- Page 1: CAHPS ® Hospital Survey (HCAHPS) Q
- Page 5 and 6: HCAHPS Quality Assurance Guidelines
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- Page 9 and 10: Reader’s Guide Purpose of Quality
- Page 11 and 12: March 2011 Reader’s Guide For Mor
- Page 13 and 14: Introduction and Overview Overview
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- Page 25 and 26: Program Requirements Overview This
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- Page 39 and 40: Communications and Technical Suppor
- Page 41 and 42: Survey Management Overview Hospital
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- Page 47 and 48: Sampling Protocol Overview This sec
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March 2011 Sampling Protocol Step 2
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March 2011 Sampling Protocol Survey
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March 2011 Sampling Protocol • Da
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March 2011 Sampling Protocol ‣ Di
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March 2011 Sampling Protocol • A
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March 2011 Sampling Protocol • Ca
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March 2011 Sampling Protocol MS-DRG
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Mail Only Survey Administration Ove
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March 2011 Mail Only Survey Adminis
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March 2011 Mail Only Survey Adminis
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March 2011 Mail Only Survey Adminis
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March 2011 Mail Only Survey Adminis
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March 2011 Mail Only Survey Adminis
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Telephone Only Survey Administratio
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March 2011 Telephone Only Survey Ad
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March 2011 Telephone Only Survey Ad
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March 2011 Telephone Only Survey Ad
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March 2011 Telephone Only Survey Ad
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Mixed Mode Survey Administration Ov
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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March 2011 Mixed Mode Survey Admini
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Active Interactive Voice Response (
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March 2011 Active Interactive Voice
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March 2011 Active Interactive Voice
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March 2011 Active Interactive Voice
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March 2011 Active Interactive Voice
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Data Specifications and Coding Over
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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March 2011 Data Specifications and
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Data Preparation and Submission Ove
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March 2011 Data Preparation and Sub
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March 2011 Data Preparation and Sub
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March 2011 Data Preparation and Sub
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March 2011 Data Preparation and Sub
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March 2011 Data Preparation and Sub
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Oversight Activities Overview In or
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March 2011 Oversight Activities ‣
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March 2011 Oversight Activities Not
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Data Reporting Overview This sectio
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March 2011 Data Reporting Hospital
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Exceptions Request/Discrepancy Repo
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March 2010 Exceptions Request/Discr
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Appendices A. HCAHPS Mail Survey (E
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APPENDIX A HCAHPS MAIL SURVEY (Engl
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YOUR CARE FROM DOCTORS 5. During th
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22. Would you recommend this hospit
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YOUR CARE FROM DOCTORS 5. During th
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22. Would you recommend this hospit
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10 March 2011
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12 March 2011
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14 March 2011
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Encuesta CAHPS ® sobre Atención H
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12. Durante esta vez que estuvo en
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26. ¿A qué raza pertenece? Por fa
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Encuesta CAHPS ® sobre Atención H
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12. Durante esta vez que estuvo en
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26. ¿A qué raza pertenece? Por fa
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[SAMPLED PATIENT NAME] [ADDRESS] [C
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[SAMPLED PATIENT NAME] [ADDRESS] [C
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OMB Paperwork Reduction Act Languag
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APPENDIX C HCAHPS MAIL SURVEY (Chin
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醫 生 對 您 的 醫 護 5. 此
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醫 院 整 體 評 分 請 針 對
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6 March 2011
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4. 此 次 住 院 期 間 , 在
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醫 院 整 體 評 分 請 針 對
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12 March 2011
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14 March 2011
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16 March 2011
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18 March 2011
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Опрос с целью оценк
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12. Во время данного
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26. Ваша раса? Пожалу
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Опрос с целью оценк
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12. Во время данного
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26. Ваша раса? Пожалу
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[SAMPLED PATIENT NAME] [ADDRESS] [C
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[SAMPLED PATIENT NAME] [ADDRESS] [C
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OMB Paperwork Reduction Act Languag
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APPENDIX E HCAHPS MAIL SURVEY (Viet
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VIỆC CHĂM SÓC CỦA BÁC SĨ Đ
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22. Quý vị sẽ giới thiệu b
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VIỆC CHĂM SÓC CỦA BÁC SĨ Đ
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THÔNG TIN VỀ QUÝ VỊ Sau đây
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10 March 2011
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12 March 2011
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14 March 2011
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Overview HCAHPS Telephone Script (E
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S1 Our records show that you were d
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Q6 During this hospital stay, how o
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Q15 During this hospital stay, were
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Q22 Would you recommend this hospit
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Q27 Q27A What language do you mainl
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APPENDIX G Telephone Script (Spanis
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INITIATING CONTACT START Buenos dí
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Q2 Durante esta vez que estuvo en e
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Q10_INTRO Las siguientes preguntas
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[NOTE: IF Q15 = “2 - NO” THEN Q
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Q24 Por favor escuche todas las res
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Q27a ¿Qué otro idioma habla princ
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HCAHPS Active Interactive Voice Res
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S1 Our records show that you were d
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Q5_INTRO Q5 The next questions are
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Q13 During this hospital stay, how
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Q19 During this hospital stay, did
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[FOR IVR QUESTION 26 IS BROKEN INTO
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APPENDIX I Interviewing Guidelines
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• attempt to gain cooperation, bu
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4 Centers for Medicare & Medicaid S
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HCAHPS Survey Frequently Asked Ques
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‣ Where can I find the results of
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‣ Can someone else complete the s
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APPENDIX K Sample Frame Layout
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Data Element Length Value Labels an
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Data Element Length Value Labels an
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NOTE: If Type of Sampling utilized
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HCAHPS DATA FILE STRUCTURE VERSION
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PATIENT ADMINISTRATIVE DATA RECORD
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Final Survey Status Survey Complet
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PATIENT RESPONSE RECORD Field Name
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Q16 Q17 Q18 Q19 Q20 Q21 “Be
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Q26 “What is your race? Please c
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APPENDIX M XML File Specification a
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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07/01/2011 and forward discharges H
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1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 1 -
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Sample XML File Layout with DSRS V3
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1 - 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
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8 Centers for Medicare & Medicaid S
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HCAHPS Quality Assurance Plan Outli
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A. Mail Only mode - describe the pr
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16. Describe the process for monito
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APPENDIX O Participation Form for H
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3. TYPE OF MODE OF SURVEY ADMINISTR
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V. Rules of Participation Any organ
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HCAHPS Participation Form For Hospi
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IVR Mode of Survey Administration (
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VII. Applicant Organization Qualifi
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APPENDIX Q Participation Form for S
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3. TYPE (S) OF MODE OF SURVEY ADMIN
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V. List of Subcontractors Check her
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6 Centers for Medicare & Medicaid S
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HCAHPS EXCEPTIONS REQUEST FORM To c
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APPENDIX S Discrepancy Report Form
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3. Description of the Discrepancy 3