Introduction to HCAHPS Survey Training Welcome!

Introduction to HCAHPS 

Survey Training 

January 2008 

Introduction to HCAHPS Survey Training 

Welcome! 

In the HCAHPS training sessions, we will: 

• Explain purpose and use of HCAHPS survey 

• Provide instruction on managing the survey 

• Discuss modes of survey administration 

• Instruct on sampling, data preparation, data 

submission and public reporting 

January 2008 

2


Session I 

January 2008 

3 


Background and Development 

of the HCAHPS Survey 

January 2008 

4


Overview of Presentation 

• Background & Development of HCAHPS 

• Composition of the Survey 

• Public Reporting of HCAHPS Results 

• Roles and Responsibilities 

• Oversight and Compliance 

• How to Join HCAHPS in 2008 

January 2008 

5 


The Name of the Survey 

• Formal name: CAHPS ® Hospital Survey 

• Also known as: 

– Hospital CAHPS ® or 

– HCAHPS 

• Pronounced “H-caps” 

CAHPS ® is a registered trademark of the Agency for Healthcare Research and Quality, 

a U.S. Government agency. 

January 2008 

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The Method of HCAHPS 

• Ask patients (survey) 

• Collect in standardized, consistent manner 

• Analyze and adjust data 

• Publicly report hospital results 

• Use to improve hospital quality of care 

January 2008 

7 


Recent & Upcoming HCAHPS Milestones 

Oct. 2006: 

July 2007: 

National Implementation begins 

Participation linked to Annual 

Payment Update (APU) for FY2008+ 

- RHQDAPU-eligible “subsection (d) hospitals” 

Jan.–Feb. 2008:Preview period for first public reporting 

Late March: 

April 9: 

First public reporting of results 

Submission deadline for 

Oct.-Dec. 2007 discharges 

January 2008 

8


New Era, New Challenges 

• Bold initiative, evolving scope 

• Appreciate cooperation, patience, and 

feedback from hospitals & survey vendors 

• Common goal: Continuously improve 

hospital quality of care 

January 2008 

9 


Objectives of HCAHPS 

• Standardized survey for meaningful 

comparisons across hospitals for public 

reporting 

• Increased hospital accountability and 

incentives for quality improvement 

• Enhanced public accountability 

January 2008 

10


HCAHPS and the HQA 

• Implementation through national 

Hospital Quality Alliance (HQA) 

– Public-private partnership on hospital quality reporting 

– Members include: AHA, FAH, AAMC, JCAHO, AMA, ANA, 

AARP, AFL-CIO, AHRQ & CMS 

• Currently reporting heart attack, heart failure, 

pneumonia care, surgical infection and mortality 

January 2008 

11 


CAHPS Family of Surveys 

Consumer Assessment of Healthcare Providers & Systems: 

January 2008 

- HCAHPS 

- Home Health CAHPS 

- Health Plan CAHPS 

- Ambulatory CAHPS 

- ESRD CAHPS 

- Nursing Home CAHPS 

- Prescription Drug Plan CAHPS 

- ECHO 

12


HCAHPS 101 

• IPPS and CAH hospitals 

– “General Hospitals” (AHA) 

• Eligible patients 

– Adult 

– Medical, surgical or maternity care 

– Overnight stay, or longer 

– Alive at discharge 

• Survey after discharge 

– Four modes of survey administration 

– Standardized protocol 

January 2008 

13 


Making HCAHPS Credible 

• Issue call for measures (2002) 

• Review of literature (2002) 

• Cognitive testing in English and Spanish (2003) 

• Conduct Three-State Pilot Test (2003) 

• Conduct pilot test in Connecticut (2004) 

• Additional testing in voluntary test sites (2004-05) 

January 2008 

14


Making HCAHPS Credible 

(cont’d) 

• NQF endorsement (May 2005) 

– “National voluntary consensus standard ” 

• Abt Associates’ cost-benefit analysis 

(October 2005) 

– For cost information 

• Final approval from federal Office of 

Management and Budget (December 2005) 

January 2008 

15 


Making HCAHPS Useful 

• Qualitative research with consumers 

– Focus groups of hospital patients (2004) 

• Consumer testing of publicly reported 

HCAHPS results 

– “Look” on Hospital Compare website 

– Integration with existing measures 

– Ongoing 

January 2008 

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Making HCAHPS Practical 

• Hold stakeholder meetings 

• Presentations to interested groups 

• Meet with survey vendors 

•Web chats 

• Testing opportunities for hospitals, survey 

vendors 

• Solicit public comments 

January 2008 

17 


Making HCAHPS Practical 

(cont’d) 

• Hospital/vendor training and continuing support 

–Website (www.hcahpsonline.org) 

– HCAHPS Hotline (1-888-884-4007) 

• Compatibility with existing surveys 

• Flexibility in administration 

• Standardized survey 

• Centralized collection, reporting and oversight 

January 2008 

18


Making HCAHPS Transparent 

• Several Federal Register notices and 

public comment periods 

• Review by National Quality Forum 

(2004-2005) 

– Final report at www.qualityforum.org 

• Review and endorsement by HQA 

January 2008 

19 


Making HCAHPS Pluralistic 

• Various models, interests, viewpoints 

– Much attention and input from beginning 

• Accommodated to extent possible 

– While adhering to goals of HCAHPS 

January 2008 

20


Composition of Survey 

HCAHPS contains 27 items: 

• Items 1-22: Core of HCAHPS 

– Put first; do not alter; keep together 

• 18 substantive questions 

• 4 “screener” items 

• Items 23-27: Demographic (“About You”) 

– Place later; do not alter 

January 2008 

21 


HCAHPS Six Composites 

What patients/consumers want to know: 

1. Communication with nurses 

2. Communication with doctors 

3. Responsiveness of hospital staff 

4. Pain management 

5. Communication about medicines 

6. Discharge information 

January 2008 

22


HCAHPS Individual Items 

What patients/consumers want to know: 

1. Cleanliness of hospital environment 

2. Quietness of hospital environment 

January 2008 

23 


HCAHPS Global Ratings 

• ‘Overall rating of hospital’ 

• 0 to 10 scale 

• ‘Recommend this hospital’ 

• Four point scale 

January 2008 

24


HCAHPS Core Items (1-22) 

Core HCAHPS items form module: 

• Can be followed by hospital-specific items 

in an integrated format 

—or — 

• Entire HCAHPS can be used as stand-alone 

questionnaire 

January 2008 

25 


Patient-Mix Adjustors 

• Service line (medical, surgical, maternity care) 

• Age 

• Education 

• Self-reported general health status 

• Language other than English spoken at home 

• Admission from Emergency Room 

• Lag time between discharge and survey completion 

January 2008 

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HCAHPS Public Reporting 

• Only HCAHPS items submitted and reported 

• Report hospital-level statistics that summarize responses to 

HCAHPS items 

– All patient data is de-identified 

– On Hospital Compare website 

• Adjustment to achieve comparability of data 

– Patient-mix 

• Race and ethnicity items NOT used for patient-mix adjustment 

– Mode effects 

• Report available on www.hcahpsonline.org 

• Suppression of public reporting permitted in 2008 

– During public reporting Preview Period (Jan. 17 – Feb. 15) 

January 2008 

27 


Public Reporting Periods & 

Display 

• Public reporting periods are based on 12 

months of discharges 

– Rolling quarters 

– First public reporting (March 2008) based on 9 

months: 

• October 2006 to June 2007 

– Public reporting display of HCAHPS results will 

include “bar graph” and “data table” 

January 2008 

28


“Drill-down” data table on Hospital Compare 

DRAFT – JANUARY 2008 (Fictitious hospitals & data) 

Hospital A 

Hospital B 

Hospital AC 

January 2008 

DRAFT 

29 


HCAHPS Footnote 6 

When the number of surveys the hospital provides to CMS is less 

than 100, the data table will show footnote 6; under the table, 

Footnote 6 will read: 

“Fewer than 100 patients completed the HCAHPS 

survey. Use these rates with caution, as the 

number of surveys may be too low to reliably 

assess hospital performance." 

The space in the bar graph for the measure will read: 

"Fewer than 100 patients completed the HCAHPS 

survey for this hospital. For more information, 

click here.” 

January 2008 

30



When CMS opts to display HCAHPS results calculated on fewer than 

the required months of data, the rate in the data table will show 

footnote 7; under the table, Footnote 7 will read: 

"This displays less than 9 months of accurate 

data.” 

• The bar graph will show the data without any notes 

− For March 2008 public reporting, the maximum and required number 

of months of data is 9 

• In subsequent public reporting periods, 12 months of data will be 

required and Footnote 7 will read, "This displays less than 12 

months of accurate data.” 

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• When a hospital has other data on Hospital 

Compare but did not participate in HCAHPS, 

• Or does not have enough months of HCAHPS data 

for public reporting purposes, 

• Or chose to suppress its HCAHPS results, 

Then Footnote 8 will appear in the bar graph and 

under the data table: 

“Survey results are not available for 

this reporting period.” 

January 2008 

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In rare instances in which a hospital has no 

patients eligible for the survey, the following 

footnote will be used in the bar graph and (as 

Footnote 9) under the data table: 

"No patients were eligible for the 

HCAHPS Survey” 

– Footnote 9 will not appear in the first HCAHPS public reporting 

January 2008 

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Roles and Responsibilities 

For hospitals using a survey vendor: 

Vendor’s role in data collection and submission 

– Develop sample frame of eligible discharges 

– Draw required sample of discharges 

– Administer survey 

– Submit HCAHPS data in standard format via QualityNet (QNet) 

Exchange 

– Monitor submission reports 

– Monitor HCAHPS website for updates 

January 2008 

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(cont’d) 

Self-administering hospital’s role in data 

collection and submission: 

– Develop sampling frame of eligible discharges 

– Draw required sample of discharges 

– Administer survey 

– Submit HCAHPS data in standard format via QualityNet (QNet) 

Exchange 

– Monitor submission reports 


January 2008 

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(cont’d) 

All Hospitals’ role in Monitoring: 

– Monitor QualityNet Exchange feedback reports 

– Monitor information from QIO 

– Monitor/respond to your survey vendor 

• Ensure data gets to survey vendor on time 


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(cont’d) 

• Government Role: Support & Report 

– Provide training and technical assistance 

– Ensure integrity of data collection 

– Accumulate data from hospitals/survey vendors 

– Calculate and publicly report HCAHPS results 

January 2008 

37 


Oversight and Compliance 

As HCAHPS results play a greater 

role in hospital payment, 

the importance of compliance and 

oversight increase 

January 2008 

38


HCAHPS Oversight 

July 1, 2007: Pay-for-Reporting Era began 

• Greater consequences for non-compliance 

• If a hospital (or its survey vendor) fails to adhere to 

HCAHPS protocols, it must develop and implement a 

Corrective Action Plan (CAP) 

• If problems persist, the hospital may not qualify as 

meeting the APU requirements for HCAHPS 

• This hospital’s APU may then be jeopardized 

January 2008 

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HCAHPS Oversight (cont’d) 

If survey vendor or selfadministering 

hospital does not 

fix persistent problems, it may 

lose its “approved” status for 

conducting HCAHPS 

January 2008 

40


HCAHPS Oversight (cont’d) 

A participating hospital should: 

• Work closely with its survey vendor (if using one) 

• Regularly monitor QualityNet Exchange Feedback 

Reports 

• Read Quality Assurance Guidelines V3.0 and monitor 

website for updates and announcements 

(www.hcahpsonline.org) 

• Comply with all HCAHPS oversight activities, as 

requested 

January 2008 

41 


Communicating with Patients 

about the HCAHPS Survey 

• Hospital/Survey vendors are not allowed to: 

– Attempt to influence or encourage patients to 

answer HCAHPS questions a particular way 

– Ask patients to explain why they didn’t rate a 

hospital with most favorable rating possible 

January 2008 

– Indicate the hospital’s goal is for all patients 

to rate them as an “Always” or other top 

response 

42


Advertising Guidelines 

•The Hospital Compare website is the 

official source of HCAHPS results 

•CMS does notendorse hospitals or survey 

vendors 

•The Hospital Compare website is intended 

to provide objective information to help 

consumers make informed decisions about 

health care providers 

January 2008 

43 


Non-Compliance 

with Program Requirements 

• Actions and possible penalties: 

– Hospitals/Survey vendors prepare written document 

within a specified time containing a root cause 

analysis and corrective actions for identified problems 

– Survey vendors’ names may be removed from CMS 

list of approved HCAHPS survey vendors 

– Hospitals’ data may not be reported on the Hospital 

Compare website 

– Hospitals’ data may not meet the HCAHPS 

requirements for the Annual Payment Update 

January 2008 

44


Steps to Join HCAHPS in 2008 

1. Submit HCAHPS Participation Form 

• For self-administering hospitals, hospitals administering survey 

for multiple sites and survey vendors 

• Form available ~Jan. 30 (online) 

2. Do a HCAHPS Dry Run 

• Voluntary in 2008, but strongly suggested 

• Last month in calendar quarter 

• Contact HCAHPS Project Team for details 

− HCAHPS@azqio.sdps.org 

3. Collect and submit HCAHPS survey data 

on continuous basis 

January 2008 

45 


More information on HCAHPS 

• Background and reports on HCAHPS: 

www.cms.hhs.gov/HospitalQualityInits 

• Registration, applications and updates: 

www.hcahpsonline.org 

• Submitting HCAHPS data: 

www.qualitynet.org 

• Publicly reported HCAHPS results: 

www.hospitalcompare.hhs.gov 

January 2008 

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Questions? 

January 2008 

47 


HCAHPS 

Participation and Program 

Requirements 

January 2008 

48


Participation Overview 

• HCAHPS Website and Technical Assistance 

• Rules of Participation 

– Step 1: Introduction to HCAHPS Survey Training 

– Step 2: Program Participation Form 

– Step 3: QualityNet Exchange Registration 

– Step 4: Data collection (voluntary dry run) 

– Step 5: Update Training 

– Step 6: Participate in Oversight Activities 

– Step 7: Public Reporting 

• Minimum Requirements 

• Exceptions Request/Discrepancy Report 

January 2008 

49 


HCAHPS Website and Technical Support 

www.hcahpsonline.org 

• Official website for content, announcements, updates, 

reminders 

• Monitor weekly for “What’s New” 

• Quick links to Current News, Background, Participation, 

etc. 

January 2008 

50


HCAHPS Website and 

Technical Support 

– Website: www.hcahpsonline.org 

– E-mail: hcahps@azqio.sdps.org 

– Telephone: 1-888-884-4007 

January 2008 

51 


Step 1: Introduction to 

HCAHPS Survey Training 

• Who is required to attend? 

– Survey Vendors 

– Hospitals conducting HCAHPS for multiple sites 

– Hospitals self-administering HCAHPS 

• Who is recommended to attend? 

– Hospitals contracting with a survey vendor or another 

hospital for survey administration 

– Quality Improvement Organizations (QIOs) 

January 2008 

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Step 2: Program 

Participation Form 

• Available online at www.hcahpsonline.org 

• Includes Rules of Participation 

• Complete Exceptions Request Form if applicable 

• Who needs to submit a Participation Form? 

– Hospitals self-administering HCAHPS 

– Hospitals conducting HCAHPS for multiple sites 

– Survey vendors (administering on behalf of hospitals) 

– Not required for hospitals contracting with survey 

vendor 

January 2008 

53 


Step 3: QualityNet Exchange 

Registration 

• Contact: 

– State QIO (hospitals) 

– HCAHPS Information and Technical Support 

(survey vendors) 

• If already registered with QualityNet, register 

specifically for HCAHPS and obtain necessary roles 

• Contact QualityNet Help Desk for questions on how 

to complete the forms at: 

qnetsupport@ifmc.sdps.org 

January 2008 

54


Step 4: Data Collection 

• Hospitals/Survey vendors will: 

– Adhere to the Quality Assurance Guidelines V3.0 

– Submit an Exceptions Request Form for approval for 

any variations in survey administration 

– Review the accuracy of their data collection processes 

– Alert HCAHPS Project Team to any discrepancies 

occurring during survey administration 

– Submit data by submission deadline 

January 2008 

55 


• Dry run 

Step 4: Data Collection 

(cont’d) 

– Participation in a dry run is voluntary for 

2008 

• Strongly suggested 

• Last month in calendar quarter 

• Contact the HCAHPS Project Team for details 

–HCAHPS@azqio.sdps.org 

January 2008 

56


Step 5: Future Update Trainings 

• As scheduled by CMS 

• Details to be posted on www.hcahpsonline.org 

• Required for all approved survey vendors, hospitals 

conducting survey for multiple sites, and selfadministering 

hospitals 

• Recommended for hospitals using a survey vendor 

• Recommended for Quality Improvement 

Organizations 

January 2008 

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Step 6: Participate in 

Oversight Activities 

• Submit HCAHPS Quality Assurance Plan 

• Comply with on-site visit requests 

• Comply with conference call requests 

• Implement corrective action plan, if necessary 

January 2008 

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Step 7: Public Reporting 

• HCAHPS results will be publicly reported on 

a quarterly basis on Hospital Compare 

website 

January 2008 

59 


Minimum Requirements 

1. Relevant survey experience 

– Demonstrated experience in fielding surveys 

using requested mode(s) of administration 

• Survey experience 

• Number of years in business 

• Number of years conducting surveys 

January 2008 

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(cont’d) 

2. Organizational/survey capacity 

– Capability and capacity to handle a 

required volume of surveys and conduct 

surveys in specified time frame 

• Personnel 

• System resources 

• Survey administration 

• Data submission 

• Technical assistance/customer support 

January 2008 

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(cont’d) 

3. Quality control procedures 

– Personnel training and quality control 

mechanisms 

• Demonstrated quality control procedures 

January 2008 

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Exceptions Request 

Discrepancy Report 

• Exceptions Request 

– Request alternative methodologies 

• Discrepancy Report 

– Notification of variation from protocols 

during survey administration 

January 2008 

63 


Exceptions Request 

• Allowable exceptions to standard protocols 

– Disproportionate stratified random sampling 

– Service line determination 

– Other exceptions 

• Exception request proposal demonstrates that 

approach will result in a minimum of 300 

completes in reporting period 

• Exceptions not allowed for modes of survey 

administration 

January 2008 

64


Exceptions Request (cont’d) 

• Request for exceptions 

– Submit Exceptions Request Form(s) 

• Justification for exception 

• Submit Exceptions Request Form through www.hcahpsonline.org 

– Submit an exception request before planning to 

implement 

– Exceptions may be submitted by hospitals or survey 

vendors on their behalf 

– Survey vendors may submit one Exceptions Request form 

on behalf of multiple hospitals as long as the hospitals are 

listed on the form 

January 2008 

65 


Exceptions Request (cont’d) 

• Appeals process for unapproved exception 

– Written notification with explanation provided 

by HCAHPS Project Team 

– Hospital/Survey vendor has five business days 

to appeal an unapproved exception 

– Use Exceptions Request Form 

January 2008 

66


Discrepancy Report 

• Notification of inadvertent and temporary 

survey administration discrepancies 

– Examples: missing eligible discharges from a 

particular date or computer programming 

issues that caused an otherwise eligible 

discharge to be excluded from the sample 

frame 

January 2008 

67 


Discrepancy Report (cont’d) 

• Complete and submit report immediately 

upon discovery of issue 

– Provide sufficient detail 

• How issue was discovered 

• Number of eligible discharges affected 

• Corrective action plan 

• Other pertinent information 

January 2008 

68


Discrepancy Report (cont’d) 

• Review Process 

– Assessment of actual or potential impact on 

publicly reported results 

– Formal review may be required 

January 2008 

69 


Questions? 

January 2008 

70


BREAK 

January 2008 

71 


Sampling Protocol 

January 2008 

72


Overview 

•Flow Chart 

•Population 

• Eligibility Criteria 

•Exclusions 

• Sample Frame 

• De-duplication 

• How to Draw a Sample 

• How to Calculate the Sample Size 

• Select Method of Sampling 

January 2008 

73 


Flow chart 

Population 

(All patient 

Discharges) 

Step 1 

Identify Eligible 

Patients 

Step 2 

All Eligible 

Patients 

January 2008 

Step 3 

Step 5 

Remove Excluded 

Sample Frame 

Calculate 

Sample Size 

De-Duplication 

Process 

Step 4 

Select random sample 

of patients using: 

SRS or PSRS or DSRS 

Sampling type 

Step 6 

74


Population (step 1) 

(All Patient Discharges) 

• Patients of all payer types are eligible for sampling 

• Hospitals contracting with survey vendors are 

strongly encouraged to provide entire discharge list 

to their survey vendor 

January 2008 

75 


Eligibility Criteria (step 2) 

Who should be included in HCAHPS? 

• Adult Inpatients – 18 years or older 

• Hospital Admission – minimum one overnight 

stay, or longer 

• Alive at discharge 

January 2008 

76


Eligibility Criteria (cont’d) 

• Non-Psychiatric MS-DRG/principal diagnosis at 

discharge 

Patient Classification Service Lines 

The hospital/survey vendor should use the principal discharge 

MS-DRG to… 

– Identify the eligible patients 

– Classify into the Service Line as either: 

»Medical 

»Surgical 

»Maternity Care 

January 2008 

77 


Eligibility Criteria (cont’d) 

Service Line MS-DRG Crosswalk Table: 

• To classify into Medical and Surgical service lines 

- The Federal Register Notice – (updated approximately twice 

per year) 

• To classify into Maternity Care service line 

- Use MS-DRGs 765 – 768, 774, 775 

• Current table information 

- Quality Assurance Guidelines (Version 3.0) 

- www.hcahpsonline.org 

January 2008 

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Summary Facts 

• Hospitals without surgical or maternity care departments 

may participate 

• Missing MS-DRG does not exclude patient from being 

sampled 

• If patient deemed ineligible prior to survey administration 

– do not administer survey 

• Hospitals not using MS-DRG codes must submit an 

Exceptions Request Form 

January 2008 

79 


Exclusions (step 3) 

Who should be excluded from HCAHPS? 

• “No Publicity” patients 

• Court/Law enforcement 

• Foreign home address 

• Discharged to hospice care 

• Excluded as a result of state regulation 

• Do not exclude patients if their eligibility is 

uncertain (i.e. missing information) 

• Hospitals or survey vendors must retain 

documentation that verifies all ineligible/excluded 

patients 

January 2008 

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Sample Frame 

• Include all patients: 

– Who meet eligible population criteria 

– Discharged between first and last days of 

month 

• Include patients even if: 

– Missing or incomplete address/telephone 

numbers 

– Missing eligibility criteria 

January 2008 

81 


Sample Frame (cont’d) 

• Sample frame file layout example 

– Appendix P -Quality Assurance Guidelines 

– Not required to use this exact layout 

• De-duplicate within each month 

• Remove patient-identifying information 

before submitting the data to CMS via 

QualityNet Exchange 

January 2008 

82


De-duplicating (step 4) 

• De-duplication by Household 

– Sample only one patient per household in a 

given month 

• De-duplicate addresses from medical records and 

patient unique IDs within each month 

• Do not de-duplicate addresses for nursing homes, 

long-term care facilities, etc., unless residents are 

family members 

January 2008 

83 


De-duplicating (cont’d) 

• De-duplication by Multiple Discharges 

– Sample patient only once in a given month 

• For continuous sampling, use the first discharge 

for a patient closest to when the sample is pulled 

• For end of the month sampling, de-duplicate 

across all discharges in the month and use only 

the last discharge 

Patients are eligible to be included in the sample 

in consecutive months. 

January 2008 

84


How to Draw the Sample 

• Target: Obtain at least 300 completed HCAHPS 

surveys over the 12-month public reporting 

period 

– Small hospitals 

•If cannotobtain 300 completed surveys, sample 

all eligible discharges 

• Complete as many surveys as possible 

January 2008 

85 



(cont’d) 

• Why 300? 

– Target for the statistical precision of the ratings 

which is based on a reliability criterion 

– 300 completes ensures that the reliability for the 

global ratings and composites will be .80 or 

higher 

– All hospitals must calculate sample size based on 

at least 300 completes no matter the number of 

discharges 

January 2008 

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(cont’d) 

• Draw a random sample of eligible discharges on 

a monthly basis 

– Sampling may be continuous or at the end of the 

month 

• Continuous – every two days, each week, every two 

weeks, etc. 

– Same sampling ratio or timeframe maintained 

• End of month – one sample is drawn following last day 

of the month 

– Sample represents entire month of discharges 

January 2008 

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(cont’d) 

• Same sampling type must be maintained 

throughout the quarter 

• Sample must include discharges from each 

month in the 12-month reporting period 

• HCAHPS random sample drawn first if multiple 

surveys administered 

• Do not stop sampling/surveying if 300 completes 

attained 

January 2008 

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(cont’d) 

• Hospitals that share a Medicare Provider 

Number (MPN) 

– 300 completes are required per MPN 

– All hospitals under one MPN must participate 

– Use same survey vendor 

– Use same mode of administration 

– Use same sample type and frequency 

January 2008 

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How to Calculate the Sample size 

(Step 5) 

• Estimate the proportion of patients expected to complete the 

survey: 

I = proportion of discharged patients who are ineligible 

R = expected response rate among eligible patients 

P = the proportion of discharged patients who 

actually respond to the survey 

P = (1 - I) x R 

• How many discharges are needed to produce 300 completes? 

C/P = N 12 (Number of discharges to be sampled over 12 month 

period ) 

N 12 /12 = N 1 (Number of discharges sampled each month) 

January 2008 

90


Example: Sample Size 

Calculation 

Assumptions: 

• ≈17% of discharged patients will be ineligible for 

the survey 

– Source: National Hospital Discharge Survey 

• ≈40% of eligible patients will respond to the 

survey 

– Source: CMS Three State Pilot 

• Ineligible rates and response rates should be 

adjusted based on each hospital’s experience 

January 2008 

91 


Example: Sample Size Calculation 

(cont’d) 

• Therefore, 

P = (1 - I) x R 

= (1 - .17) x .40 

= .33 

300 / P = 300 / .33 = 909 discharged patients should be surveyed 

• Twelve-month public reporting period: 

• Number of discharges needed per month 

= 909 / 12 = 76 

January 2008 

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How to Calculate the Sample size 

(cont’d) 

• Should estimate I and R from hospital’s 

own data 

• Should adjust the target in subsequent 

quarters 

January 2008 

93 


If More than 300 Completes: 

• Do not stop surveying when a total of 300 is 

reached 

• Continue to survey every patient in the sample 

• Surveying must continue even if predetermined 

target (quota) is met 

• Full protocol for each mode of administration 

must be completed 

• Submit the entire sample 

January 2008 

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If Less Than 300 Completes: 

• Attempt to obtain as many as possible 

• Survey all eligible discharges 

• All hospital results will be publicly reported on 

Hospital Compare website 

• If a hospital obtains less than 300 completed 

surveys during the reporting period 

– Lower precision of the ratings will be noted for less than 

100 completes 

January 2008 

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Select Method of Sampling 

(step 6) 

Simple Random sampling: 

• HCAHPS preferred sampling method 

• Group of patients randomly selected from a 

larger group 

• Census sample is considered a simple random 

sample 

January 2008 

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(cont’d) 

Proportionate Stratified Random Sampling 

(PSRS): 

• Patient discharge population divided into strata 

– Due to continuous sampling (by day, or week, etc.) 

– Divided by hospital unit, or floor, etc 

– Multiple hospitals share the same Medicare Provider Number (MPN) 

and the random sample is drawn separately from each hospital 

before each hospital’s data is combined 

• Same sampling ratio applied to each stratum 

• Exceptions Request Form not required 

January 2008 

97 

January 2008 


Select Method of Sampling (cont’d) 

Example of PSRS 

• Hospital pulls sample each week, creating 4 strata named wk1, wk2, 

wk3 and wk4 

• Even though the number of eligible discharges differs between 

weeks, the hospital takes the same proportion of ‘sampled’ to 

‘eligibles’ each week. 

• 20% of eligible discharges are randomly pulled from each stratum 

Number of ‘eligibles’ per week X proportion of 20/100 or .2 

– Wk1 20 X .2 = 4 sampled 

– Wk2 25 X .2 = 5 sampled 

– Wk3 30 X .2 = 6 sampled 

– Wk4 15 X .2 = 3 sampled 

• Results in different number sampled from each week, but each 

eligible discharge had an equal chance of being chosen 

98



(cont’d) 

Disproportionate Stratified Random sampling 

(DSRS): 

Patient discharge population divided into strata 

• Dissimilar sampling ratio applied to each stratum 

• Additional data collected 

• Sampling data will be used to weight monthly data 

• Exceptions Request Form required 

January 2008 

99 


Select Method of Sampling (cont’d) 

Example of DSRS 

• Hospital pulls a sample each month, creating four strata: Unit 1, 

Unit 2, Unit 3 and Unit 4 

• Ten eligible discharges are randomly pulled from each Unit 

• The number of eligible discharges selected for the sample does not 

result in the same proportion of discharges across the four units 

– Unit 1: 10 selected of 20 eligible = a proportion of 50% 




• DSRS sampling results in the same number of sampled patients 

from each unit, but the proportion (percentage) of the eligible 

discharges selected from each unit is different 

January 2008 

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Questions? 

January 2008 

101 


Survey Administration 

Protocol 

January 2008 

102


Overview 

• Survey Instrument 

• Supplemental Questions 

• Options for Survey Integration 

• Modes of Survey Administration 

• Polling Question 

• Survey Management 

January 2008 

103 


Survey Instrument 

• Survey content 

– Core Survey questions 1-22 

– “About You” questions 23-27 

• Survey instrument availability 

– English language survey (Appendix A) 

– Spanish language survey (Appendix D) 

– Chinese language survey (Appendix G) 

– English telephone script (Appendix K) 

– Spanish telephone script (Appendix L) 

– English IVR script (Appendix M) 

January 2008 

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Supplemental Questions 

• May add a reasonable number of supplemental questions 

to the survey after the core survey items (1-22) 

– Must ask the “About You” questions (23-27) following the core 

survey items but placement in the survey is at the discretion of 

the hospital/survey vendor 

• Use appropriate phrasing to transition from the HCAHPS 

survey to the supplemental items 

– “Now we would like to gather some additional detail on topics 

we have asked you about before. These items use a somewhat 

different way of asking for your response since they are getting 

at a little different way of thinking about topics.” 

January 2008 

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Supplemental Questions 

(cont’d) 

• Recommend avoiding the following types 

of supplemental questions 

- Numerous, lengthy and complex questions 

- Questions with potential impact on responses 

to HCAHPS questions 

- Sensitive medical or personal topics which 

may cause a person to terminate the survey 

- Questions that may jeopardize a patient’s 

confidentiality such as SSN 

January 2008 

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Three Options for Integration 

of Hospital Surveys 

1. Integrate hospital’s existing survey into HCAHPS 

survey using one consistent format and transitions 

– HCAHPS Items 1-22 (Core questions) are first 

questions 

– HCAHPS Items 23-27 (“About You” questions) 

2. Have a separate HCAHPS survey and hospital 

survey in the same mailing 

3. Send two separate mailings – one with the HCAHPS 

survey and another with the hospital-specific 

survey 

January 2008 

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Modes of Survey 

Administration 

• Mail Only 

• Telephone Only 

• Mixed (Mail with Telephone Follow-up) 

• Active Interactive Voice Response (IVR) 

January 2008 

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Modes of Administration 

Overview 

• Modes of administration designed to achieve, on average, a 40% 

response rate 

• No proxy respondents 

• No communication to patients that is intended to influence survey 

results 

• No incentives of any kind 

• Data collection begins within 48 hours to 6 weeks (42 days) after 

discharge 

• If a patient is found to be ineligible, discontinue survey 

administration for that patient 

• Final data files submitted to CMS via QualityNet Exchange by the 

data submission deadline 

January 2008 

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Mail Only Mode 

• Protocol 

- Send first questionnaire with initial cover letter to 

sampled patient(s) between 48 hours and 6 weeks (42 

days) after discharge 

- Send second questionnaire with follow-up cover letter 

to non-respondent(s) approximately 21 days after the 

first questionnaire mailing 

- Complete data collection within 42 days after the first 

questionnaire mailing 

- Submit data to CMS via QualityNet Exchange by the 


January 2008 

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Mail Only Mode (cont’d) 

• Cover letter specifications 

– Name and address of sampled patient included 

• “To Whom It May Concern” is not acceptable 

– OMB language included 

– Letter is not attached to the survey 

– Customization is acceptable; cannot add content that 

would introduce bias 

January 2008 

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• Cover letter language requirements: 

– Purpose of survey 

• “Questions 1-22 in the enclosed survey are part of a national 

initiative by the United States Department of Health and 

Human Services to measure the quality of care in hospitals.” 

– Answers may be shared with hospitals for the 

purposes of quality improvement 

– Participation is voluntary 

– Hospital name and discharge date of patient 

– Patient’s health benefits will not be affected by 

participation in the survey 

– Customer support number 

January 2008 

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• Cover letter requirements (cont’d): 

– OMB Paperwork Reduction Act language: “According to the 

Paperwork Reduction Act of 1995, no persons are required to 

respond to a collection of information unless it displays a valid 

OMB control number. The valid OMB control number for this 

information collection is 0938-0981. The time required to 

complete this information collected is estimated to average 7 

minutes per response for questions 1-22 on the survey, including 

the time to review instructions, search existing data resources, 

gather the data needed, and complete and review the 

information collection. If you have any comments concerning the 

accuracy of the time estimate(s) or suggestions for improving 

this form, please write to: Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, S1-13-05, Baltimore, MD 

21244-1850.” 

January 2008 

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• Cover letter options: 

– Language about why there are two mailings in one 

envelope 

– Spanish and Chinese versions of cover letters 

– Language directing the patient how to request the 

mail survey in Spanish or Chinese 

– Repetition of any instructions that appear on the 

questionnaire 

– Name and return address of hospital/survey vendor 

January 2008 

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• Questionnaire guidelines and formatting 

requirements 

- Question and answer category wording is not changed nor is 

the order of core HCAHPS questions (items 1-22) 

- “About You” questions follow the core HCAHPS questions 

- Question and answer categories remain together in the same 

columns and on the same pages 

- Randomly generated unique identifiers for patient tracking 

purposes are placed on the first or last page of the survey 

- All instructions on the top of the survey are copied verbatim 

- The patient’s name is not printed on the survey 

- No matrix formats for question and answer categories 

- The OMB control number must appear on the front page of the 

survey or on the cover letter. It is OMB # 0938-0981 

January 2008 

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• Questionnaire guidelines and 

formatting options 

– Small coding numbers next to response 

choices 

– Patient discharge date 

– Place for patients to voluntarily fill in their 

name/telephone number placed after the core 

HCAHPS questions (1-22) 

January 2008 

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• Questionnaire guidelines and formatting 

suggestions 

– Minimum font size 10 point 

– Readable font such as Arial 

– Margins are wide (at least 3/4 inch) and survey has 

white space to enhance its readability 

– Question formatting in two columns 

– Name and return address of hospital/survey vendor 

January 2008 

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• Guidelines for mailings 

– Addresses acquired from hospital record 

– Addresses updated using commercial software 

– Mailings sent to patients by name 

• Mailing content 

– Survey mailings include 

• Cover letter 

• Questionnaire(s) 

• Self-addressed, stamped business reply envelope 

• First class postage or indicia, suggested 

January 2008 

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• Data receipt and entry 

– Surveys recorded in a timely manner 

– Surveys are date stamped 

– Ambiguous situations follow HCAHPS decision rules 

– Key-entry or scanning allowed for data entry 

• A sample of key-entered data is entered a second time 

by different staff and any discrepancies between the two 

entries are identified. Supervisors reconcile any 

discrepancies 

• Programs verify that record is unique and has not been 

returned already 

• Programs identify invalid or out-of-range responses 

January 2008 

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• Data retention/storage guidelines 

– Paper questionnaires that are key-entered 

must be stored in a secure and 

environmentally controlled location for a 

minimum of three years 

– Optically scanned questionnaire images must 

be retained in a secure manner for a 

minimum of three years 

January 2008 

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• Quality control guidelines 

– Validate address information 

• National Change of Address (NCOA) 

• USPS CASS Certified Zip+4 software 

• Other commercial software/search engines 

– Check quality of printed materials 

– Check survey packet contents 

– Check a sample of mailings for inclusion 

of all sampled patients 

– Check for timeliness of manual or automated date 

stamping 

January 2008 

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• Quality control guidelines (cont’d) 

– Oversight of staff and subcontractors 

– Strongly recommend seeded mailings to 

project staff 

• Timeliness and accuracy of delivery 

• Accuracy of mailing contents 

January 2008 

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Telephone Only Mode 


– Initiate systematic telephone contact with sampled 

patient(s) between 48 hours and 6 weeks (42 days) 

after discharge 

– Complete telephone sequence within 42 days of 

initiation so that a total of 5 telephone calls are 

attempted 

• at different times of day 

• on different days of the week 

• and in different weeks 

– Submit data to CMS via QualityNet Exchange by the 


January 2008 

123 


Telephone Only Mode (cont’d) 

• Telephone script 

– Standardized telephone script provided for 

HCAHPS portion of survey 

• Question and answer category wording may not be changed 

nor the order of questions for the HCAHPS core questions 

• “About You” questions 23-27 must be placed anywhere after 

the core survey questions 1-22 

• Supplemental questions may be added after the core survey 

questions 1-22 

• Transitional phrases should be added for supplemental 

questions 

January 2008 

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• Interviewing systems 

– Electronic telephone interviewing, including CATI or 

other alternative systems (required of survey 

vendors and of hospitals conducting surveys for 

multiple sites) 

• Programmed with standardized HCAHPS telephone script 

– Manual data collection (allowed only for hospitals 

self-administering surveys) 

• Follow standardized HCAHPS telephone script using paper 

questionnaires 

January 2008 

125 



• Obtaining telephone numbers 

– Main source of telephone numbers is 

hospital discharge records 

– Update missing or incorrect telephone 

numbers using 

• commercial software 

• internet directories 

• directory assistance 

• other tested methods 

January 2008 

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• Data receipt and data entry 

– Electronic data collection, CATI 

• Linked electronically to survey management system 

– Manual data collection of paper questionnaires 

• Key entry 

• Scanning 

January 2008 

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• Data retention/storage guidelines 

– Data collected through electronic telephone 

interviewing systems must be maintained in a secure 

manner for a minimum of three years 

– Paper questionnaires collected manually and then 

key-entered must be stored in a secure and 

environmentally controlled location for a minimum of 

three years 

– Optically scanned paper questionnaire images must 

be retained in a secure manner for a minimum of 

three years 

January 2008 

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• Quality control guidelines 

– Formal interviewer training to ensure 

standardized, non-directive interviews 

– Telephone monitoring and oversight 

• At least 10% of interviews are monitored 

January 2008 

129 


Mixed Mode 

• Protocol—Mail followed by telephone 

- Send questionnaire with cover letter to sampled patient(s) 

between 48 hours and 6 weeks (42 days) after discharge 

- Initiate systematic telephone contact for all non-respondent(s) 

approximately 21 days after mailing the questionnaire 

- Complete telephone sequence within 42 days of initiation so that 

a total of 5 telephone calls are attempted 

- at different times of day 

- on different days of the week 

- and in different weeks 

- Submit data to CMS via QualityNet Exchange by the data 

submission deadline 

January 2008 

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Mixed Mode (cont’d) 

• Mixed mode survey administration 

– Follow guidelines for mail only mode 

•Use onequestionnaire mailing instead of two 

– Follow guidelines for telephone only mode 

January 2008 

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Active Interactive Voice 

Response (IVR) Mode 


– Initiate systematic IVR contact to sampled patient(s) 

between 48 hours and 6 weeks (42 days) after 

discharge 

– Complete IVR sequence within 42 days after 

initiation so that a total of 5 telephone calls are 

attempted 

• at different times of day 

• on different days of the week 

• and in different weeks 

– Submit data to CMS via QualityNet Exchange by the 


January 2008 

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Active IVR Mode (cont’d) 

• IVR interviewing systems 

– Programmed with standardized HCAHPS IVR script 

– Capable of recording and storing patient answers 

– Capable of touch tone key pad response 

– Opt out option available for patients who do not want 

to continue with IVR (other interviewing option 

available) 

January 2008 

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• Live operator 

– Introduces patient to the survey and IVR system 

– Obtains patient consent to participate 

– Transitions patient to IVR 

– Available to answer questions/FAQs 

– Available to triage patients to another electronic 

system (CATI) or to conduct the interview themselves 

for reluctant respondents 

January 2008 

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• Follow telephone only mode guidelines 

– Data collection 

– Data receipt and retention 

– Quality control guidelines 

• Staff training 

• Monitoring and oversight 

January 2008 

135 


Polling Question 

• Which primary mode of survey 

administration are you requesting to 

use? 

A. Mail Only 

B. Telephone Only 

C. Mixed (Mail with Telephone follow-up) 

D. Active Interactive Voice Response (IVR) 

January 2008 

136


Survey Management 

• Establish survey management process to 

administer survey 

– System resources 

– Customer support lines 

– Personnel training 

– Monitoring and quality oversight 

– Safeguarding patient confidentiality and privacy 

– Data security 

– Data retention 

January 2008 

137 


Survey Management (cont’d) 

•System resources 

– Adequate physical plant resources available to 

handle survey volume 

– Survey system to track sampled patients 

through the data collection protocol 

•Store the sample frame 

• Track key events 

• Assign unique IDs and match to outcome for each 

sampled patient 

January 2008 

138



• Recommended customer support telephone line 

options 

– Staffed live 9 AM to 8 PM Monday thru Friday 

– Sufficient capacity – 90% answered live 

– Voice mailbox for nights and weekends 

– Messages returned within one business day 

– Established return call standard of two business days 

for questions that cannot be answered at the time of 

the call 

– Database or tracking log of calls 

• Optional support via the Internet 

January 2008 

139 



• Personnel training 

– Project staff 

– Customer support personnel 

– Mail data entry personnel 

– Telephone interviewers and IVR operators 

January 2008 

140



• Monitoring and quality oversight 

– Ongoing monitoring of staff and the survey 

administration process 

– Performance evaluations and feedback 

– System to evaluate patterns of errors 

– Detection and correction of performance 

problems 

January 2008 

141 



• Safeguarding patient data 

– Follow HIPAA guidelines 

– Restrict access to confidential data 

– Obtain confidentiality agreements from staff 

and subcontractors who have access to 

confidential information 

– Establish protocols for identifying security 

breaches and instituting corrective actions 

January 2008 

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• Confidentiality and privacy assurances 

to patient 

– HCAHPS survey question responses will be 

confidential and private and reported in an 

aggregate format to CMS 

– Hospital supplemental questions may 

voluntarily ask for patient name 

• Patients told that only hospital/survey vendor staff 

will see their responses 

January 2008 

143 



• Physical and electronic data security 

– Store returned mail surveys in secure location 

– Firewalls and other mechanisms for 

preventing unauthorized system access 

– Access levels and security passwords to 

safeguard sensitive data 

– Backup procedures to safeguard system data 

– Frequent saves to media to minimize data 

losses 

January 2008 

144


Questions? 

January 2008 

145 


Telephone and Active IVR 

Training 

January 2008 

146


Overview 

• Telephone and Active IVR Script and Programs 

• Introducing the Survey 

• Reaching Respondents/Telephone and IVR 

Attempts 

• Interviewing Guidelines and Conventions 

– Avoiding Refusals 

–Probing for Complete Answers 

– System Conventions 

• Customer Service FAQs 

January 2008 

147 


Telephone & Active IVR Script 

and Programs 

• No changes allowed to question and answer wording or ordering 

• All transitional wording is read verbatim 

• Supplemental questions allowed for hospital-specific items 

• Skip patterns should be programmed into the telephone and IVR 

systems 

• Conventions provide instructions for programmers and 

interviewers 

• Every question should have a “Missing/Don’t Know” option 

programmed 

• See Appendices K, L, & M in the Quality Assurance Guidelines 

V3.0 for scripts 

January 2008 

148


Survey Introduction 

• Critical to gaining cooperation 

• Provides survey purpose 

• Confirms respondent eligibility 

• Informs respondent that survey will take 

about seven minutes 

• Any changes to introduction require an 

approved Exceptions Request 

January 2008 

149 


Identifying Possible Ineligible 

Respondents 

• INEL1: Were you ever at this hospital? 

– YES [GO TO INEL2] 

– NO [GO TO END2] 

• INEL2: Were you a patient at this hospital in the last year? 

– YES [GO TO INEL3] 

– NO [GO TO END2] 

• INEL3: When was this? 

– IF ANY PERIOD WAS WITHIN TWO WEEKS OF [DISCHARGE DATE], GO 

TO Q1; OTHERWISE, GO TO END2. 

• END2: Thank you for your time. It looks like we made a mistake. I 

apologize for taking up your time. Have a good (day/evening). 

January 2008 

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Introducing the Survey 

• Introduction script provided 

• Speak professionally and with confidence 

• After gaining agreement to participate, 

interviewers should move swiftly into first 

question without rushing 

• Maintain pace and avoid long pauses 

January 2008 

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Introducing Active IVR 

• Live operator connects patient to active 

IVR system after: 

– gaining participation through initial telephone 

contact 

– confirming patient eligibility 

• Patient will hear electronic message 

confirming successful connection to active 

IVR system 

January 2008 

152


Reaching Respondents 

• Five attempts to reach patient 

• Do not leave messages on answering machines 

since this could violate a patient’s privacy 

• Maximize the probability of reaching the patient 

by attempting contacts 

– at various times of the day 

– on different days of the week 

– in different weeks 

January 2008 

153 


Guidelines for Reaching 

Respondents (cont’d) 

• If the patient is away temporarily, he or she is 

contacted upon return 

• If the patient does not speak the language the 

survey is being administered in, thank the patient 

for his or her time and terminate the interview 

• If the patient is temporarily ill, re-contact the 

patient to see if there has been a recovery before 

the end of data collection 

• Attempt to correct wrong telephone numbers 

January 2008 

154


Definition of a Telephone/ 

Active IVR Attempt 

• Telephone rings six times with no answer 

• Busy signal—interviewer gets a busy signal on 

each of 3 consecutive attempts (counts as one 

attempt) 

• Interviewer or operator reaches the household 

and is told that the patient is not available to 

come to the telephone 

• Patient asks the interviewer or operator to call 

back at a more convenient time 

January 2008 

155 


Interviewing Guidelines and 

Conventions 

• Interviewer/Operator tone: 

– Speak in an upbeat and courteous tone 

– Establish rapport 

– Maintain professional and neutral relationship 

– Do not provide personal information or opinions 

– Do not try to influence patients’ responses to 

questions in a certain way 

• See Appendix N in Quality Assurance Guidelines V3.0 

January 2008 

156



Conventions (cont’d) 

• Question asking: 

– Questions, transitions and response choices 

are read exactly as worded on script 

– Do not provide extra information or lengthy 

explanations to respondent questions 

– Never skip questions 

– End the survey by thanking the respondent 

for his or her time 

January 2008 

157 




• System conventions 

– Text that appears in lower case letters should be read 

– Text in UPPER CASE letters should not be read out 

loud 

– Text that is underlined should be emphasized by the 

interviewer 

– Characters in < > should not be read out loud 

– [Square brackets] are used to show programming 

instructions which would not actually appear on the 

computerized interviewing screens 

January 2008 

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• Avoiding refusals 

– Be prepared to convert a refusal into a 

completed survey 

– Emphasize importance of participation 

– Never argue with or antagonize a patient 

– Remember! First moments of the interview 

are most critical for gaining participation 

January 2008 

159 




• Probing for complete data 

– When respondent fails to provide 

adequate answer 

– Never interpret answers for respondents 

– Code “Missing/Don’t Know” when 

respondent cannot/does not provide 

complete answer after probing 

January 2008 

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• Types of probes: 

• Repeat question and answer categories 

• Interviewer says: 

–“Take a minute to think about it” 

–“So would you say…” 

–“Which would you say is closer to the 

answer?” 

January 2008 

161 




Example of response probe: Question 23 

In general, how would you rate your overall health? Would you say that it 

is… 

1 Excellent, 

2 Very good, 

3 Good, 

4 Fair, or 

5 Poor? 

M 

MISSING/DK 

Probe: “We’re asking you to choose one response. 

Would you say your overall health is….” 

January 2008 

162




Example of response probe: Question 21 

We want to know your overall rating of your stay at 

[FACILITYNAME]. This is the stay that ended around 

[DISCHARGE DATE]. Please do not include any other hospital 

stays in your answer. 

Using any number from 0 to 10, where 0 is the worst hospital 

possible and 10 is the best hospital possible, what number would 

you use to rate this hospital during your stay? 

Probe: “Please pick a number from 0-10, where 0 is the 

worst hospital possible and 10 is the best hospital 

possible. What number would you say is closest to your 

answer?” 

January 2008 

163 




• [FOR TELEPHONE INTERVIEWING THIS QUESTION IS BROKEN INTO PARTS A-E] 

• Q26 When I read the following list, please tell me if the category describes your 

race. You may choose one or more. 

– Q26A Are you White? 

– YES/WHITE 

– NO/NOT WHITE 

– MISSING/DK 

– Q26B Are you Black or African-American? 

– YES/BLACK OR AFRICAN-AMERICAN 

– NO/NOT BLACK OR AFRICAN-AMERICAN 

– MISSING/DK 

Read Q.’s A through E to capture multiple races. Do not stop 

reading the list when you get a Yes answer. 

January 2008 

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Customer Service FAQs 

• Interviewers/Operators should be 

knowledgeable about the survey and its goals, 

and be prepared to answer questions 

• FAQs provide answers to: 

– General questions about the survey 

– Concerns about participating in the survey 

– Questions about completing/returning the survey 

• See Appendix O in Quality Assurance Guidelines 

V3.0 

January 2008 

165 


Questions? 

January 2008 

166


Contact Us 

HCAHPS Information and Technical Support 

•Website: www.hcahpsonline.org 

• E-mail: hcahps@azqio.sdps.org 

• Telephone: 1-888-884-4007 

January 2008 

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