercial or competitive purposes involving those Participating Organizations, or to
determine the rights, benefits, or privileges of Participating Organizations.
10.2 Release of Hospital-Identifiable Data for Research Purposes: AHRQ and AHRQ’s Contractor, Westat, may receive
requests from researchers interested in linking Child HCAHPS Survey Data to other measures, such as patient safety
and quality outcome data. These studies require hospital-identifiable data, or data that can be linked to a specific
hospital through the use of hospital identifiers such as hospital name, hospital address, AHA ID or Medicare Provider
ID.
Individuals requesting Hospital-Identifiable Child HCAHPS Survey 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. Data requesters must also sign a
Confidentiality Agreement in which they agree that they: 1) will not release or disclose any Hospital-Identifiable Child
HCAHPS Survey Data that identifies persons or Participating Organizations directly or indirectly and will not release,
disclose or make public any identifying information about Participating Organizations at any time in any analyses or
summaries of results; 2) will not attempt to learn the identity of any person included in the Hospital-Identifiable Child
HCAHPS Survey Data or to contact any such person for any purpose and will not attempt to contact Participating
Organizations for the purpose of verifying information supplied in the Hospital-Identifiable Child HCAHPS Survey Data
set; 3) will not use, and will prohibit others from using or disclosing, the Hospital-Identifiable Child HCAHPS Survey Data
except for the purposes specified in their Research Abstract Form; 4) will ensure that the Hospital-Identifiable Child
HCAHPS Survey Data are kept in a secured environment and that only authorized users will have access to it; and 5) will
limit the use of the Hospital-Identifiable Child HCAHPS Survey Data to the individuals who require access in order to
perform activities for the purposes specified in the Research Abstract Form.
Valid purposes for using Hospital-Identifiable Child HCAHPS Survey Data include research linking such data to outside
datasets. Valid purposes for the use of Hospital-Identifiable Child HCAHPS Survey Data do not include the use of data
for public reporting, proprietary, commercial, or competitive purposes involving those Participating Organizations, or to
determine the rights, benefits, or privileges of Participating Organizations.
10.2.1 To allow for the release of Hospital-Identifiable Child HCAHPS Survey Data for valid research purposes as
specified in 10.2, AHRQ and AHRQ’s Contractor, Westat, have developed three options for Participating
Organizations to indicate their preferences for providing authorization to release such data. Participating
Organizations must select from one of the options below and provide signature in item 14:
Option 1: Selective release of Hospital-Identifiable Child HCAHPS Survey Data to specific Data Requesters
provided by written authorization on a case-by-case basis. If Option 1 is selected (this is the default if no
option is selected in item 14), brief summaries of research data requests will periodically be provided to
Participating Organizations for review, asking for written authorization to release their Hospital-Identifiable
Child HCAHPS Survey Data to specific Data Requesters. Research Abstract Forms will have been reviewed and
approved by AHRQ and AHRQ’s Contractor, Westat, before being forwarded to Participating Organizations for
review.
Option 2: Pre-approval for release of Hospital-Identifiable Child HCAHPS Survey Data to all Data Requesters
whose proposals have been reviewed and approved by AHRQ and AHRQ’s Contractor, Westat. If Option 2 is
selected, Participating Organizations will grant authority to AHRQ and AHRQ’s Contractor, Westat, to review
and evaluate all research proposals and authorize release of their Hospital-Identifiable Child HCAHPS Survey
Data to Data Requesters whose proposals have been deemed acceptable and approved by AHRQ and AHRQ’s
Contractor, Westat. By selecting Option 2, Participating Organizations entrust the release of their HospitalData Use Agreement – Child HCAHPS Survey Database

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Identifiable Child HCAHPS Survey Data to Data Requesters approved by AHRQ and AHRQ’s Contractor, Westat,
per the valid research purposes specified in 10.2.
Option 3: Prohibiting release of all hospital-identifiable Child HCAHPS Survey Data. If Option 3 is selected,
AHRQ and AHRQ’s Contractor, Westat, will not release Participating Organization’s Hospital-Identifiable Child
HCAHPS Survey Data to anyone, including researchers. Participating Organization indicates it does not want to
be offered research proposals to review and will not release its Hospital-Identifiable Child HCAHPS Survey Data.
10.2.2 At any time, Participating Organizations may request from AHRQ’s Contractor, Westat, a list of approved Data
Requesters who have received Participating Organization’s Hospital-Identifiable Child HCAHPS Survey Data and
obtain a copy of the Research Abstract Form which state their intended uses of the data.
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 a written request to revoke
consent.
13. If Participating Organization represents more than one hospital, use the space below to (1) TYPE OR WRITE THE NAME OF
EACH INDIVIDUAL HOSPITAL, and (2) TYPE OR WRITE ITS ADDRESS, INCLUDING CITY AND STATE, which is represented by
the Participating Organization and therefore covered under this Data Use Agreement. Attach additional sheet(s) if necessary.
Add
hospitals
as needed

Name of Hospital

Data Use Agreement – Child HCAHPS Survey Database

Address, City and State

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14. PLEASE SELECT ONE OPTION BELOW, SIGN, AND RETURN ALL PAGES OF THIS DATA USE AGREEMENT TO WESTAT.
Options for release of Hospital-Identifiable Child HCAHPS Survey Data for research purposes (described in item 10.2.1).
SELECT ONE OPTION AND SIGN BELOW. If no option is selected, Option 1 becomes the default.
Select one option
Option 1 (Default option): Selective release of Hospital-Identifiable Child HCAHPS Survey Data to specific Data
Requesters provided through written authorization on a case-by-case basis.
Option 2: Pre-approval for release of Hospital-Identifiable Child HCAHPS Survey Data to all Data Requesters
whose proposals have been reviewed and approved by AHRQ and AHRQ’s Contractor, Westat.
Option 3: Prohibiting release of all Hospital-Identifiable Child HCAHPS Survey Data.
By selecting one of the options above, the duly authorized representative consents to the conditions of release of
Participating Organization’s Hospital-Identifiable Child HCAHPS Survey Data under the conditions specified in item 10.2
relevant to the option selected. If no option is selected, Option 1 becomes the default selection.
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 Name, Title, and Sign
Name:
Title:

(Signature)

(Date)

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

Fax 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.

Patrick J. Coleman

Digitally signed by Patrick J. Coleman
Date: 2023.05.03 10:44:08 -04'00'

Patrick Coleman, Vice President, Westat

Data Use Agreement – Child HCAHPS Survey Database

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