EQUIPOS ASOCIADOS AL SISTEMA DE COMPRESIÓN

This section describes guidelines for the mail phase of the mixed mode of survey administration.

Production of Questionnaire and Related Materials

The mail phase of the mixed mode of survey administration can be conducted in English or Spanish only. Hospitals/Survey vendors are provided with the HCAHPS questionnaire in English or Spanish (Appendices A and B), and sample cover letters in English or Spanish (Appendices A and B). Hospitals/Survey vendors are not permitted to create or use any other translations of the HCAHPS cover letter or questionnaire.

For HCAHPS survey administration, the OMB Paperwork Reduction Act language must appear in the mailing, either in the cover letter or on the front or back of the questionnaire. (See Appendices A and B for the exact language in English and Spanish.) In addition, the OMB control number should appear on the front page of the questionnaire. It is OMB #0938-0981. To ensure that no one other than the sampled patient completes the survey, language must be included in the questionnaire, and optionally in the cover letter, clearly stating that only the sampled patient may fill out the survey.

Each hospital/survey vendor must submit a sample of their HCAHPS mailing materials (e.g., questionnaire and cover letter) along with their annual QAP update for review by the HCAHPS Project Team. Supplemental questions should be submitted if used as part of an integrated survey. Please see the Oversight section for more detail.

Questionnaire

The HCAHPS questionnaire contains 27 questions. Questions 1-22 are referred to as the core HCAHPS questions, and Questions 23-27 are the “About You” HCAHPS questions. The core HCAHPS questions (Questions 1-22) must be placed at the beginning of the survey. The “About You” HCAHPS questions (Questions 23-27) and any hospital-specific supplemental questions must follow the core HCAHPS questions (Questions 1-22). However, the order of the “About You” questions must not be altered even if they are placed before or after any supplemental questions.

Required

Hospital/Survey vendors must adhere to the following specifications for questionnaire formatting and the production of mailing materials.

¾ Question and answer category wording must not be changed

¾ No changes are permitted to the order of the core HCAHPS questions (Questions 1-22) ¾ No changes are permitted to the order of the “About You” HCAHPS questions, even if

they are placed before or after any supplemental questions

¾ No changes are permitted to the order of the answer categories for the core and “About You” HCAHPS questions

¾ Questions and answer categories must remain together in the same columns and on the same pages

¾ Randomly generated, unique identifiers must be placed at least on the first page of the questionnaire. Hospitals/Survey vendors may add other identifiers on the survey for tracking purposes, e.g., unit identifiers. The patient’s name must not be printed on the survey.

¾ Response choices must be listed individually for each question, not presented in a matrix format. For example, when a series of questions is asked that have the same answer categories (Never, Sometimes, Usually, or Always) the answer categories must be repeated with every question. A matrix format which simply lists the answer categories across the top of the page and the questions down the side of the page is not allowed, because it has been shown that this format tends to produce inaccurate and incomplete responses.

¾ All survey instructions written at the top of the questionnaire must be copied verbatim ¾ The OMB control number must appear on the front page of the questionnaire. It is OMB

#0938-0981.

¾ The OMB language must appear on either the front or back page of the questionnaire or on the cover letter, and may appear on both

¾ The hospital’s/survey vendor’s return address must be added to the questionnaire in order to ensure that the questionnaire is returned to the correct address in the event that the enclosed return envelope is misplaced by the patient. The hospital’s/survey vendor’s next annual QAP submission must include a timeline for implementing this requirement. At a minimum, the next time the hospital/survey vendor updates their survey templates this requirement must be incorporated.

Note: The “About You” questions cannot be eliminated from the questionnaire. Optional

Hospitals/Survey vendors have some flexibility in formatting the HCAHPS questionnaire by following the guidelines described below:

¾ Small coding numbers next to the response choices may be included on the questionnaire, at the discretion of the hospital/survey vendor

¾ It is optional to put the patient discharge date on the questionnaire, but it is required on the cover letter

¾ It is acceptable to have a place on the survey for patients to voluntarily fill in their name/telephone number as long as the name/telephone number items are placed after the core HCAHPS questions (Questions 1-22)

Hospitals/Survey vendors should consider the following recommendations in formatting the HCAHPS questionnaire to increase the likelihood of receiving a returned survey:

¾ Two-column format that is used in Appendices A and B ¾ Minimum font size (10 point)

¾ Wide margins (at least 3/4 inch) so that the survey has sufficient white space to enhance its readability

Hospitals that choose to use their existing survey in addition to the HCAHPS survey have three options for mailing: 1) add the hospital’s existing survey to the end of the HCAHPS survey; 2) enclose a separate HCAHPS survey and a separate hospital survey in the same mailing; or, 3) send two separate mailings, one containing the HCAHPS survey and another containing the hospital-specific survey.

Supplemental Questions

Hospitals/Survey vendors may add a reasonable number of hospital-specific supplemental questions to the HCAHPS survey following the guidelines described below:

¾ Hospital-specific supplemental questions or a hospital’s existing survey are added after the core HCAHPS questions (Questions 1-22). This approach will ensure that the survey is conducted consistently across participating hospitals and that data across hospitals are comparable.

¾ The “About You” section (Questions 23-27) of the HCAHPS survey must be placed anywhere after the core HCAHPS questions (Questions 1-22)

¾ Phrases should be added to indicate a transition from the HCAHPS questions to the hospital-specific supplemental questions. An example of such phrasing is as follows:

“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 the topics.”

Hospitals/Survey vendors should avoid the following types of hospital-specific supplemental questions that:

¾ pose a burden to the patient (e.g., number, length, and complexity of supplemental questions)

¾ may affect responses to the HCAHPS survey

¾ may cause the patient to terminate the survey (e.g., items that ask about sensitive medical, health or personal topics)

¾ jeopardize patient confidentiality (e.g., items that ask for the patient’s social security number)

The number of supplemental questions added is left to the discretion of the hospital/survey vendor.

Cover Letter

While hospitals/survey vendors may adapt the sample cover letters provided (see Appendices A and B), or compose their own cover letters. In either case, hospitals/survey vendors must follow the guidelines described below when altering the letter templates provided in this manual:

Required

¾ Cover letter must include:

• the name and address of the sampled patient. “To Whom It May Concern” is not an acceptable salutation.

• language indicating the purpose of the 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”

• language indicating that answers may be shared with the hospital for purposes of quality improvement

• an explanation that participation is voluntary

• the hospital name and discharge date, to ensure that the patient completes the survey based on the hospital stay associated with that particular discharge date

• language stating that the patient’s health benefits will not be affected by participation in the survey

• a customer support number for hospitals self-administering the survey and a toll-free customer support number for survey vendors. In some instances, hospitals contracting with survey vendors may want their own telephone number on the survey in addition to, or in lieu of, the survey vendor’s number. In cases where the hospital has a customer support number but the survey vendor does not, it is the responsibility of the survey vendor to ensure that the hospital’s number is operational and the hospital is prepared to receive questions prior to the mailing of the questionnaire.

• hospital’s/survey vendor’s return address must be included in the cover letter to ensure that the questionnaire is returned to the correct address, in the event that the enclosed return envelope is misplaced by the patient

¾ The OMB language (Appendices A and B) must appear on either the questionnaire or cover letter, and may appear on both

Optional

¾ Hospitals/Survey vendors that send two mailings in one envelope (the HCAHPS survey and a hospital-specific survey) are strongly encouraged to include language that explains why there are two questionnaires

¾ Use of the Spanish cover letter is allowed if the hospital/survey vendor is sending a Spanish questionnaire to the patient

¾ Language may be added to the English cover letter (in English or Spanish) that indicates that the patient may request a mail survey in Spanish

¾ Any instructions that appear on the survey may be repeated in the cover letter

Mailing of Materials

Hospitals/Survey vendors must mail materials follow the guidelines described below:

¾ Attempts must be made to contact every eligible patient drawn into the sample, whether or not they have a complete mailing address. Hospitals/Survey vendors must use commercial software or other means to update addresses provided by the hospital for sampled patients. (Mailings returned as undeliverable must be coded as “9 − Non-

response: Bad address.”) Hospitals/Survey vendors retain a record of attempts to acquire missing address data. All materials relevant to survey administration are subject to review.

¾ Self-addressed, stamped business return envelopes must be enclosed in the survey envelope along with the cover letter and questionnaire. The HCAHPS survey cannot be administered without both a cover letter and self-addressed, stamped business return envelope.

¾ All mailings are sent to patients by name, and to the patient’s address listed in the hospital record. This includes patients who are discharged from the hospital to other institutions, such as nursing homes or assisted living facilities.

It is strongly suggested that the mailing be sent with first class postage or indicia to ensure delivery in a timely manner and to maximize response rates because, first class mail is more likely to be opened.