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Protocol - Quality of Care - Children

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Description:

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 4.0 Child Medicaid Questionnaire includes general questions about access to care and quality of care and additional questions about the services provided to children with chronic conditions. Items CC1-CC38 of the questionnaire are version 4.0 of the Children with Chronic Conditions Item Set.

Protocol:

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 4.0 Child Medicaid Questionnaire

Survey Instructions

Answer each question by marking the box to the left of your answer.

You are sometimes told to skip over some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this:

Yes If Yes, go to # 1 on page 1

Please answer the questions for the child listed on the envelope. Please do not answer for any other children.

1. Our records show that your child is now in {INSERT HEALTH PLAN NAME}. Is that right?

[ ] 1 Yes If Yes, go to # 3

[ ] 2 No

2. What is the name of your child’s health plan?

Please print:_______________________ __________________________________

Your Child’s Health Care in the Last 6 Months

These questions ask about your child’s health care. Do not include care your child got when he or she stayed overnight in a hospital. Do not include the times your child went for dental care visits.

3. In the last 6 months, did your child have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor’s office?

[ ] 1 Yes

[ ] 2 No If No, go to #5

4. In the last 6 months, when your child needed care right away, how often did your child get care as soon as you thought he or she needed?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

5. In the last 6 months, not counting the times your child needed care right away, did you make any appointments for your child’s health care at a doctor’s office or clinic?

[ ] 1 Yes

[ ] 2 No If No, go to #7

6. In the last 6 months, not counting the times your child needed care right away, how often did you get an appointment for health care at a doctor’s office or clinic as soon as you thought your child needed?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

7. In the last 6 months, not counting the times your child went to an emergency room, how many times did he or she go to a doctor’s office or clinic to get health care?

[ ] None If None, go to #9 on page 4 [If items CC5-CC7 or CC5-CC18 are included: go to #CC5; if only items CC8-CC18 are included: go to #CC8]

[ ] 1

[ ] 2

[ ] 3

[ ] 4

[ ] 5 to 9

[ ] 10 or more

CC1. In the last 6 months, how often did you have your questions answered by your child’s doctors or other health providers?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

CC2. Choices for your child’s treatment or health care can include choices about medicine, surgery, or other treatment. In the last 6 months, did your child’s doctor or other health provider tell you there was more than one choice for your child’s treatment or health care?

[ ] 1 Yes

[ ] 2 No If No, go to #8

CC3. In the last 6 months, did your child’s doctor or other health provider talk with you about the pros and cons of each choice for your child’s treatment or health care?

[ ] 1 Yes

[ ] 2 No

CC4. In the last 6 months, when there was more than one choice for your child’s treatment or health care, did your child’s doctor or other health provider ask you which choice was best for your child?

[ ] 1 Yes

[ ] 2 No

8. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your child’s health care in the last 6 months?

[ ] 0 Worst health care possible

[ ] 1


[ ] 2


[ ] 3


[ ] 4


[ ] 5


[ ] 6


[ ] 7


[ ] 8


[ ] 9


[ ] 10 Best health care possible

CC5. Is your child now enrolled in any kind of school or daycare?

[ ] 1 Yes

[ ] 2 No If No, go to #9 on page 4 [If items CC8-CC18 are included: go to #CC8]

CC6. In the last 6 months, did you need your child’s doctors or other health providers to contact a school or daycare center about your child’s health or health care?

[ ] 1 Yes

[ ] 2 No If No, go to #9 on page 4 [If items CC8-CC18 are included: go to #CC8]

CC7. In the last 6 months, did you get the help you needed from your child’s doctors or other health providers in contacting your child’s school or daycare?

[ ] 1 Yes

[ ] 2 No

Option: Insert additional questions about general health care here.

Specialized Services

CC8. Special medical equipment or devices include a walker, wheelchair, nebulizer, feeding tubes, or oxygen equipment. In the last 6 months, did you get or try to get any special medical equipment or devices for your child?

[ ] 1 Yes

[ ] 2 No If No, go to #CC11

CC9. In the last 6 months, how often was it easy to get special medical equipment or devices for your child?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

CC10. Did anyone from your child’s health plan, doctor’s office, or clinic help you get special medical equipment or devices for your child?

[ ] 1 Yes

[ ] 2 No

CC11. In the last 6 months, did you get or try to get special therapy such as physical, occupational, or speech therapy for your child?

[ ] 1 Yes

[ ] 2 No If No, go to #CC14

CC12. In the last 6 months, how often was it easy to get this therapy for your child?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

CC13. Did anyone from your child’s health plan, doctor’s office, or clinic help you get this therapy for your child?

[ ] 1 Yes

[ ] 2 No

CC14. In the last 6 months, did you get or try to get treatment or counseling for your child for an emotional, developmental, or behavioral problem?

[ ] 1 Yes

[ ] 2 No If No, go to #CC17

CC15. In the last 6 months, how often was it easy to get this treatment or counseling for your child?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

CC16. Did anyone from your child’s health plan, doctor’s office, or clinic help you get this treatment or counseling for your child?

[ ] 1 Yes

[ ] 2 No

CC17. In the last 6 months, did your child get care from more than one kind of health care provider or use more than one kind of health care service?

[ ] 1 Yes

[ ] 2 No If No, go to #9

CC18. In the last 6 months, did anyone from your child’s health plan, doctor’s office, or clinic help coordinate your child’s care among these different providers or services?

[ ] 1 Yes

[ ] 2 No

Your Child’s Personal Doctor

9. A personal doctor is the one your child would see if he or she needs a check-up or gets sick or hurt. Does your child have a personal doctor?

[ ] 1 Yes

[ ] 2 No If No, go to #19 on page 6

10. In the last 6 months, how many times did your child visit his or her personal doctor for care?

[ ] None If None, go to #18

[ ] 1

[ ] 2

[ ] 3

[ ] 4

[ ] 5 to 9

[ ] 10 or more

11. In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy to understand?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

12. In the last 6 months, how often did your child’s personal doctor listen carefully to you?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

13. In the last 6 months, how often did your child’s personal doctor show respect for what you had to say?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

14. Is your child able to talk with doctors about his or her health care?

[ ] 1 Yes

[ ] 2 No If No, go to #16

15. In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy for your child to understand?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

16. In the last 6 months, how often did your child’s personal doctor spend enough time with your child?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

17. In the last 6 months, did your child’s personal doctor talk with you about how your child is feeling, growing, or behaving?

[ ] 1 Yes

[ ] 2 No

18. Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your child’s personal doctor?

[ ] 0 Worst personal doctor possible

[ ] 1


[ ] 2


[ ] 3


[ ] 4


[ ] 5


[ ] 6


[ ] 7


[ ] 8


[ ] 9


[ ] 10 Best personal doctor possible

CC19. Does your child have any medical, behavioral, or other health conditions that have lasted for more than 3 months?

[ ] 1 Yes

[ ] 2 No If No, go to #19

CC20. Does your child’s personal doctor understand how these medical, behavioral, or other health conditions affect your child’s day-to-day life?

[ ] 1 Yes

[ ] 2 No

CC21. Does your child’s personal doctor understand how your child’s medical, behavioral, or other health conditions affect your family’s day-to-day life?

[ ] 1 Yes

[ ] 2 No

Option: Insert additional questions about personal doctor here.

Getting Health Care From a Specialist

When you answer the next questions, do not include dental visits or care your child got when he or she stayed overnight in a hospital.

19. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 6 months, did you try to make any appointments for your child to see a specialist?

[ ] 1 Yes

[ ] 2 No If No, go to #23

20. In the last 6 months, how often was it easy to get appointments for your child with specialists?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

21. How many specialists has your child seen in the last 6 months?

[ ] 0 None If None, go to #23

[ ] 1 specialist

[ ] 2

[ ] 3

[ ] 4

[ ] 5 or more specialists

22. We want to know your rating of the specialist your child saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?

[ ] 0 Worst specialist possible

[ ] 1


[ ] 2


[ ] 3


[ ] 4


[ ] 5


[ ] 6


[ ] 7


[ ] 8


[ ] 9


[ ] 10 Best specialist possible

Option: Insert additional questions about specialist care here.

Your Child’s Health Plan

The next questions ask about your experience with your child’s health plan.

23. In the last 6 months, did you try to get any kind of care, tests, or treatment for your child through his or her health plan?

[ ] 1 Yes

[ ] 2 No If No, go to #25

24. In the last 6 months, how often was it easy to get the care, tests, or treatment you thought your child needed through his or her health plan?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

25. In the last 6 months, did you try to get information or help from customer service at your child’s health plan?

[ ] 1 Yes

[ ] 2 No If No, go to #28

26. In the last 6 months, how often did customer service at your child’s health plan give you the information or help you needed?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

27. In the last 6 months, how often did customer service staff at your child’s health plan treat you with courtesy and respect?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

28. In the last 6 months, did your child’s health plan give you any forms to fill out?

[ ] 1 Yes

[ ] 2 No If No, go to #30

29. In the last 6 months, how often were the forms from your child’s health plan easy to fill out?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

30. Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your child’s health plan?

[ ] 0 Worst health plan possible

[ ] 1


[ ] 2


[ ] 3


[ ] 4


[ ] 5


[ ] 6


[ ] 7


[ ] 8


[ ] 9


[ ] 10 Best health plan possible

Option: Insert additional questions about the health plan here.

Prescription Medicines

CC22. In the last 6 months, did you get or refill any prescription medicines for your child?

[ ] 1 Yes

[ ] 2 No If No, go to # 31

CC23. In the last 6 months, how often was it easy to get prescription medicines for your child through his or her health plan?

[ ] 1 Never

[ ] 2 Sometimes

[ ] 3 Usually

[ ] 4 Always

CC24. Did anyone from your child’s health plan, doctor’s office, or clinic help you get your child’s prescription medicines?

[ ] 1 Yes

[ ] 2 No

About Your Child and You

31. In general, how would you rate your child’s overall health?

[ ] 1 Excellent

[ ] 2 Very Good

[ ] 3 Good

[ ] 4 Fair

[ ] 5 Poor

CC25. Does your child currently need or use medicine prescribed by a doctor (other than vitamins)?

[ ] 1 Yes

[ ] 2 No If No, go to #CC28

CC26. Is this because of any medical, behavioral, or other health condition?

[ ] 1 Yes

[ ] 2 No If No, go to #CC28

CC27. Is this a condition that has lasted or is expected to last for at least 12 months?

[ ] 1 Yes

[ ] 2 No

CC28. Does your child need or use more medical care, more mental health services, or more educational services than is usual for most children of the same age?

[ ] 1 Yes

[ ] 2 No If No, go to #CC31

CC29. Is this because of any medical, behavioral, or other health condition?

[ ] 1 Yes

[ ] 2 No If No, go to #CC31

CC30. Is this a condition that has lasted or is expected to last for at least 12 months?

[ ] 1 Yes

[ ] 2 No

CC31. Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?

[ ] 1 Yes

[ ] 2 No If No, go to #CC34

CC32. Is this because of any medical, behavioral, or other health condition?

[ ] 1 Yes

[ ] 2 No If No, go to #CC34

CC33. Is this a condition that has lasted or is expected to last for at least 12 months?

[ ] 1 Yes

[ ] 2 No

CC34. Does your child need or get special therapy such as physical, occupational, or speech therapy?

[ ] 1 Yes

[ ] 2 No If No, go to #CC37

CC35. Is this because of any medical, behavioral, or other health condition?

[ ] 1 Yes

[ ] 2 No If No, go to #CC37

CC36. Is this a condition that has lasted or is expected to last for at least 12 months?

[ ] 1 Yes

[ ] 2 No

CC37. Does your child have any kind of emotional, developmental, or behavioral problem for which he or she needs or gets treatment or counseling?

[ ] 1 Yes

[ ] 2 No If No, go to #32

CC38. Has this problem lasted or is it expected to last for at least 12 months?

[ ] 1 Yes

[ ] 2 No

32. What is your child’s age?

[ ] 1 Less than 1 year old

______ YEARS OLD (write in)

33. Is your child male or female?

[ ] 1 Male

[ ] 2 Female

34. Is your child of Hispanic or Latino origin or descent?

[ ] 1 Yes, Hispanic or Latino

[ ] 2 No, not Hispanic or Latino

35. What is your child’s race? Please mark one or more.

[ ] 1 White

[ ] 2 Black or African-American

[ ] 3 Asian

[ ] 4 Native Hawaiian or other Pacific Islander

[ ] 5 American Indian or Alaska Native

[ ] 6 Other

36. What is your age?

[ ] 0 Under 18

[ ] 1 18 to 24

[ ] 2 25 to 34

[ ] 3 35 to 44

[ ] 4 45 to 54

[ ] 5 55 to 64

[ ] 6 65 to 74

[ ] 7 75 or older

37. Are you male or female?

[ ] 1 Male

[ ] 2 Female

38. What is the highest grade or level of school that you have completed?

[ ] 1 8th grade or less

[ ] 2 Some high school, but did not graduate

[ ] 3 High school graduate or GED

[ ] 4 Some college or 2-year degree

[ ] 5 4-year college graduate

[ ] 6 More than 4-year college degree

39. How are you related to the child?

[ ] 1 Mother or father

[ ] 2 Grandparent

[ ] 3 Aunt or uncle

[ ] 4 Older sibling

[ ] 5 Other relative

[ ] 6 Legal guardian

40. Did someone help you complete this survey?

[ ] 1 Yes

[ ] 2 No Thank you. Please return the completed survey in the postage-paid envelope.

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Proxy-administered questionnaire

Life Stage:

Adult

Participants:

Primary caregiver of children and adolescents, ages 17 and younger.

Specific Instructions:

None

Selection Rationale

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 4.0 Child Medicaid Questionnaire is a reliable, validated, and widely used questionnaire for measuring patient/family experience of pediatric health care.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Sickle Cell Disease Child Quality of Care Questionnaire Assessment Text 4922437 CDE Browser
Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Agency for Healthcare Research and Quality, (2007). Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 4.0 Child Medicaid Questionnaire. Retrieved from www.cahps.ahrq.gov/surveys-guidance/item-sets/children-chronic/index.html.

General References

Co, J. P., Sternberg, S. B., & Homer, C. J. (2011). Measuring patient and family experiences of health care for children. Academic Pediatrics 11(3 Suppl), S59-67.

Protocol ID:

820102

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX820102_QualityOfCareChildrenDoctor_HealthProvider_Contact_School_Daycare_Last6Months PX820102080300 In the last 6 months, did you need your child's doctors or other health providers to contact a school or daycare center about your child's health or health care? 4 N/A
PX820102_QualityOfCareChildrenDoctor_HealthProvider_Help_School_Daycare_Last6Months PX820102080400 In the last 6 months, did you get the help you needed from your child's doctors or other health providers in contacting your child's school or daycare? 4 N/A
PX820102_QualityOfCareChildrenDoctor_Provider_Answered_Questions_Last6Months PX820102070200 In the last 6 months, how often did you have your questions answered by your child's doctors or other health providers? 4 N/A
PX820102_QualityOfCareChildren_Appointment_Office_Clinic_Last6Months PX820102050000 In the last 6 months, not counting the times your child needed care right away, did you make any appointments for your child's health care at a doctor's office or clinic? 4 N/A
PX820102_QualityOfCareChildren_Appointment_Specialists_Easy_GetLast6Months PX820102200000 In the last 6 months, how often was it easy to get appointments for your child with specialists? 4 N/A
PX820102_QualityOfCareChildren_Appointment_Specialists_Last6Months PX820102190000 Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 6 months, did you try to make any appointments for your child to see a specialist? 4 N/A
PX820102_QualityOfCareChildren_Best_For_Child_Treatment_Care_Choice_Last6Months PX820102070500 In the last 6 months, when there was more than one choice for your child's treatment or health care, did your child's doctor or other health provider ask you which choice was best for your child? 4 N/A
PX820102_QualityOfCareChildren_CareTests_Treatment_HealthPlan_Last6Months PX820102230000 In the last 6 months, did you try to get any kind of care, tests, or treatment for your child through his or her health plan? 4 N/A
PX820102_QualityOfCareChildren_Child_Age PX820102320000 What is your child's age? 4 N/A
PX820102_QualityOfCareChildren_Child_AgeOther PX820102330100 What is your child's age? Write in 4 N/A
PX820102_QualityOfCareChildren_Child_Gender PX820102330200 Is your child male or female? 4 N/A
PX820102_QualityOfCareChildren_Child_Origin_Descent PX820102340000 Is your child of Hispanic or Latino origin or descent? 4 N/A
PX820102_QualityOfCareChildren_Child_Race PX820102350000 What is your child's race? Please mark one or more. 4 N/A
PX820102_QualityOfCareChildren_Child_Talk_Health_Care PX820102140000 Is your child able to talk with doctors about his or her health care? 4 N/A
PX820102_QualityOfCareChildren_Condition_LastExpected_AtLeast_12months PX820102310700 Is this a condition that has lasted or is expected to last for at least 12 months? 4 N/A
PX820102_QualityOfCareChildren_Condition_Last_Expected_12months PX820102310400 Is this a condition that has lasted or is expected to last for at least 12 months? 4 N/A
PX820102_QualityOfCareChildren_Current_Reported_Health_Plan_Name PX820102020000 What is the name of your child's health plan? 4 N/A
PX820102_QualityOfCareChildren_CustomerService_CourtesyRespect_HealthPlan_Last6Months PX820102270000 In the last 6 months, how often did customer service staff at your child's health plan treat you with courtesy and respect? 4 N/A
PX820102_QualityOfCareChildren_CustomerService_Give_HealthPlan_Last6Months PX820102260000 In the last 6 months, how often did customer service at your child's health plan give you the information or help you needed? 4 N/A
PX820102_QualityOfCareChildren_EasyGetCare_Tests_TreatmentHealthPlan_Last6Months PX820102240000 In the last 6 months, how often was it easy to get the care, tests, or treatment you thought your child needed through his or her health plan? 4 N/A
PX820102_QualityOfCareChildren_Easy_GetPrescription_Medicines_Last6Months PX820102300300 In the last 6 months, how often was it easy to get prescription medicines for your child through his or her health plan? 4 N/A
PX820102_QualityOfCareChildren_Easy_GetSpecialMedicalEquipment_Devices_Last6Months PX820102080600 In the last 6 months, how often was it easy to get special medical equipment or devices for your child? 4 N/A
PX820102_QualityOfCareChildren_Easy_GetSpecial_Therapy_Last6Months PX820102080900 In the last 6 months, how often was it easy to get this therapy for your child? 4 N/A
PX820102_QualityOfCareChildren_Easy_GetTreatment_Counseling_Last6Months PX820102081200 In the last 6 months, how often was it easy to get this treatment or counseling for your child? 4 N/A
PX820102_QualityOfCareChildren_Enrolled_School_Daycare PX820102080200 Is your child now enrolled in any kind of school or daycare? 4 N/A
PX820102_QualityOfCareChildren_Have_EmotionalDevelopmental_BehavioralTreatment_Counseling PX820102311400 Does your child have any kind of emotional, developmental, or behavioral problem for which he or she needs or gets treatment or counseling? 4 N/A
PX820102_QualityOfCareChildren_Have_PersonalDoctor PX820102090000 A personal doctor is the one your child would see if he or she needs a check-up or gets sick or hurt. Does your child have a personal doctor? 4 N/A
PX820102_QualityOfCareChildren_HealthPlan_Forms_EasyFill_Last6Months PX820102290000 In the last 6 months, how often were the forms from your child's health plan easy to fill out? 4 N/A
PX820102_QualityOfCareChildren_HealthPlan_Forms_Last6Months PX820102280000 In the last 6 months, did your child's health plan give you any forms to fill out? 4 N/A
PX820102_QualityOfCareChildren_HelpCoordinate_DifferentProvidersServices_Last6Months PX820102081500 In the last 6 months, did anyone from your child's health plan, doctor's office, or clinic help coordinate your child's care among these different providers or services? 4 N/A
PX820102_QualityOfCareChildren_Help_Complete_Survey PX820102400000 Did someone help you complete this survey? 4 N/A
PX820102_QualityOfCareChildren_Help_GetPrescription_Medicines PX820102300400 Did anyone from your child's health plan, doctor's office, or clinic help you get your child's prescription medicines? 4 N/A
PX820102_QualityOfCareChildren_Help_GetSpecialMedicalEquipment_Devices PX820102080700 Did anyone from your child's health plan, doctor's office, or clinic help you get special medical equipment or devices for your child? 4 N/A
PX820102_QualityOfCareChildren_Help_GetSpecial_Therapy PX820102081000 Did anyone from your child's health plan, doctor's office, or clinic help you get this therapy for your child? 4 N/A
PX820102_QualityOfCareChildren_Help_GetTreatment_Counseling PX820102081300 Did anyone from your child's health plan, doctor's office, or clinic help you get this treatment or counseling for your child? 4 N/A
PX820102_QualityOfCareChildren_Information_Help_HealthPlan_Last6Months PX820102250000 In the last 6 months, did you try to get information or help from customer service at your child's health plan? 4 N/A
PX820102_QualityOfCareChildren_Limited_PreventedAbility PX820102310800 Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do? 4 N/A
PX820102_QualityOfCareChildren_Limited_PreventedCondition_LastExpected_12months PX820102311000 Is this a condition that has lasted or is expected to last for at least 12 months? 4 N/A
PX820102_QualityOfCareChildren_Limited_PreventedMedicalBehavioral_OtherHealth PX820102310900 Is this because of any medical, behavioral, or other health condition? 4 N/A
PX820102_QualityOfCareChildren_Medical_BehavioralHealthConditions_MoreThan_3months PX820102180200 Does your child have any medical, behavioral, or other health conditions that have lasted for more than 3 months? 4 N/A
PX820102_QualityOfCareChildren_MoreThanOne_Provider_Service_Last6Months PX820102081400 In the last 6 months, did your child get care from more than one kind of health care provider or use more than one kind of health care service? 4 N/A
PX820102_QualityOfCareChildren_Needed_Immediate_Care_Last6Months PX820102030000 In the last 6 months, did your child have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office? 4 N/A
PX820102_QualityOfCareChildren_NeedUseMore_BecauseMedicalBehavioral_Other_Health PX820102310600 Is this because of any medical, behavioral, or other health condition? 4 N/A
PX820102_QualityOfCareChildren_NeedUseMore_MedicalMentalHealth_Educational PX820102310500 Does your child need or use more medical care, more mental health services, or more educational services than is usual for most children of the same age? 4 N/A
PX820102_QualityOfCareChildren_Need_GetSpecial_Therapy PX820102311100 Does your child need or get special therapy such as physical, occupational, or speech therapy? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_ExplainChild_Understand_Last6Months PX820102150000 In the last 6 months, how often did your child's personal doctor explain things in a way that was easy for your child to understand? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_Explain_Understand_Last6Months PX820102110000 In the last 6 months, how often did your child's personal doctor explain things in a way that was easy to understand? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_Listen_Carefully_Last6Months PX820102120000 In the last 6 months, how often did your child's personal doctor listen carefully to you? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_Show_Respect_Last6Months PX820102130000 In the last 6 months, how often did your child's personal doctor show respect for what you had to say? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_TalkWith_You_Last6Months PX820102170000 In the last 6 months, did your child's personal doctor talk with you about how your child is feeling, growing, or behaving? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_TimeWith_Child_Last6Months PX820102160000 In the last 6 months, how often did your child's personal doctor spend enough time with your child? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_UnderstandAffectChild_DailyLife PX820102180300 Does your child's personal doctor understand how these medical, behavioral, or other health conditions affect your child's day-to-day life? 4 N/A
PX820102_QualityOfCareChildren_PersonalDoctor_UnderstandAffectFamily_DailyLife PX820102180400 Does your child's personal doctor understand how your child's medical, behavioral, or other health conditions affect your family's day-to-day life? 4 N/A
PX820102_QualityOfCareChildren_Prescription_Medicines_Last6Months PX820102300200 In the last 6 months, did you get or refill any prescription medicines for your child? 4 N/A
PX820102_QualityOfCareChildren_Problem_Last_Expected_12months PX820102311500 Has this problem lasted or is it expected to last for at least 12 months? 4 N/A
PX820102_QualityOfCareChildren_Pros_Cons_Treatment_Care_Choice_Last6Months PX820102070400 In the last 6 months, did your child's doctor or other health provider talk with you about the pros and cons of each choice for your child's treatment or health care? 4 N/A
PX820102_QualityOfCareChildren_Rate_Health_Care_Last6Months PX820102080100 Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your child's health care in the last 6 months? 4 N/A
PX820102_QualityOfCareChildren_Rate_Health_Plan PX820102300100 Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your child's health plan? 4 N/A
PX820102_QualityOfCareChildren_Rate_Overall_Health PX820102310100 In general, how would you rate your child's overall health? 4 N/A
PX820102_QualityOfCareChildren_Rate_PersonalDoctor PX820102180100 Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your child's personal doctor? 4 N/A
PX820102_QualityOfCareChildren_Rate_SpecialistSeen_Last6Months PX820102220000 We want to know your rating of the specialist your child saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist? 4 N/A
PX820102_QualityOfCareChildren_Received_Appointment_Office_Clinic_Last6Months PX820102060000 In the last 6 months, not counting the times your child needed care right away, how often did you get an appointment for health care at a doctor's office or clinic as soon as you thought your child needed? 4 N/A
PX820102_QualityOfCareChildren_Received_Health_Care_Last6Months PX820102070100 In the last 6 months, not counting the times your child went to an emergency room, how many times did he or she go to a doctor's office or clinic to get health care? 4 N/A
PX820102_QualityOfCareChildren_Recorded_Health_Plan_Name PX820102010000 Our records show that your child is now in {INSERT HEALTH PLAN NAME}. Is that right? 4 N/A
PX820102_QualityOfCareChildren_Related_To_Child PX820102390000 How are you related to the child? 4 N/A
PX820102_QualityOfCareChildren_SpecialistsSeen_Last6Months PX820102210000 How many specialists has your child seen in the last 6 months? 4 N/A
PX820102_QualityOfCareChildren_SpecialMedicalEquipment_Devices_Last6Months PX820102080500 Special medical equipment or devices include a walker, wheelchair, nebulizer, feeding tubes, or oxygen equipment. In the last 6 months, did you get or try to get any special medical equipment or devices for your child? 4 N/A
PX820102_QualityOfCareChildren_SpecialTherapy_Condition_LastExpected_12months PX820102311300 Is this a condition that has lasted or is expected to last for at least 12 months? 4 N/A
PX820102_QualityOfCareChildren_SpecialTherapy_Medical_Behavioral_Health PX820102311200 Is this because of any medical, behavioral, or other health condition? 4 N/A
PX820102_QualityOfCareChildren_Special_Therapy_Last6Months PX820102080800 In the last 6 months, did you get or try to get special therapy such as physical, occupational, or speech therapy for your child? 4 N/A
PX820102_QualityOfCareChildren_Think_Received_Immediate_Care_Last6Months PX820102040000 In the last 6 months, when your child needed care right away, how often did your child get care as soon as you thought he or she needed? 4 N/A
PX820102_QualityOfCareChildren_Treatment_Care_Choice_Last6Months PX820102070300 Choices for your child's treatment or health care can include choices about medicine, surgery, or other treatment. In the last 6 months, did your child's doctor or other health provider tell you there was more than one choice for your child's treatment or health care? 4 N/A
PX820102_QualityOfCareChildren_Treatment_Counseling_Last6Months PX820102081100 In the last 6 months, did you get or try to get treatment or counseling for your child for an emotional, developmental, or behavioral problem? 4 N/A
PX820102_QualityOfCareChildren_Use_PrescribedMedicine PX820102310200 Does your child currently need or use medicine prescribed by a doctor (other than vitamins)? 4 N/A
PX820102_QualityOfCareChildren_Use_PrescribedMedicine_MedicalBehavioral_Health PX820102310300 Is this because of any medical, behavioral, or other health condition? 4 N/A
PX820102_QualityOfCareChildren_Visit_PersonalDoctor_Last6Months PX820102100000 In the last 6 months, how many times did your child visit his or her personal doctor for care? 4 N/A
PX820102_QualityOfCareChildren_Your_Age PX820102360000 What is your age? 4 N/A
PX820102_QualityOfCareChildren_Your_Gender PX820102370000 Are you male or female? 4 N/A
PX820102_QualityOfCareChildren_Your_Highest_GradeLevel_Completed PX820102380000 What is the highest grade or level of school that you have completed? 4 N/A
Research Domain Information
Measure Name:

Quality of Care

Release Date:

July 30, 2015

Definition

A measure used to assess patient-reported utilization and perceptions about quality of care for individuals treated for sickle cell disease (SCD).

Purpose

These questions are used to assess the patient-reported health care needs and quality of service from health care providers for individuals with chronic conditions such as sickle cell disease (SCD).

Keywords

Adult Sickle Cell Quality-of-Life Measurement Information System, ASCQ-Me, Consumer Assessment of Healthcare Providers and Systems, CAHPS Health Plan Survey, Child Medicaid Survey, Sickle cell disease, SCD, Quality of care, Quality of life, QOL, Pain, Emergency room visits, ER visits, CAHPS, Health care utilization, Patient perspective