Quality Supplement (QS) Section

Fall 2021

BOX_00 (QS1000)

Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60

02 Loop = LOOP_10

03 End Loop = END_LP10

04 Single Select = QS20_01, QS20_02, QS20_04, QS20_05, QS20_06

20 OS Text Field = QS20_03, QS20_07

24 Information Screen = QS10, QS20_08, QS20_09


Programmer Instructions: Placeholder for question types.


BOX_10 (QS1005)

Route Details: Context Header Display Instructions: SEE CONTEXT HEADER SPEC



BOX_20 (QS1010)

Route Details: Note: AHRQ will determine what hard copy materials are distributed and followed-up on during each round. This section needs to be configurable to allow for the addition of other supplemental materials as they are needed in future panels.

The QS section is currently asked in any round with a hard copy supplement that is eligible for data collection and Panel 24 Round 1 (Spring 2019 only). If there are no hard copy supplements eligible for data collection, CAPI will continue to the next section in the questionnaire.

DCS Collection Rules:

DCS: Distribution only in rounds that cross two calendar years or the final round of the panel (RndType=Cross or Final) for all panel years.

SAQ Collection Rules for Spring 2018 only:

SAQ (core+CAHPS): Follow-up in Panel 22, Round 3 and Panel 21, Round 5.

SAQ Collection Rules Beginning in Fall 2018 (P23R2/P22R4) and Later:

SAQ (core+CAHPS): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).

SAQ (core+CAHPS): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).

SAQ (core+CAHPS): Distribution in Rounds 6 and follow-up in Round 7 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).

SAQ (core+CAHPS): Distribution in Rounds 8 and follow-up in Round 9 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).

PSAQ (core + prevention): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).

PSAQ (core + prevention): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).

PSAQ (core + prevention): Distribution in Rounds 6 and follow-up in Round 7 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).

PSAQ (core + prevention): Distribution in Rounds 8 and follow-up in Round 9 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).

VSAQ (Veteran's SAQ): Collection Rules for Spring 2019 (P24R1, P23R3, P22R5) only:

VSAQ: Distribution only in Rounds 1, 3, and 5 for just Spring 2019.

SDOH (Social Determinants of Health): Follow-up Rules for Fall 2021 only (P26R2, P25R4, P24R6, P23R8): SDOH: Follow-up only in Rounds 2, 4, 6, and 8 Fall 2021. (Distribution occurred during the SD section in Spring 2021)



BOX_30 (QS1015)

Route Details: If at least one RU member where

DCSFlag=YES

OR

SAQFlag=YES

OR

SAQFlagFlwUp=YES

OR

PSAQFlag=YES

OR

PSAQFlagFlwUp=YES

OR

VSAQFlag=YES

OR

SDOHFlagFlwUp=YES

Continue with QS10.

Otherwise, go to BOX_60.


Programmer Instructions: Determine the number of DCS’s and (P)SAQ’s required for this household: Refer to the Global Spec item: AgeCalculation for all age calculations required for the flags. Set flags as described for each RU member that meets the required criteria.

DCS (RndType=Cross or Final)DCS (RndType=Cross or Final)

-If current round crosses two calendar years OR is the final round of the panel (RndType=Cross or final)

AND

-person is => 18 years of age or in age categories 4-9

AND

-person is a current RU member (included in person array)

AND

-person is Key (CtrlPersKey=Yes)

AND

-person is not deceased (PersRndStatus ≠Deceased)

AND

- 'DIABETES' is on person's-medical-conditions-roster and was created in the PE section (in any round), then set Person.DCSFlag=YES.

SAQ (RndType=Within), core+CAHPS)

-[(If round 2 and panel year is odd (FirstPanYear=odd)) OR (If round 4 and panel year is even(FirstPanYear=even)) OR (If round 6 and panel year is odd (FirstPanYear=odd)) OR (If round 8 and panel year is even (FirstPanYear=even))]

AND

-person is a current RU member (included in person array)

AND

- person is Key (CtrlPersKey=Yes)

AND

-person is not deceased or institutionalized (PersRndStatus ≠Deceased or institutionalized)

AND

-person is in the RU at the current round's interview date (EndRefDt = EndRefM, EndRefD, EndRefY).

AND

-RU member is = > 18 years of age or in age categories 4-9 on July 1, {YEAR}, where ‘YEAR’

is

the first calendar year of the panel (FirstPanYear), if round 2 or on July 1, {YEAR}, where ‘YEAR’ is the second calendar year of the panel (SecondPanYear), if round 4,or on July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel (ThirdPanYear), if round 6,

or on July 1, {YEAR} where 'YEAR' is the fourth calendar year of the panel (FourthPanYear), if round 8,

or has turned 18 between July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel, and the date of the interview if round 2,

or July 1, {year}, where ‘YEAR’ is the second calendar year of the panel, and the date of the interview if round 4,

or July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel, and the date of the interview if round 6,

or July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel, and the date of the interview if round 8,

then set Person.SAQFlag=YES.

SAQ Follow-up (RndType=Cross or Final, core+CAHPS)

-[(If Panel 22, Round 3 or Panel 21, Round 5) or (If current round is a round that crosses two calendar years (RndType=Cross) and panel year is odd

(FirstPanYear=odd)) OR (If current round is the final round of the panel (RndType=Final) and panel year is even (FirstPanYear=even))]

AND

-person is a current RU member (included in person array)

AND

-person was prompted for an SAQ in Round 2 (if Round 3) or 4 (if Round 5) or 6 (if Round 7) or 8 (if Round 9) and that SAQ is

outstanding [PL_Person.SAQRecCtrlStatus= ‘3’ (REFUSED), ‘5’ (BLANK), ‘6’ (WRONG TYPE), ‘7’ (WRONG YEAR USED), '8' (NOT RECEIVED)], then set

Person.SAQFlagFlwUp=YES.

PSAQ (RndType=Within, core+prevention)

-[(If round 2 or round 6 and panel year is even (FirstPanYear=even)) OR (If round 4 or round 8 and panel year is odd (FirstPanYear=odd))]

AND

-person is a current RU member (included in person array)

AND

- person is Key (CtrlPersKey=Yes)

AND

-person is not deceased or institutionalized (PersRndStatus ≠Deceased or institutionalized)

AND

-person is in the RU at the current round's interview date (EndRefDt = EndRefM, EndRefD,

EndRefY).

AND

-RU member is = > 18 years of age or in age categories 4-9 on July 1, {YEAR}, where ‘YEAR’

is

the first calendar year of the panel (FirstPanYear), if round 2

or on July 1, {YEAR}, where ‘YEAR’ is the second calendar year of the panel (SecondPanYear), if round 4,

or on July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel (ThirdPanYear), if round 6,

or on July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel (FourthPanYear), if round 8,

or has turned 18 between July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel,

and the date of the interview if round 2,

or July 1, {year}, where ‘YEAR’ is the second calendar year of the panel, and the date of the interview if round 4,

or July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel, and the date of the interview if round 6,

or July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel, and the date of the interview if round 8

then set Person.PSAQFlag=YES.

PSAQ Follow-up (RndType=Cross or Final), core+prevention)

-[(If current round is a round that crosses two calendar years (RndType=Cross)

OR

(If current round is the final round of the panel (RndType=Final) and panel year is odd (FirstPanYear=odd))]

AND

-person is a current RU member (included in person array)

AND

-person was prompted for an PSAQ in Round 2 (if Round 3) or 4 (if Round 5) or 6 (if Round 7) or 8 (if Round 9) and that PSAQ is

outstanding [PL_Person.PSAQRecCtrlStatus= ‘3’ (REFUSED), ‘5’ (BLANK), ‘6’ (WRONG TYPE), ‘7’ (WRONG YEAR USED), '8' (NOT RECEIVED)], then set Person.PSAQFlagFlwUp=YES.

VSAQ (Spring 2019, rounds 1, 3 and 5)

-If P24R1, P23R3, and P22R5 AND


QS10 (QS1020)

BLAISE NAME: FormMatrl

Question Text:

FOR THIS SECTION, YOU WILL NEED THE FOLLOWING HARDCOPY MATERIALS FOR THIS HOUSEHOLD:

{{NUMBER 1} A SURVEY ABOUT YOUR DIABETES CARE FORMS (DCS) }

{{NUMBER 2} YOUR HEALTH AND HEALTH OPINION FORMS (SAQ) }

{{NUMBER 3} YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-MALE=BLUE)}

{{NUMBER 4} YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-FEMALE=PURPLE)}

{{NUMBER 5} A SURVEY FOR VETERANS (VSAQ) }

{{NUMBER 6} Social and Health Experiences Survey (SDOH) }

PLEASE PULL THESE MATERIALS OUT NOW.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 LOOP_10 (QS1025)

Display Instructions: Display “{NUMBER 1} ... (DCS)” if at least one person where Person.DCSFlag=Yes. Otherwise, use a null display. For “NUMBER 1”, display the count of Person.DCSFlag=Yes for this RU.

Display “{NUMBER 2} ... (SAQ)” if at least one person where Person.SAQFlag=Yes or Person.SAQFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 2”, display the count of Person.SAQFlag=Yes and Person.SAQFlagFlwUp=Yes for this RU.

Display “{NUMBER 3} ... (PSAQ-MALE=BLUE)” if at least one male RU member where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 3”, display the count of male RU members where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes for this RU.

Display “{NUMBER 4} ... (PSAQ-FEMALE=PURPLE)” if at least one female (or gender=DK/RF) RU member where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 4”, display the count of female (or gender=DK/RF) RU members where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes for this RU.

Display “{NUMBER 5} ... (VSAQ)” if at least one person where Person.VSAQFlag=Yes. Otherwise, use a null display. For “NUMBER 5”, display the count of Person.VSAQFlag=Yes for this RU.

Display “{NUMBER 6} ... (SDOH)” if at least one person where Person.SDOHFlagFlwUp=Yes.

Otherwise, use a null display. For “NUMBER 6”, display the count of Person.SDOHFlagFlwUp=Yes for this RU.


LOOP_10 (QS1025)

Route Details: For each element in the RU-members-roster, ask BOX_40 - END_LP10.

Loop definition: LOOP_10 distributes all hardcopy materials to each eligible RU member.

This loop cycles on persons who meet the following conditions:

RU member has at least one of the following flags set for in the current round:

Person.DCSFlag=YES

OR

Person.SAQFlag=YES

OR

Person.SAQFlagFlwUp=YES

OR

Person.PSAQFlag=YES

OR

Person.PSAQFlagFlwUp=YES

OR

Person.VSAQFlag=YES

OR

Person.SDOHFlagFlwUp=YES

Continue with BOX_40



BOX_40 (QS1030)

Route Details: If Person.DCSFlag=YES, continue with QS20_01.

If Person.VSAQFlag=YES, go to QS20_08.

Otherwise, go to QS20_04.

Display Instructions:

Each flag that has been set should display a row for the corresponding hardcopy questionnaire.

-Display “DCS” on Col #1, Row #1 as an uneditable, protected cell

-Display “SAQ” on Col#1, Row #2 as an uneditable, protected cell

-Display “PSAQ” on Col#1, Row #3 as an uneditable, protected cell

-Display “SDOH” on Col#1, Row #4 as an uneditable, protected cell

Row #1 should display as active if Person.DCSFlag-YES.

Row #2 should display as active if Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES.

Row #3 should display as active if Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES.

Row #4 should display as active if Person.VSAQFlag=Yes and if P22R4, P23R1, P22R5.

Row #4 should display as active if Person.SDOHFlwUpFlag=YES and if P26R2, P25R4, P24R6, or P23R8.

(NOTE: An RU member will never have BOTH the SAQ and PSAQ active in the same round.)

Roster Report 1

Format the form pane column headers as follows:

Roster Definition: Display the hardcopy materials required for this RU member set at BOX_30

Col#2 Header: DCS Type (QS20_01)

Col#3 Header: Proxy Reason (QS20_02)

Col#4 Header: Proxy Other (QS20_03)

Col#5 Header: Form Available? (QS20_04)

Col#6 Header: Form Status (QS20_05)

Col#7 Header: Reason for Refusal (QS20_06)

Col#8 Header: Other Reason for Refusal (QS20_07)

Col#9 Header: Distribute Form (QS20_08)


Programmer Instructions: For each flag RU member has set (Person.DCSFlag= YES, Person.SAQFlag=YES, Person.SAQFlagFlwUp=YES, Person.PSAQFlag=YES, Person.PSAQFlagFlwUp=YES, Person.VSAQ=YES, Person.SDOHFlagFlwUp=Yes) configure the QS20 grid in the following manner:

The grid should be Preloaded Grid Type 1: forced navigation, including QS20_01, QS20_02, QS20_03, QS20_04, QS20_05, QS20_06, QS20_07, and QS20_08.

NOTE TO PROGRAMMERS: This grid needs to be configurable to accommodate the addition of other required hardcopy materials as requested by the client in future panels.


QS20_01 (QS1035)

BLAISE NAME: FormType

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

{In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members of your household. Let’s start with {you/{PERSON}}./I now have some hard copy materials for {you/{PERSON}}.}

{During an earlier interview, it/It} was mentioned that {you/{PERSON}} {have/has} diabetes. To obtain more information on the care of adults with diabetes, we have a short questionnaire for {you/him/her}.

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, OR OTHERWISE INCAPACITATED.

ENTER TYPE OF DCS DISTRIBUTED NECESSARY FOR {PERSON}. {ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS.}

CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.

Responses: SELF 1 QS20_08 (QS1070)

PROXY 2 QS20_02 (QS1040)

Programmer Instructions: RF/DK not allowed.

Display Instructions: Display ‘CURRENT’ if the person being asked about is a current RU member (Display ‘CURRENT’ if the person being asked about is a current RU member (person included on person array) and is not institutionalized or deceased (PersRndStatus≠ Institutionalized or Deceased). Display “INSTITUTIONALIZED” if the person being asked about is institutionalized (PersRndStatus=Institutionalized) for the current round.

Display “In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members your household. Let’s start with {you/{PERSON}}.” If first cycle of Loop_10. Otherwise, display “I now have some hard copy materials for {you/{PERSON}}.”

Display “and collecting” if at least one person in the RU has Person.SAQFlag=YES, or

Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES or

Person.SDOHFlagFlwUp=Yes in the current round. Otherwise, use a null display.

Display ‘you and’ if the respondent has a Person.DCSFlag=YES, or Person.SAQFlag=YES, or

Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES or

Person.SDOHFlagFlwUp=Yes in the current round. Otherwise, use a null display.

Display ‘During an earlier interview, it’ if diabetes was not created during the current round for the person being looped on. Display ‘It’ if diabetes created during the current round for the person being looped on.

Display “ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS.” if the person being asked about is institutionalized (PersRndStatus=Institutionalized) for the current round.

Otherwise, use a null display.

The label ACTION: should be displayed in the traditional interviewer instruction font size – but in red. The text after “ACTION” should be displayed in the traditional blue interviewer instruction size and color.


QS20_02 (QS1040)

BLAISE NAME: FormProxyResn

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

ENTER REASON FOR PROXY DCS.

Responses: INSTITUTIONALIZED 2 QS20_08 (QS1070)

OTHER 3 QS20_03 (QS1045)

Programmer Instructions: RF/DK not allowed.

Display Instructions:


QS20_03 (QS1045)

BLAISE NAME: FormProxyResnOS

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

SPECIFY OTHER REASON FOR PROXY DCS:

Responses: 1 QS20_08 (QS1070)

Programmer Instructions: RF/DK not allowed.

Display Instructions:


QS20_04 (QS1050)

BLAISE NAME: FormCmpl

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

{In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members of your household. Let’s start with {you/{PERSON}}./I now have some hard copy materials for {you/{PERSON}}.}

{Now} I would like to ask {you/{PERSON}} to complete a brief survey about {health and health opinions/social and health experiences}. You/{PERSON}} may have already received this in the mail.

I want to check if {you/{PERSON}} completed that questionnaire already or {need/needs} a replacement.

{IF SDOH SAQ COLLECTED, SAY: We will mail {you/him/her} $20 after the MEPS office receives the completed survey.}

{{SAQ/PSAQ/SDOH} STATUS FROM PREVIOUS ROUND: {PREVIOUS ROUND STATUS -40}}

{COLLECT {MALE (BLUE)/FEMALE (PURPLE)} PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ‘2’ (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ.}

{PERSON IS {DECEASED/INSTITUTIONALIZED/PARTIALLY ELIGIBLE - MOVED FROM RU}. IF {SAQ/PSAQ/SDOH} ALREADY COMPLETED BECAUSE IT WAS MAILED TO HOUSEHOLD, COLLECT IT.

HOWEVER, IF NOT ALREADY COMPLETED, CODE ‘3’ AND DO NOT DISTRIBUTE NEW {SAQ/PSAQ/SDOH}.} {CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.}

Responses: COMPLETED /RETURNING QUESTIONNAIRE 1 QS20_05 (QS1055)

NEEDS REPLACEMENT 2 QS20_08 (QS1070)

{NOT COMPLETED-NO REPLACEMENT NECESSARY} 3 BOX_50 (QS1075)

Programmer Instructions: RF/DK not allowed.

Display Instructions: Display “In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members your household. Let’s start with {you/{PERSON}}.” If first cycle of Loop_10 and QS20_01 was not on route for the person being looped on.

Display “I now have some hard copy materials for {you/{PERSON}}.” If not first cycle of Loop_10 and QS20_01 was not on route for the person being looped on. Otherwise (i.e., QS20_01 was on route), use a null display.

Display “and collecting” if at least one person in the RU has Person.SAQFlag=YES, or Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES or Person.SDOHFlagFlwUp=YES in the current round. Otherwise, use a null display.

Display ‘you and’ if the respondent has a Person.SAQFlag=YES, or Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES or Person.SDOHFlagFlwUp=YES in the current round. Otherwise, use a null display.

Display “Now” if QS20_01 was on route for the person being looped on. Otherwise, use a null display.

Display “health and health opinions” if asking about SAQ or PSAQ (Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES) for the person being looped on. Display “social and health experiences” if asking SDOH (Person.SDOHFlagFlwUp=YES) for the person being looped on.

Display ‘IF SDOH SAQ COLLECTED, SAY: We will mail {you/him/her} $20 after the MEPS office receives the completed survey.’ if asking about SDOH (Person.SDOHFlagFlwUp=YES). Otherwise, use a null display.

Display "{SAQ/PSAQ/SDOH} STATUS FROM PREVIOUS ROUND: {PREVIOUS ROUND STATUS -40}” if person was prompted for an SAQ/PSAQ/SDOH in previous round and that SAQ/PSAQ/SDOH is outstanding (Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=Yes or Person.SDOHFlagFlwUp=YES). Otherwise, use a null display.

Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.

Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.

Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.

For ‘PREVIOUS ROUND STATUS-40’, display the following text:

If PL_Person.SAQRecCtrlStatus=3 display 'REFUSED'.

If PL_Person.SAQRecCtrlStatus=5 display 'BLANK'.

If PL_Person.SAQRecCtrlStatus=6 display 'WRONG TYPE'.

If PL_Person.SAQRecCtrlStatus=7 display 'WRONG YEAR USED'.

If PL_Person.SAQRecCtrlStatus=8 display 'NOT RECEIVED'.

If PL_Person.PSAQRecCtrlStatus=3 display 'REFUSED'.

If PL_Person.PSAQRecCtrlStatus=5 display 'BLANK'.

If PL_Person.PSAQRecCtrlStatus=6 display 'WRONG TYPE'.

If PL_Person.PSAQRecCtrlStatus=7 display 'WRONG YEAR USED'.

If PL_Person.PSAQRecCtrlStatus=8 display 'NOT RECEIVED'.

If PL_Person.SDOHRecCtrlStatus=3 display 'REFUSED'.

If PL_Person.SDOHRecCtrlStatus=5 display 'BLANK'.

If PL_Person.SDOHRecCtrlStatus=8 display 'NOT RECEIVED'.

Display “COLLECT {MALE (BLUE)/FEMALE (PURPLE)} PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ‘2’ (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ..” If Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on. Otherwise, use a null display.

Display “MALE (BLUE)” if person being looped on is male. Otherwise, display “FEMALE (PURPLE)”.

If Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=YES or SDOHFlagFlwUp and (person is NOT in the RU at the current round's interview date (EndRefDt ≠ EndRefM, EndRefD, EndRefY)), then display FI instruction “PERSON…NEW DOCUMENT.” and response option ‘3’ (NOT COMPLETED, NO REPLACEMENT NECESSARY). Otherwise, use a null display.

Display “DECEASED” if PersRndStatus=Deceased. Display “INSTITUTIONALIZED” if PersRndStatus=Institutionalized. Otherwise, display “PARTIALLY ELIGIBLE - MOVED FROM RU.”

Display “CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.” If QS20_01 was not on route for the person being looped on. Otherwise, use a null display.


QS20_05 (QS1055)

BLAISE NAME: FormCollect

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

COLLECT {PERSON}’S COMPLETED {SAQ/PSAQ/SDOH}.

Responses: COMPLETED AND GIVEN TO INTERVIEWER 1 BOX_50 (QS1075)

{NOT COMPLETED, WILL PICK UP AT A LATER DATE} 2 BOX_50 (QS1075)

{NOT COMPLETED, WILL MAIL TO OFFICE} 3 BOX_50 (QS1075)

{MAILED TO SAQ RESPONDENT} 4 BOX_50 (QS1075)

REFUSED TO COMPLETE (NO FORM LEFT) 5 QS20_06 (QS1060)

NOT COMPLETED, COLLECT UPDATED STATUS AT RESPONDENT FORM SECTION 6 BOX_50 (QS1075)

OTHER 91

Programmer Instructions: RF/DK not allowed.

Display Instructions: Do not display response categories 2, 3, or 4. Those are reserved for the Respondent Form (RF) Section.

Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.

Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.

Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.


QS20_06 (QS1060)

BLAISE NAME: FormRfResn

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

SELECT MAIN REASON FOR REFUSAL:

Responses: TOO BUSY 1 BOX_50 (QS1075)

TOO PERSONAL/SENSITIVE INFORMATION 2 BOX_50 (QS1075)

TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP 3 BOX_50 (QS1075)

HAS ALREADY GIVEN ENOUGH INFORMATION 4 BOX_50 (QS1075)

WANTS MORE INFORMATION 5 BOX_50 (QS1075)

NOT INTERESTED 6 BOX_50 (QS1075)

NO REASON GIVEN 7 BOX_50 (QS1075)

OTHER 91 QS20_07 (QS1065)

Programmer Instructions: RF/DK not allowed.

Display Instructions:


QS20_07 (QS1065)

BLAISE NAME: FormRfOS

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

ENTER OTHER REASON FOR REFUSAL:

Responses: 1 END_LP10 (QS1080)

Programmer Instructions: RF/DK not allowed.

Display Instructions:


QS20_08 (QS1070)

BLAISE NAME: FormPrep

Context Header: {PERSON’S FIRST, MIDDLE, AND LAST NAME}

Question Text:

{In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members of your household. Let’s start with {you/{PERSON}}./I now have some hardcopy materials for {you/{PERSON}}.}

{PREPARE {SELF/PROXY} DIABETES CARE SUPPLEMENT (DCS) FOR {PERSON}: WRITE IN PERSON’S NAME, DOB, PID, AND RUID.

NAME: {FIRST NAME} {MIDDLE NAME} {LAST NAME}

DOB: {MM/DD/YYYY} PID: {PID}

RU ID: {RU ID}

STATUS: {CURRENT/INSTITUTIONALIZED}

HAND PREPARED {SELF/PROXY} DCS TO RESPONDENT AND SAY:

We hope that {you/{PERSON}}/you or someone else in the family} would be able to fill out this short questionnaire on the care {you/{PERSON}} {get/gets} for diabetes. {You/He/She} can give it to me before I leave today, or I can pick it up later.

{PREPARE {MALE (BLUE)/FEMALE (PURPLE)} {SAQ/PSAQ/VSAQ/SDOH} FOR {PERSON} USING THE INFORMATION BELOW:

REGION: {REGION} RU ID: {RU ID} PID: {PID}

NAME: {FIRST NAME} {MIDDLE NAME} {LAST NAME}{SDOH NAME: {SDOHFNAME} {SDOHLNAME}}

DOB: {MM/DD/YYYY}

HAND PREPARED {SAQ/PSAQ/VSAQ/SDOH} {AND RETURN ENVELOPE} TO RESPONDENT AND SAY:

We hope {you/{PERSON}} will be able to fill out this short questionnaire about {health and health opinions/health choices/health care needs of military veterans/social and health experiences}. {You/He/She} can give it to me before I leave today, or I can pick it up later./Once {you are finished, please/he is finished, he should/she is finished, she should} place it back in the return envelope and seal it. {You/He/She} can give it to me before I leave today, or drop it in the mail once it’s completed. We will mail {you/him/her} $20 after the MEPS office receives the completed survey.}

{CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.}

PRESS 1 AND ENTER TO CONTINUE.

HELP:F1

Responses: CONTINUE 1 BOX_50 (QS1075)

Programmer Instructions: When asking about DCS for this RU member display ‘PREPARE {SELF/PROXY} DIABETES… or I can pick it up later.’ Do not display the other fills on SAQ. When asking about SAQ use a null display.

Display 'SELF' and '{you/{PERSON}}' if QS10_01 is coded ‘1’ (SELF).

Display 'PROXY' and 'you or someone else in the family' if QS10_01 is coded ‘2’ (PROXY).

Display date of birth for person being asked about for 'MM/DD/YYYY.' Display PID of person being asked about for 'PID'.

Display the RU ID for the current case for 'RUID'.

Display ‘CURRENT’ if the person being asked about is a current RU member (person included on person array) and is not institutionalized or deceased (PersRndStatus≠ Institutionalized or Deceased). Display “INSTITUTIONALIZED” if the person being asked about is institutionalized (PersRndStatus=Institutionalized).

When asking about SAQ/PSAQ/SDOH for this RU member display ‘PREPARE {MALE (BLUE)/FEMALE (PURPLE)} {SAQ/PSAQ/SDOH} FOR {PERSON}…or I can pick it up later.’ Do not display the other fills on DCS. When asking about DCS use a null display.

Display region for the current case being asked about for ‘REGION’. Display the RU ID for the current case for 'RUID'.

Display PID of RU member being asked about for 'PID'.

Display date of birth for RU member being asked about for 'MM/DD/YYYY.'

RF/DK not allowed.

Display Instructions: Display “In this next section, I will be distributing {and collecting} some hardcopy materials for {you and} members your household. Let’s start with {you/{PERSON}}.” If first cycle of Loop_10 and QS20_01 and QS20_04 were not on route for the person being looped on. Otherwise, display "I now have some hardcopy materials for {you/{PERSON}}".

When asking about the DCS, display all the fill text in bold black, “FIRST NAME”, “MIDDLE NAME”, “LAST NAME”,“MM/DD/YYYY”,“PID”,“RUID” “CURRENT/INSTITUTIONALIZED”. All other text should adhere to the UI document specifications.

Display “SDOH NAME: {SDOHFNAME} {SDOHLNAME}”, if the person whose cell the cursor is in has an alias (Person.SDOHAliasFlag=Yes). If Person.SDOHAliasFlag<>Yes, use a null display.

When asking about the SAQ/PSAQ/VSAQ/SDOH, display all the fill text in bold black: “REGION”, “RUID”, “PID” “FIRST NAME”, “MIDDLE NAME”, “LAST NAME”, “MM/DD/YYYY”. All other text should adhere to the UI document specifications.

Display “{MALE (BLUE)/FEMALE (PURPLE)}” If Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on. Otherwise, use a null display.

Display “MALE (BLUE)” if person being looped on is male. Otherwise, display “FEMALE (PURPLE)”.

Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.

Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.

Display “VSAQ” if Person.VSAQFlag=YES for the person being looped on.

Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.

Display ‘AND RETURN ENVELOPE’ when asking about the SDOH. Otherwise, use a null display.

Display 'health and health opinions' when asking about the SAQ. Display 'health choices' when asking about PSAQ. Display ‘health care needs of military veterans’ when asking about the VSAQ. Display ‘social and health experiences’ when asking about the SDOH.

Display ‘{You/He/She} can give it to me before I leave today, or I can pick it up later.’ if asking about a form other than the SDOH. Display ‘Once {you are finished, please/he is finished, he should/she is finished, she should} place it back in the return envelope and seal it. {You/He/She} can give it to me before I leave today, or drop it in the mail once it’s completed. We will mail {you/him/her} $20 after the MEPS office receives the completed survey.’ if asking about the SDOH.

Display “CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.” If both QS20_01 and QS20_04 were not on route for the person being looped on. Otherwise, use a null display.


BOX_50 (QS1075)

Route Details: If Row #1 (DCS) completed and Person.SAQFlag=Yes or Person.SAQFlagFlwUp=Yes or Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes, go to QS20_04 to complete Row#2/Row #3 (SAQ/PSAQ) for this person.

If Row #1 (DCS) completed and Row #2/Row #3 (SAQ/PSAQ) also completed and Person.SDOHFlagFlwUp=YES, go to QS20_04 to complete Row #4 for this person.

If all rows and cells are completed for this person, continue with END_LP10.



END_LP10 (QS1080)

Route Details: Cycle on the next RU member that meets the conditions of LOOP_10.

If no more RU members meet those criteria, continue with BOX_60.



BOX_60 (QS1085)

Route Details: Go to the next questionnaire section.

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