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Crosswalk Between Current ICH CAHPS Survey and the ICH/Home CAHPS Survey
ICR 202611-0938-008 · OMB 0938-0926 · Object 174866600.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Crosswalk Between Current ICH CAHPS Survey and the ICH/Home CAHPS Survey |
| Subject | Survey crosswalk for ICH CAHPS |
| Keywords | dialysis; in-center hemodialysis; ICH CAHPS; home dialysis; ICH CAHPS Survey; survey crosswalk; crosswalk |
| Author | ICH CAHPS |
| Last Modified By | Acrobat PDFMaker 26 for Excel |
| File Modified | 2026-11-03 |
| File Created | 2026-06-22 |
| Conversion State | complete |
Extracted Text
The current ICH CAHPS Survey compared to the proposed ICH/Home CAHPS Survey Columns A and B show the question number and text for the current survey. Columns D and E show the corresponding question number (if applicable) and text for the proposed ICH/Home Survey; if it differs from the question text in the current survey, Column D is asterisked and highlighted. Current Q# Intro Q1 Q2 Current Question Text This survey is about your experiences with dialysis care at [SAMPLE FACILITY NAME]. Where do you get your dialysis treatments? How long have you been getting dialysis at [SAMPLE FACILITY NAME]? ICH/Home Q# Intro* Q1* Q2* ICH/Home Question Text This survey is about your experiences with dialysis care through [SAMPLE FACILITY NAME]. When answering each question, please think about this dialysis center that supports your dialysis care, whether that is in a dialysis center (in-center hemodialysis) or in your home (home hemodialysis or peritoneal dialysis [PD]). What type of dialysis do you currently receive most often? Please mark only one response. How long have you been getting dialysis through [SAMPLE FACILITY NAME]? The next questions ask about your interactions with dialysis center staff such as nurses, technicians, dietitians, and social workers. For these questions, dialysis center staff does For the next questions, dialysis center staff does not Q3 Intro include doctors. Dialysis center staff means nurses, technicians, dietitians, and social workers at this dialysis center. Q3 Intro* not include doctors, Nurse Practitioners (NPs), or Physician Assistants (PAs). Q3 In the last 3 months, how often did the dialysis center staff listen carefully to you? Q3 In the last 3 months, how often did the dialysis center staff listen carefully to you? Q4 Q5 Q6 Q7 In the last 3 months, how often did the dialysis center staff explain things in a way that was easy for you to understand? In the last 3 months, how often did the dialysis center staff show respect for what you had to say? In the last 3 months, how often did the dialysis center staff spend enough time with you? In the last 3 months, how often did dialysis center staff make you as comfortable as possible during dialysis? Q4 Q5 Q6 Q17 (ICH only) In the last 3 months, how often did the dialysis center staff explain things in a way that was easy for you to understand? In the last 3 months, how often did the dialysis center staff show respect for what you had to say? In the last 3 months, how often did the dialysis center staff spend enough time with you? In the last 3 months, how often did dialysis center staff make you as comfortable as possible during dialysis? Current Q# Q8 Current Question Text In the last 3 months, did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care? Q9 The dialysis center staff can connect you to the dialysis machine through a graft, fistula, or catheter. Do you know how to take care of your graft, fistula, or catheter? Q10 Q11 Q12 Q13 Q14 Q15 Intro Q15 Q16 Q17 Q18 In the last 3 months, which one did they use most often to connect you to the dialysis machine? In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine? In the last 3 months, did any problems occur during your dialysis? In the last 3 months, how often was the dialysis center staff able to manage problems during your dialysis? In the last 3 months, how often did dialysis center staff behave in a professional manner? Please remember that for these questions, dialysis center staff does not include doctors. Dialysis center staff means nurses, technicians, dietitians, and social workers at this dialysis center. In the last 3 months, how often did dialysis center staff explain blood test results in a way that was easy to understand? As a patient you have certain rights. For example, you have the right to be treated with respect and the right to privacy. Did this dialysis center ever give you any written information about your rights as a patient? Did dialysis center staff at this center ever review your rights as a patient with you? Has dialysis center staff ever told you what to do if you experience a health problem at home? ICH/Home Q# Q7 Q11* Q10* Q18 (ICH only) Q21 (ICH only) Q22 (ICH only) Q8 NA Q9 Q12 Q13 Q14* ICH/Home Question Text In the last 3 months, did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care? Do you know how to take care of your graft, fistula, catheter, or PD catheter? You can receive hemodialysis through a graft, fistula, or catheter and peritoneal dialysis (PD) through a PD catheter. In the last 3 months, which one was used most often for your dialysis? In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine? In the last 3 months, did any problems occur during your dialysis? In the last 3 months, how often was the dialysis center staff able to manage problems during your dialysis? In the last 3 months, how often did dialysis center staff behave in a professional manner? NA In the last 3 months, how often did dialysis center staff explain blood test results in a way that was easy to understand? As a patient you have certain rights. For example, you have the right to be treated with respect and the right to privacy. Did this dialysis center ever give you any written information about your rights as a patient? Did dialysis center staff at this center ever review your rights as a patient with you? Did dialysis center staff ever tell you what to do if you experience a health problem at home? Current Q# Current Question Text ICH/Home Q# Q22 Has any dialysis center staff ever told you how to get off the machine if there is an emergency at the center? Using any number from 0 to 10, where 0 is the worst dialysis center staff possible and 10 is the best dialysis center staff possible, what number would you use to rate your dialysis center staff? In the last 3 months, when you arrived on time, how often did you get put on the dialysis machine within 15 minutes of your appointment or shift time? In the last 3 months, how often was the dialysis center as clean as it could be? Q23 Using any number from 0 to 10, where 0 is the worst dialysis center possible and 10 is the best dialysis center possible, what number would you use to rate this dialysis center? Q26 Q24 Intro The next few questions ask about your care in the last 12 months. As you answer these questions, think only about your experience at [SAMPLE FACILITY NAME], even if you have not been receiving care there for the entire 12 months. Q27 Intro* Q19 Q20 Q21 Q24 Q25 Q26 Q27 You can treat kidney disease with dialysis at a center, a kidney transplant, or with dialysis at home. In the last 12 months, did your kidney doctors or dialysis center staff talk to you as much as you wanted about which treatment is right for you? Are you eligible for a kidney transplant? In the last 12 months, has a doctor or dialysis center staff explained to you why you are not eligible for a kidney transplant? Peritoneal dialysis is dialysis given through the belly and is usually done at home. In the last 12 months, did either your kidney doctors or dialysis center staff talk to you about peritoneal dialysis? Q15* Q16 Q19 (ICH only) Q20 (ICH only) Q27* Q28 Q29* Q34* ICH/Home Question Text Did dialysis center staff ever tell you how to get off the dialysis machine if there is an emergency during dialysis, either at the center or at home? Using any number from 0 to 10, where 0 is the worst dialysis center staff possible and 10 is the best dialysis center staff possible, what number would you use to rate your dialysis center staff? In the last 3 months, when you arrived on time, how often did you get put on the dialysis machine within 15 minutes of your appointment or shift time? In the last 3 months, how often was the dialysis center as clean as it could be? Using any number from 0 to 10, where 0 is the worst dialysis center possible and 10 is the best dialysis center possible, what number would you use to rate this dialysis center? The next few questions ask about your care in the last 12 months. As you answer these questions, think only about your experience with [SAMPLE FACILITY NAME], even if you have not been receiving care through them for the entire 12 months. Kidney disease can be treated with dialysis at a center, with dialysis at home, or with a kidney transplant. In the last 12 months, did your kidney doctors, Nurse Practitioners (NPs), Physician Assistants (PAs), or dialysis center staff talk to you as much as you wanted about which treatment is right for you? Are you eligible for a kidney transplant? In the last 12 months, have your kidney doctors, NPs, PAs, or dialysis center staff explained to you why you are not eligible for a kidney transplant? In the last 12 months, if you receive in-center hemodialysis, did your kidney doctors, NPs, PAs, or dialysis center staff talk with you about home hemodialysis or peritoneal dialysis (PD)? Current Q# Q28 Q29 Current Question Text In the last 12 months, were you as involved as much as you wanted in choosing the treatment for kidney disease that is right for you? In the last 12 months, were you ever unhappy with the care you received at the dialysis center or from your kidney doctors? ICH/Home Question Text NA NA Q31* In the last 12 months, were you ever unhappy with the care you received through the dialysis center? Q37 Q38 In the last 12 months, did you ever talk to your kidney doctors, NPs, PAs, or the dialysis center staff about this? In the last 12 months, how often were you satisfied with the way they handled your concerns? In general, how would you rate your overall health? In general, how would you rate your overall mental or emotional health? What is the highest grade or level of school that you have completed? What language do you mainly speak at home? What is that language? Q38a (phone mode only) What is that language? Q36 Q37 What is your race or ethnicity? Please mark one or more. Did someone help you complete this survey? Q39 Q40 What is your race or ethnicity? Please mark one or more. Did someone help you complete this survey? Q38 How did that person help you? Please mark one or more. Q41 NA NA Q23 (home only)* NA NA Q24 (home only)* NA NA Q25 (home only)* How did that person help you? Please mark one or more. In the last 3 months, when you had problems with your home dialysis equipment , how often did dialysis center staff help you solve them? (A second NA response option was added after the 60-day OMB comment period) In the last 3 months, when you had problems receiving supplies for your home dialysis, how often did dialysis center staff help you solve them? (A second NA response option was added after the 60-day OMB comment period) Think about any other problems you had with your home dialysis, not including problems with your equipment or receiving supplies. In the last 3 months, when you had any other problems with your home dialysis, how often did dialysis center staff help you solve them? (A second NA response option was added after the 60-day OMB comment period) Q30 Q31 Q32 Q33 Q34 Q35 Q35a (phone mode only) In the last 12 months, did you ever talk to someone on the dialysis center staff about this? In the last 12 months, how often were you satisfied with the way they handled these problems? In general, how would you rate your overall health? In general, how would you rate your overall mental or emotional health? What is the highest grade or level of school that you have completed? What language do you mainly speak at home? ICH/Home Q# Q32* Q33* Q35 Q36 Current Q# NA Current Question Text NA ICH/Home Q# ICH/Home Question Text Q30* In the last 12 months, did your kidney doctors, NPs, PAs, or dialysis center staff give your family/friends information about your care or treatment plan if you asked them to?