MEPS-HC Survey Instrument

Quality (Priority Cond) Supp. (PC) Section
Beta

BOX_01
NOTE: CURRENTLY THE QUALITY SUPPLEMENT CONTAINS QUESTIONS FOR PERSONS FOR
WHOM DIABETES OR ASTHMA WAS REPORTED IN THE PRIORITY CONDITION ENUMERATION
(PE) SECTION. OTHER QUALITY QUESTIONS ARE LOCATED IN THE PREVENTIVE CARE
(AP) SECTION. HOWEVER, THE QUALITY SECTION COULD INCLUDE QUESTIONS FOR
THE OTHER PRIORITY CONDITIONS AS THEY ARE NEEDED IN FUTURE PANELS.

BOX_01A
IF PERSON IS >= 18 YEARS OF AGE OR IN AGE CATEGORIES 4-9 AND IF 'DIABETES'
ON PERSON'S-MEDICAL-CONDITIONS-ROSTER AND FLAGGED AS CREATED IN THE PE
SECTION (IN ANY ROUND), CONTINUE WITH PC02A.
OTHERWISE, GO TO BOX_01B.

1

Quality (Priority Cond) Supp. (PC) Section
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PC02A

Help Enabled
Variable Name
PRND.REFDIAB

Comment Enabled

Jump Back Enabled

Label

Size

REFERENCE TO DIABETES

{PERSON'S FIRST MIDDLE AND LAST NAME}
The care of adults with diabetes is an interest of the Public Health Service.
{During an earlier interview, it/It} was mentioned that (PERSON) (have/has)
diabetes. We have a short questionnaire on the care adults may get for their
diabetes.

SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS DIABETES
REPORTED IN ERROR.
CONTINUE
(PERSON) DOES NOT HAVE DIABETES
DISPLAY
DISPLAY
CREATED
CREATED

1
2

{PC03}
{BOX_01B}

INSTRUCTIONS:
‘During an earlier interview, it’ IF DIABETES WAS NOT
DURING THE CURRENT ROUND. DISPLAY ‘It’ IF DIABETES
DURING THE CURRENT ROUND.

PROGRAMMER NOTES:
Display 'PERSON' in purple in the answer text.
If 'PERSON DOES NOT HAVE DIABETES' is selected, this does not
re-set the data from the PE section (PRND.PCOIABET).
The response to PC02A will determine whether PC03 is asked and
whether there is DCS follow-up for this person in the CL
Section.

2

Quality (Priority Cond) Supp. (PC) Section
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PC03

Help Enabled
Variable Name
PRND.DIABRESP

Comment Enabled

Jump Back Enabled

Label

Size
2

TYPE OF SAQ DISTRIBUTED

{PERSON’S FIRST MIDDLE AND LAST NAME}
PID: {PID}
DOB: {MM/DD/YYYY}
STATUS: {CURRENT/INSTITUTIONALIZED/DECEASED}
DETERMINE IF SELF OR PROXY DIABETES CARE SUPPLEMENT (DCS)
SHOULD BE DISTRIBUTED:
SELF DCS: FOR ANY CURRENT RU MEMBER (18 YEARS OR OLDER)
WHO HAS DIABETES.
PROXY DCS: FOR ANY RU MEMBER (18 OR OLDER) WHO IS
INSTITUTIONALIZED, DECEASED, OR OTHERWISE
INCAPACITATED.
CODE TYPE OF DCS DISTRIBUTED FOR (PERSON).
SELF

1

{PC03A}

PROXY

2

{PC03OV1}

DISPLAY INSTRUCTIONS:
DISPLAY PID OF PERSON BEING ASKED ABOUT FOR 'PID'.
DISPLAY DATE OF BIRTH FOR PERSON BEING ASKED ABOUT FOR
'MM/DD/YYYY.'
DISPLAY 'CURRENT' IF PERSON BEING ASKED ABOUT IS A CURRENT RU
MEMBER AND IS NOT DECEASED OR INSTITUTIONALIZED. DISPLAY
'INSTITUTIONALIZED' IF PERSON BEING ASKED ABOUT IS FLAGGED AS
'INSTITUTIONALIZED' FOR THE CURRENT ROUND. DISPLAY 'DECEASED'
IF PERSON BEING ASKED ABOUT IS FLAGGED AS 'DECEASED' FOR THE
CURRENT ROUND.
PROGRAMMER NOTES:
FLAG ALL PERSONS WHO ARE ASKED PC03 FOR DCS FOLLOW-UP IN THE
CLOSING (CL) SECTION.

3

Quality (Priority Cond) Supp. (PC) Section
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PC03OV1

Help Enabled
Variable Name
PRND.PROXYDCS

Comment Enabled

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Label

Size

REASON FOR PROXY DIABETES-DCS

CODE REASON FOR PROXY DCS.

DECEASED
INSTITUTIONALIZED

1
2

{PC03A}
{PC03A}

OTHER

3

{PC03OV2}

PC03OV2

Help Enabled
Variable Name
PRND.OTHRSPRX

Comment Enabled

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Label
OV2 OTHER REASON FOR PROXY DIABETES SAQ

SPECIFY OTHER _______________________
REASON FOR
PROXY DCS:

4

Size
20

{PC03A}

Quality (Priority Cond) Supp. (PC) Section
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PC03A

Help Enabled

Comment Enabled

Jump Back Enabled

{PERSON’S FIRST MIDDLE AND LAST NAME}
PID: {PID}

DOB: {MM/DD/YYYY}

PREPARE {SELF/PROXY} DIABETES CARE SUPPLEMENT (DCS): WRITE
IN PERSON NAME, PID, DATE OF BIRTH, AND RUID.
HAND PREPARED {SELF/PROXY} DCS TO RESPONDENT AND SAY:
We hope that {(PERSON)/you or someone else in the family} would be able to
fill out this short questionnaire on the care (PERSON) get(s) for (PERSON)'s
diabetes. {(PERSON)/You} can give it to me before I leave today, or I can pick
it up later.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY
DISPLAY
DISPLAY
IF PC03

INSTRUCTIONS:
'SELF' AND '(PERSON)' IF PC03 IS CODED ‘1’ (SELF).
'PROXY', 'you or someone else in the family' AND 'You'
IS CODED ‘2’ (PROXY).

DISPLAY PID OF PERSON BEING ASKED ABOUT FOR 'PID'.
DISPLAY DATE OF BIRTH FOR PERSON BEING ASKED ABOUT FOR
'MM/DD/YYYY.'

BOX_01B
IF ‘ASTHMA’ ON PERSON’S-MEDICAL-CONDITIONS-ROSTER, AND FLAGGED AS CREATED
IN THE PE SECTION (IN ANY ROUND), CONTINUE WITH PC04B.
OTHERWISE, GO TO BOX_03.

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Quality (Priority Cond) Supp. (PC) Section
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PC04B

Help Enabled
Variable Name
PRND.REFASTHM

Comment Enabled

Jump Back Enabled

Label

Size

CHECK REFERENCE TO ASTHMA

{PERSON'S FIRST MIDDLE AND LAST NAME}
{During an earlier interview, it was mentioned that (PERSON) (have/has)
asthma.}
Now I would like to ask you a few questions about (PERSON)’s asthma and
the course of treatment (PERSON) received.
SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS ASTHMA
REPORTED IN ERROR.
CONTINUE
(PERSON) DOES NOT HAVE ASTHMA

1
2

{PC05A}
{BOX_03}

DISPLAY INSTRUCTIONS:
DISPLAY ‘During an earlier interview....’ IF ASTHMA WAS NOT
CREATED DURING THE CURRENT ROUND. IF ASTHMA WAS CREATED DURING
THE CURRENT ROUND, USE A NULL DISPLAY.
PROGRAMMER NOTES:
DISPLAY 'PERSON' IN PURPLE IN THE ANSWER TEXT.
IF 'PERSON DOES
SET THE DATA AS
THE RESPONSE TO
DETAILED ASTHMA

NOT HAVE ASHTMA' IS SELECTED, THIS DOES NOT RERECORDED IN THE PE SECTION (PRND.PCASTHMA).
PC04B WILL DETERMINE WHETHER SUBSEQUENT
QUESTIONS ARE ASKED IN THIS PC SECTION.

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Quality (Priority Cond) Supp. (PC) Section
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PC05A

Help Enabled
Variable Name
PRND.INHALER

Comment Enabled

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Label
USED THE KIND OF PRESCRIPTION INHALER

Size
2

{PERSON’S FIRST MIDDLE AND LAST NAME}
I am going to ask you about two different kinds of asthma medicine. One is
for quick relief. The other does not give quick relief but protects your lungs
and prevents symptoms over the long term.
During the past 3 months, (have/has) (PERSON) used the kind of
prescription inhaler that you breathe in through your mouth that gives
quick relief from asthma symptoms?

YES
NO

1
2

{PC05B}
{PC06A}

----------------------------------------------------------------------------------------------------------------------------------

Refused
Don't Know

RF
DK

7

{PC06A}
{PC06A}

Quality (Priority Cond) Supp. (PC) Section
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PC05B

Help Enabled
Variable Name
PRND.USEMORE

Comment Enabled

Jump Back Enabled

Label

Size
2

USE MORE THAN THREE CANISTERS

{PERSON’S FIRST MIDDLE AND LAST NAME}
During the past 3 months, did (PERSON) use more than three canisters of
this type of inhaler?

YES

1

{PC06A}

NO

2

{PC06A}

----------------------------------------------------------------------------------------------------------------------------------

Refused
Don't Know

RF
DK

8

{PC06A}
{PC06A}

Quality (Priority Cond) Supp. (PC) Section
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PC06A

Help Enabled
Variable Name
PRND.LUNGMED

Comment Enabled

Jump Back Enabled

Label

Size
2

MEDICINE USED TO PROTECT LUNG

{PERSON’S FIRST MIDDLE AND LAST NAME}
(Have/Has) (PERSON) ever taken the preventive kind of asthma medicine
used every day to protect your lungs and keep you from having attacks?
Include both oral medicine and inhalers. This is different from inhalers used
for quick relief.
YES
NO

1
2

{PC06B}
{PC08}

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Refused
Don't Know

RF
DK

9

{PC08}
{PC08}

Quality (Priority Cond) Supp. (PC) Section
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PC06B

Help Enabled
Variable Name
PRND.DAILYMED

Comment Enabled

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Label

Size
2

TAKING MEDICATION DAILY

{PERSON’S FIRST MIDDLE AND LAST NAME}
(Are/Is) (PERSON) now taking this medication (that protects the lungs) daily
or almost daily?
YES
NO

1
2

{PC08}
{PC08}

----------------------------------------------------------------------------------------------------------------------------------

Refused
Don't Know

RF
DK

10

{PC08}
{PC08}

Quality (Priority Cond) Supp. (PC) Section
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PC08

Help Enabled
Variable Name
PRND.PEAKFLOW

Comment Enabled

Jump Back Enabled

Label

Size
2

HAVE PEAK FLOW METER AT HOME

{PERSON’S FIRST MIDDLE AND LAST NAME}
A peak flow meter measures how hard you can blow air out of your lungs.
(Do/Does) (PERSON) currently have a peak flow meter at home?
YES
NO

1
2

{PC08A}
{BOX_03}

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Refused
Don't Know

RF
DK

11

{BOX_03}
{BOX_03}

Quality (Priority Cond) Supp. (PC) Section
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PC08A

Help Enabled
Variable Name
PRND.FLWMETER

Comment Enabled

Jump Back Enabled

Label

Size
2

USED FLOW METER

{PERSON’S FIRST MIDDLE AND LAST NAME}
Did (PERSON) ever use the peak flow meter?
YES

1

{PC08B}

NO

2

{BOX_03}

----------------------------------------------------------------------------------------------------------------------------------

Refused
Don't Know

RF
DK

12

{BOX_03}
{BOX_03}

Quality (Priority Cond) Supp. (PC) Section
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PC08B

Help Enabled
Variable Name
PRND.FLOWPEAK

Comment Enabled

Jump Back Enabled

Label
PERSON LAST USE THE PEAK FLOW METER

Size
2

{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD PC-2
When did (PERSON) last use the peak flow meter? Was it within the last
seven days, more than seven days ago but within the last thirty days, or more
than thirty days ago?

WITHIN LAST 7 DAYS

1

{BOX_03}

MORE THAN 7, BUT WITHIN LAST 30
DAYS

2

{BOX_03}

MORE THAN 30 DAYS AGO

3

{BOX_03}

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Refused
Don't Know

RF
DK

BOX_03
GO TO NEXT QUESTIONNAIRE SECTION.

13

{BOX_03}
{BOX_03}