CAHPS Clinician and Group Survey

®

CAHPS Clinician & Group Survey
Version: 3.0
Population: Adult
Language: English

Notes

• References to “this provider” rather than “this doctor:” This survey uses “this provider”

to refer to the individual specifically named in Question 1. A “provider” could be a doctor,
nurse practitioner, physician assistant, or other individual who provides clinical care. Survey
users may change “provider” to “doctor” throughout the questionnaire. For guidance, please
see Preparing a Questionnaire Using the CAHPS Clinician & Group Survey.

• Supplemental items: Survey users may add questions to this survey. Documents with

supplemental items developed by the CAHPS Consortium and descriptions of major item
sets are available on the Agency for Healthcare Research and Quality’s Web site:
www.cahps.ahrq.gov.

For assistance with this survey, please contact the CAHPS Help Line at 800-492-9261 or
cahps1@westat.com.

File name: Adult_Eng_CG30_2351a.docx
Last updated: July 1, 2015

CAHPS Clinician & Group Adult Survey 3.0

Documents Available for the CAHPS Clinician & Group Survey
This document is part of a comprehensive set of instructional materials that address implementing the
Clinician & Group Survey, analyzing the data, and reporting the results. All documents are available on the
Agency for Healthcare Research and Quality’s Web site: www.cahps.ahrq.gov. For assistance in accessing
these documents, please contact the CAHPS Help Line at 800-492-9261 or cahps1@westat.com.

For descriptions of these documents, refer to: What's Available for the Clinician & Group Survey.

Questionnaires
•
•
•

CAHPS Clinician & Group Survey:
Overview of the Questionnaires
Clinician & Group Survey 3.0 (Adult and
Child, English and Spanish)
Clinician & Group Survey 2.0 (Adult and
Child, English and Spanish)
o 12-Month Survey 2.0
o Patient-Centered Medical Home Survey
2.0
o Visit Survey 2.0

Supplemental Items
•
•
•
•
•
•

Supplemental Items for the Adult Survey
Supplemental Items for Child Survey
About the Health Literacy Item Set for
Clinicians & Groups
About the Cultural Competence Item Set
About the Health Information Technology
Item Set
About the Patient-Centered Medical Home
(PCMH) Item Set

Adult_Eng_CG30_2351a.docx

Survey Administration Guidelines
•
•
•
•
•

Preparing a Questionnaire Using the
CAHPS Clinician & Group Survey
Fielding the CAHPS Clinician & Group
Survey
Sample Notification Letters for the CAHPS
Clinician & Group Survey
Sample Telephone Script for the CAHPS
Clinician & Group Survey
Translating CAHPS Surveys

Data Analysis Program and Guidelines
•

CAHPS Analysis Program (SAS)

•

Preparing and Analyzing Data from the
CAHPS Clinician & Group Survey
Instructions for Analyzing Data from
CAHPS Surveys

•

Reporting Measures and Guidelines
•

Patient Experience Measures for the
CAHPS Clinician & Group Survey

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CAHPS Clinician & Group Adult Survey 3.0

Instructions for Front Cover
• Replace the cover of this document with your own front cover. Include a user-friendly title
and your own logo.

• Include this text regarding the confidentiality of survey responses:
Your Privacy is Protected. All information that would let someone identify you or
your family will be kept private. {VENDOR NAME} will not share your personal
information with anyone without your OK. Your responses to this survey are also
completely confidential. You may notice a number on the cover of the survey. This
number is used only to let us know if you returned your survey so we don’t have to
send you reminders.
Your Participation is Voluntary. You may choose to answer this survey or not. If
you choose not to, this will not affect the health care you get.
What To Do When You’re Done. Once you complete the survey, place it in the
envelope that was provided, seal the envelope, and return the envelope to [INSERT
VENDOR ADDRESS].
If you want to know more about this study, please call XXX-XXX-XXXX.

Instructions for Format of Questionnaire
Proper formatting of a questionnaire improves response rates, the ease of completion, and the
accuracy of responses. The CAHPS team’s recommendations include the following:

• If feasible, insert blank pages as needed so that the survey instructions (see next page)
and the first page of questions start on the right-hand side of the questionnaire booklet.

• Maximize readability by using two columns, serif fonts for the questions, and ample white
space.

• Number the pages of your document, but remove the headers and footers inserted to help
sponsors and vendors distinguish among questionnaire versions.

Additional guidance is available in Preparing a Questionnaire Using the CAHPS Clinician &
Group Survey.

Adult_Eng_CG30_2351a.docx

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CAHPS Clinician & Group Adult Survey 3.0

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
No

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CAHPS Clinician & Group Adult Survey 3.0

Your Provider
1.

Your Care From This Provider in the
Last 6 Months

Our records show that you got care from
the provider named below in the last 6
months.

These questions ask about your own health
care. Do not include care you got when you
stayed overnight in a hospital. Do not include
the times you went for dental care visits.

Name of provider label goes here

4.

Is that right?
1
2

Yes
No → If No, go to #23 on page 4

In the last 6 months, how many times did
you visit this provider to get care for
yourself?
None → If None, go to #23 on
page 4
1 time
2
3
4
5 to 9
10 or more times

The questions in this survey will refer to the
provider named in Question 1 as “this provider.”
Please think of that person as you answer the
survey.
2.

Is this the provider you usually see if you
need a check-up, want advice about a health
problem, or get sick or hurt?
1
2

3.

5.

Yes
No

How long have you been going to this
provider?
1
2
3
4
5

In the last 6 months, did you contact this
provider’s office to get an appointment for
an illness, injury, or condition that needed
care right away?
1
2

Less than 6 months
At least 6 months but less than 1 year
At least 1 year but less than 3 years
At least 3 years but less than 5 years
5 years or more

6.

In the last 6 months, when you contacted
this provider’s office to get an appointment
for care you needed right away, how often
did you get an appointment as soon as you
needed?
1
2
3
4

Adult_Eng_CG30_2351a.docx

1

Yes
No → If No, go to #7

Never
Sometimes
Usually
Always

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CAHPS Clinician & Group Adult Survey 3.0

7.

1
2

8.

1

Yes
No → If No, go to #9

2
3
4

In the last 6 months, when you made an
appointment for a check-up or routine
care with this provider, how often did you
get an appointment as soon as you needed?
1
2
3
4

9.

11. In the last 6 months, how often did this
provider explain things in a way that was
easy to understand?

In the last 6 months, did you make any
appointments for a check-up or routine
care with this provider?

12. In the last 6 months, how often did this
provider listen carefully to you?

Never
Sometimes
Usually
Always

1
2
3
4

In the last 6 months, did you contact this
provider’s office with a medical question
during regular office hours?
1
2

Yes
No → If No, go to #11

1
2

4

10. In the last 6 months, when you contacted
this provider’s office during regular office
hours, how often did you get an answer to
your medical question that same day?
2
3
4

Never
Sometimes
Usually
Always

13. In the last 6 months, how often did this
provider seem to know the important
information about your medical history?

3

1

Never
Sometimes
Usually
Always

Never
Sometimes
Usually
Always

Never
Sometimes
Usually
Always

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CAHPS Clinician & Group Adult Survey 3.0

14. In the last 6 months, how often did this
provider show respect for what you had to
say?
1
2
3
4

18. Using any number from 0 to 10, where 0 is
the worst provider possible and 10 is the
best provider possible, what number would
you use to rate this provider?

Never
Sometimes
Usually
Always

0 Worst provider possible
1
2
3
4
5
6
7
8
9
10 Best provider possible

15. In the last 6 months, how often did this
provider spend enough time with you?
1
2
3
4

Never
Sometimes
Usually
Always

16. In the last 6 months, did this provider order
a blood test, x-ray, or other test for you?
1
2

19. In the last 6 months, did you take any
prescription medicine?

Yes
No → If No, go to #18

1
2

17. In the last 6 months, when this provider
ordered a blood test, x-ray, or other test for
you, how often did someone from this
provider’s office follow up to give you
those results?
1
2
3
4

20. In the last 6 months, how often did you and
someone from this provider’s office talk
about all the prescription medicines you
were taking?
1

Never
Sometimes
Usually
Always

Adult_Eng_CG30_2351a.docx

Yes
No → If No, go to #21

2
3
4

3

Never
Sometimes
Usually
Always

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CAHPS Clinician & Group Adult Survey 3.0

Clerks and Receptionists at This
Provider’s Office

About You
23. In general, how would you rate your overall
health?

21. In the last 6 months, how often were clerks
and receptionists at this provider’s office as
helpful as you thought they should be?
1
2
3
4

1
2

Never
Sometimes
Usually
Always

3
4
5

24. In general, how would you rate your overall
mental or emotional health?

22. In the last 6 months, how often did clerks
and receptionists at this provider’s office
treat you with courtesy and respect?
1
2
3
4

Excellent
Very good
Good
Fair
Poor

1
2

Never
Sometimes
Usually
Always

3
4
5

Excellent
Very good
Good
Fair
Poor

25. What is your age?
1
2
3
4
5
6
7

18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older

26. Are you male or female?
1
2

Adult_Eng_CG30_2351a.docx

4

Male
Female

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CAHPS Clinician & Group Adult Survey 3.0

30. Did someone help you complete this
survey?

27. What is the highest grade or level of school
that you have completed?
1
2
3
4
5
6

1

8th grade or less
Some high school, but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree

2

31. How did that person help you? Mark one or
more.

28. Are you of Hispanic or Latino origin or
descent?
1
2

1
2
3

Yes, Hispanic or Latino
No, not Hispanic or Latino

4
5

29. What is your race? Mark one or more.
1
2
3
4
5
6

Yes
No → Thank you.
Please return the completed
survey in the postage-paid
envelope.

Read the questions to me
Wrote down the answers I gave
Answered the questions for me
Translated the questions into my
language
Helped in some other way

White
Black or African American
Asian
Native Hawaiian or Other Pacific
Islander
American Indian or Alaska Native
Other

Thank you.
Please return the completed survey in the postage-paid envelope.

Adult_Eng_CG30_2351a.docx

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