Version: Supplemental Item Set for the Adult Primary Care Questionnaire 1.0

Language: English

Response Scale: 4 points

File Name: Final HL Item Set_4pt

Last Updated: September 10, 2009

This item set was developed as a supplement to the CAHPS Clinician & Group Survey: Adult Primary Care Questionnaire 1.0. This survey is available with a 4-point and 6-point response scale.

Note regarding the Never-to-Always response scale: This questionnaire employs a four-point response – “Never/Sometimes/Usually/Always” – which is the standard scale for CAHPS surveys. An alternative six-point scale adds “Almost never” and “Almost always” to the response options. Questionnaires with the six-point scale are available for downloading at https://www.cahps.ahrg.gov/cahpskit/CG/CGChooseQX6p.asp.

A version of the questionnaire with the six-point scale has been used by several early adopters of the survey; it is also the version that was endorsed by the National Quality Forum. The CAHPS Consortium is examining the performance of the two response scales in the context of this survey.

The CAHPS Clinician & Group Survey and Reporting Kit contains complete information on preparing, fielding, analyzing, and reporting the CAHPS Clinician & Group Survey. The Survey and Reporting Kit can be accessed at https://www.cahps.ahrg.gov/cahpskit/CG/CGChooseQX.asp

Insert HL1 – HL4 after core question 14.

Please note that HL1 was formerly C3. C3 was part of the Communication supplemental items but has been updated as part of the Health Literacy Item Set.

HL1. In the last 12 months, how often were the explanations this doctor gave you hard to understand because of an accent or the way the doctor spoke English?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL2. In the last 12 months, how often did this doctor use medical words you did not understand?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL3. In the last 12 months, how often did this doctor talk too fast when talking with you?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL4. In the last 12 months, how often did this doctor use pictures, drawings, or models to explain things to you?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL5 – HL9 after core question 15

Please note that HL5 was formerly C5.

HL5. In the last 12 months, how often did this doctor ignore what you told him or her?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL6. In the last 12 months, how often did this doctor interrupt you when you were talking?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Please note that HL7 was formerly C7.

HL7. In the last 12 months, how often did this doctor show interest in your questions and concerns?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL8. In the last 12 months, how often did this doctor answer all your questions to your satisfaction?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL9. In the last 12 months, how often did this doctor give you all the information you wanted about your health?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL10 before core question 16.

Please note that HL10 was formerly C1.

HL10. In the last 12 months, how often did this doctor encourage you to talk about all your health problems or concerns?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL11 – HL15 after core question 18.

HL11. In the last 12 months, did you see this doctor for a specific illness or for any health condition?

1. □ Yes

2. □ No If No, go to core question 19

HL12. In the last 12 months, how often did this doctor give you easy to understand instructions about what to do to take care of this illness or health condition?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL13. In the last 12 months, how often did this doctor ask you to describe how you were going to follow these instructions?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL14. Sometimes doctors give instructions that are hard to follow. In the last 12 months, how often did this doctor ask you whether you would have any problems doing what you need to do to take care of this illness or health condition?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL15. In the last 12 months, how often did this doctor explain what to do if this illness or health condition got worse or came back?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL16 after core question 19.

Please note that HL16 was formerly C6.

HL16. In the last 12 months, how often did this doctor use a condescending, sarcastic, or rude tone or manner with you?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL17 – HL24 after core question 20.

HL17. In the last 12 months, how often did you feel this doctor really cared about you as a person?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL18. In the last 12 months, did this doctor prescribe any new medicines or change how much medicine you should take?

1. □ Yes

2. □ No If No, go to core question 21

HL19. In the last 12 months, how often did this doctor give you easy to understand instructions about how to take your medicines?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL20. In the last 12 months, did this doctor explain the possible side effects of your medicines?

1. □ Yes

2. □ No If No, go to #HL22

HL21. In the last 12 months, how often did this doctor explain the possible side effects of your medicines in a way that was easy to understand?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL22. In the last 12 months, other than a prescription, did this doctor give you written information or write down information about how to take your medicines?

1. □ Yes

2. □ No If No, go to #HL24

HL23. In the last 12 months, how often was the written information you were given easy to understand?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL24. In the last 12 months, how often did this doctor suggest ways to help you remember to take your medicines?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL25 after core question 22. Core items 21-22 must be used prior to HL25.

Core question 21. Did this doctor order a blood test, x-ray or other test for you?

1. □ Yes

2. □ No If No, go to core question 23

Core question 22. When this doctor ordered a blood test, x-ray or other test for you, how often did someone from this doctor's office follow up to give you those results?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL25. In the last 12 months, how often were the results of your blood test, x-ray or other test easy to understand?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Insert HL26 – HL30 after core question 23.

HL26. In the last 12 months, did you have to fill out or sigh any forms at this doctor’s office?

1. □ Yes

2. □ No If No, go to core question 24

HL27. In the last 12 months, how often did someone explain the purpose of a form before you signed it?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL28. In the last 12 months, how often were you offered help in filling out a form at this doctor’s office?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

HL29. In the last 12 months, how often were the forms that you got at this doctor’s office easy to fill out?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

Please note that HL30 is only included in the Spanish version of the Item Set

HL30. In the last 12 months, how often were the forms that you had to fill out available in Spanish?

1. □ Never

2. □ Sometimes

3. □ Usually

4. □ Always

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