Quality Supplement (QS) Section

Fall 2024

BOX_00 (QS1000)

Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_35, BOX_37, BOX_50, BOX_60

02 Loop = LOOP_10

03 End Loop = END_LP10

04 Single Select = QS05, QS20_01, QS20_02, QS20_04, QS20_06, QS20_07

20 OS Text Field = QS20_03, QS20_06OS, QS20_08

24 Information Screen = QSIntro, QS03, QS20_05



BOX_10 (QS1005)

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



QSIntro (QS1007)

BLAISE NAME: QSIntro

Question Text:

CAPI WILL NOW DETERMINE IF ANY SAQS ARE REQUIRED FOR THIS HOUSEHOLD.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_20 (QS1010)

Display Instructions:


BOX_20 (QS1010)

Route Details: Go to BOX_30.

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. Please see below for SAQ types and collection rules.

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)

CSAQ (Cancer SAQ) Collection Rules: CSAQ: Distribution in Fall 2024 Rounds 2 and 4 (P29R2, P28R4). Follow-up in Spring 2025 Rounds 3 and 5 (P29R3, P28R5).



BOX_30 (QS1015)

Route Details: If at least one RU member where:

SAQFlag=YES OR

DCSFlag=YES OR

SAQFlagFlwUp=YES OR

PSAQFlag=YES OR

PSAQFlagFlwUp=YES OR

VSAQFlag=YES OR

SDOHFlagFlwUp=YES OR

CSAQFlag=YES

Continue with BOX_35.

Otherwise, go to BOX_60.

Programmer Instructions: Determine SAQs 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)

-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

-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 or institutionalized (PersRndStatus ≠Deceased or institutionalized) AND

- person is in the RU at the round 1, 3, or 5 interview date (EndRefDt = EndRefM, EndRefD, EndRefY) AND

- RE111 or RE1102 is coded ‘2’ (NO, WAS ON ACTIVE DUTY IN THE PAST, BUT NOT NOW), ‘RF’ (REFUSED) or ‘DK’ (DON’T KNOW) for this person then set Person.VSAQFlag=YES. SDOH Follow-up

-If P26R2, P25R4, P24R6, or P23R8 AND

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

-person was prompted for an SDOH in Spring 2021 and that SDOH is outstanding [PL_Person.SDOHRecCtrlStatus= ‘3’ (REFUSED), ‘5’ (BLANK), '8' (NOT RECEIVED)], then set Person.SDOHFlagFlwUp=YES.

CSAQ (Fall 2024, Rounds 2 and 4)

-If P29R2 or P28R4 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 or institutionalized (PersRndStatus ≠Deceased or institutionalized) AND

-person is in the RU at the round 2 or 4 interview date (EndRefDt = EndRefM, EndRefD, EndRefY) AND

-one or more ‘CANCER’ conditions is on the person's-medical-conditions-roster and was created in the PE section (in any round), then set Person.CSAQFlag=YES.



BOX_35 (QS1016)

Route Details: Continue with QS03.

Programmer Instructions: For all RU members with Person.DCSFlag=YES OR Person.SAQFlagFlwUp=YES, set Person.SAQMode=2 (Paper).

For all RU members with Person.SAQFlag=YES or Person.PSAQFlag=YES or Person.CSAQFlag=YES, set Person.SAQMode:

If contact information recorded for person [(Person.EmailAddr<>Empty) OR (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING)))] set Person.SAQMode=1 (Web).

Otherwise, set Person.SAQMode=2 (Paper).

If Person.SAQMode=2 (Paper), set Person.ContactMode=4 (Paper).

For all RU members with Person.SAQMode=1 (Web), set Person.ContactMode:

If email recorded for person (Person.EmailAddr<>Empty) AND cellphone recorded with text permissions yes or pending (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING))), set Person.ContactMode=1 (Both).

If email recorded for person (Person.EmailAddr<>Empty) AND no cellphone or text permissions recorded (Person.Cellphone=Empty or (Person.CMTextCell<>1,3)), set Person.ContactMode=2 (Email).

If no email recorded for person (Person.EmailAddr=Empty) AND cellphone recorded with text permissions yes or pending (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING))), set Person.ContactMode=3 (SMS).



QS03 (QS1017)

BLAISE NAME: SAQSumm

Question Text:

RU Member SAQ Type PSAQ Status CSAQ Status SAQ Mode

{FULLNAME_1} {SAQ TYPE} {PSAQ STATUS} {CSAQ STATUS} {SAQ MODE}

{FULLNAME_2} {SAQ TYPE} {PSAQ STATUS} {CSAQ STATUS} {SAQ MODE}

{FULLNAME_3} {SAQ TYPE} {PSAQ STATUS} {CSAQ STATUS} {SAQ MODE}

{FULLNAME_4} {SAQ TYPE} {PSAQ STATUS} {CSAQ STATUS} {SAQ MODE}

{FULLNAME_N} {SAQ TYPE} {PSAQ STATUS} {CSAQ STATUS} {SAQ MODE}

MEPS sometimes asks participants to complete short personal surveys so we can hear their experiences and opinions directly.

{Thank {COMP_PERSON 1, COMP_PERSON_2, COMP_PERSON_3, COMP_PERSON_4, COMP_PERSON_N} for already completing {your/their} web survey!}

{We are asking {REQ_PERSON_1, REQ_PERSON_2, REQ_PERSON_3, REQ_PERSON_4, REQ_PERSON_N} to complete a survey about health choices. {{C_PERSON_1, C_PERSON_2, C_PERSON_3, C_PERSON_4, C_PERSON_N} will also be asked about {your/their} experiences with cancer.}}

{PLEASE PULL OUT PAPER SAQS NOW.}

PRESS 1 AND ENTER TO CONTINUE.

HELP:F1

Responses: CONTINUE 1

Programmer Instructions: If at least one RU member has eligible SAQs that have not been completed [(Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete)) or (Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible))], continue with LOOP_10.

Otherwise, go to BOX_60.

Display Instructions: Roster 1 - Report Roster definition:

This item displays RU-members-roster for display of RU-members. Display RU members’ first, middle, and last names (Person.FullName). Roster filter: Display RU-members who meet the following conditions: 1. Person is eligible for the PSAQ (Person.PSAQFlag=YES) or CSAQ (Person.CSAQFlag=YES)

Display the following columns formatted in the info in nonproportional text: Column Header #1: RU Member Display the full name (Person.FullName) of each RU member meeting the roster filter definition.

Column Header #2: SAQ Type

Display the type of SAQs each RU member is eligible for. Display "PSAQ" if Person.PSAQFlag=YES and Person.CSAQFlag≠YES. Display "PSAQ, CSAQ" if Person.PSAQFlag=YES and Person.CSAQFlag=YES.

Column Header #3: PSAQ Status

If Person.PSAQFlag=YES and Person.PSAQ_Web_Status= ‘20’ (Complete), display "Complete". If Person.PSAQFlag=YES and Person.PSAQ_Web_Status= ‘10’ (In progress), display "In Progress". Else, display "Not Started".

Column Header #4: CSAQ Status

If Person.CSAQFlag=YES and Person.CSAQ_Web_Status= ‘20’ (Complete) or '29’ (Complete, ineligible), display "Complete". If Person.CSAQFlag=YES and Person.CSAQ_Web_Status= ‘10’ (In progress), display "In Progress".

Else if Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’' (Complete, ineligible) or ‘10’ (In progress), display "Not Started". Note: This includes the situation where Person.CSAQFlag=YES and Person.CSAQ_Web_Status is empty. Else (Person.CSAQFlag≠YES), display "N/A".

Column Header #5: SAQ Mode

If RU member has completed all of their eligible SAQs [(Person.PSAQFlag=YES and Person.CSAQFlag≠YES and Person.PSAQ_Web_Status= ‘20’ (Complete)) or (Person.PSAQFlag=YES and Person.CSAQFlag=YES and Person.PSAQ_Web_Status= ‘20’ (Complete) and Person.CSAQ_Web_Status= ‘20’ (Complete) or ‘29’ (Complete, ineligible))], use a null display. Otherwise, display Person.SAQMode for each RU member. Display "Web" if Person.SAQMode=1 (Web). Display "Paper" if Person.SAQMode=2 (Paper).

Display "Thank… web survey!" if any RU member has completed all of their eligible SAQs [(Person.PSAQFlag=YES and Person.CSAQFlag≠YES and Person.PSAQ_Web_Status= ‘20’ (Complete)) or (Person.PSAQFlag=YES and Person.CSAQFlag=YES and Person.PSAQ_Web_Status= ‘20’ (Complete) and Person.CSAQ_Web_Status= ‘20’ (Complete) and Person.CSAQ_Web_Status= ‘20’ (Complete) or ‘29’ (Complete, ineligible))].

Otherwise, use a null display.

For "COMP_PERSON_1, COMP_PERSON_2, COMP_PERSON_3, COMP_PERSON_4, COMP_PERSON_N" display the first names (Person.FName) of all RU members that have completed all of their eligible SAQs [(Person.PSAQFlag=YES and Person.CSAQFlag≠YES and Person.PSAQ_Web_Status= ‘20’ (Complete)) or (Person.PSAQFlag=YES and Person.CSAQFlag=YES and Person.PSAQ_Web_Status= ‘20’ (Complete) and Person.CSAQ_Web_Status= ‘20’ (Complete) or ‘29’ (Complete, ineligible))]. Substitute "you" for the person’s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Display "your" if the people who have completed all of their eligible SAQs includes the respondent. Otherwise, display "their".

Display second paragraph "We are asking…" if any RU member has eligible SAQs that have not been completed [(Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete)) or (Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible))]. Otherwise, use a null display. For "REQ_PERSON_1, REQ_PERSON_2, REQ_PERSON_3, REQ_PERSON_4, REQ_PERSON_N" display the first names (Person.FName) of all RU members with eligible SAQs that have not been completed [(Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete)) or(Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible))]. Substitute "you" for the person’s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Display "{C_PERSON_1… experiences with cancer." if any RU member is eligible for the CSAQ and it has not been completed (Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible)). Otherwise, use a null display. For "C_PERSON_1, C_PERSON_2, C_PERSON_3, C_PERSON_4, C_PERSON_N" display the first names (Person.FName) of all RU members eligible for the CSAQ that has not completed it (Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible)). Substitute "you" for the person’s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Display "your" if the people eligible for the CSAQ includes the respondent. Otherwise, display "their".

Display "PLEASE PULL OUT PAPER SAQS NOW." if any RU member assigned to paper mode has eligible SAQs that have not been completed [Person.SAQMode= ‘2’ (Paper) AND [(Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete)) or (Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible))]]. Otherwise, use a null display.


LOOP_10 (QS1019)

Route Details: For each RU member, ask BOX_37 – END_LP10.

Loop definition: LOOP_10 introduces, distributes, or collects any eligible SAQs that have not been completed. This loop cycles on RU members who meet at least one of the following conditions: Person.DCSFlag=YES OR

Person.SAQFlag=YES OR

Person.SAQFlagFlwUp=YES OR

Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete) OR

Person.PSAQFlagFlwUp=YES OR

Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible)



BOX_37 (QS1020)

Route Details: If Person.SAQMode=1 (Web), continue with QS05. Otherwise (Person.SAQMode=2 (Paper)), go to QS20_01.



QS05 (QS1022)

BLAISE NAME: SAQWebIntro

Question Text:

We hope {you/{PERSON}} will complete a personal web survey about health choices {and experiences with cancer}. MEPS will send an invitation by text or email in the next few days that includes a link to the web survey as well as the PIN to login.

{If it is helpful, I can share the personalized PIN now so that {you/he/she} can complete the web survey anytime.

IF REQUESTED, SHARE MEPSDOCS WEBSITE AND PIN. PIN FOR {PERSON}: {M3PIN}}

Responses: CONTINUE 1 END_LP10 (QS1080)

IF VOLUNTEERED: UNWILLING TO ACCESS ONLINE SURVEY 2

Programmer Instructions: Refused and Don’t Know disallowed.

If coded ‘2’, change Person.SAQMode to ‘2’ (Paper) and Person.ContactMode to ‘4’ (Paper). Then go to QS20_01.

Display Instructions: For "PERSON" display the first name (Person.FName) of the RU member being looped on.

Display "and experiences with cancer" if Person.CSAQFlag=YES. Otherwise, use a null display.

Display "If it is helpful… M3PIN" if Person.M3PIN<>empty. Otherwise, use a null display. For "M3PIN", display Person.M3PIN.


QS20_01 (QS1035)

BLAISE NAME: FormType

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

Question Text:

{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.}

Responses: SELF 1 QS20_05 (QS1054)

PROXY 2 QS20_02 (QS1040)

Programmer Instructions: Preloaded Grid Type 1: forced navigation, including QS20_01, QS20_02, QS20_03, QS20_04, QS20_05, QS20_06, QS20_06OS, QS20_07, and QS20_08. NOTE TO PROGRAMMERS: This grid needs to be configurable to accommodate the addition of other paper SAQs as requested by the client in future panels. When creating this grid, set QS20Form for each SAQ type in the grid:

‘1’ for DCS

‘2’ for SAQ

‘3’ for PSAQ

‘4’ for VSAQ [Note: Not currently in use.]

‘5’ for SDOH [Note: Not currently in use.]

‘6’ for CSAQ

If current row is for DCS, display QS20_01 as an active cell. Otherwise, display cell as inactive. RF/DK not allowed.

Display Instructions: Roster Report 1

Roster Definition: Display the eligible SAQs that this RU member has not completed. Roster Filter:

Display a separate row for each eligible paper SAQ that has not been completed:

If Person.DCSFlag=YES and Person.SAQMode= ‘2’ (Paper), display a row for the DCS.

If [Person.SAQFlag=YES OR Person.SAQFlagFlwUp=YES] and Person.SAQMode= ‘2’ (Paper), display a row for the SAQ.

If [Person.PSAQFlag=YES and Person.PSAQ_Web_Status≠ ‘20’ (Complete)] and Person.SAQMode= ‘2’ (Paper), display a row for the PSAQ.

If [Person.CSAQFlag=YES and Person.CSAQ_Web_Status≠ ‘20’ (Complete) or ‘29’ (Complete, ineligible)] and Person.SAQMode= ‘2’ (Paper), display a row for the CSAQ.

Col#1 Header: Blank

Instructions: Display the SAQ type for current row (QS20Form). This column is protected and =uneditable.

If QS20Form= ‘1’ (DCS), display "DCS".

If QS20Form= ‘2’ (SAQ), display "SAQ".

If QS20Form= ‘3’ (PSAQ), display "PSAQ".

If QS20Form= ‘6’ (CSAQ), display "CSAQ".

Format response pane in columns with headers as follows:

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: Distribute Form (QS20_05)

Col#7 Header: Final Status (QS20_06)

Col#8 Header: Specify Status (QS20_06OS)

Col#9 Header: Refusal Reason (QS20_07)

Col#10 Header: Specify Refusal (QS20_08)

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_05 (QS1054)

OTHER 3 QS20_03 (QS1045)

Programmer Instructions: If QS20_01 is coded ‘2’ (PROXY), display QS20_02 as an active cell. Otherwise, display cell as inactive.

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_05 (QS1054)

Programmer Instructions: If QS20_02 is coded ‘3’ (OTHER), display QS20_03 as an active cell. Otherwise, display cell as inactive.

RF/DK not allowed.

Display Instructions:


QS20_04 (QS1050)

BLAISE NAME: FormCmpl

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

Question Text:

{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}.}

Responses: COMPLETED /RETURNING QUESTIONNAIRE 1 QS20_06 (QS1055)

NEEDS REPLACEMENT 2 QS20_05 (QS1054)

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

Programmer Instructions: If current row is for SAQ follow-up (Person.SAQFlagFlwUp=YES), display QS20_04 as an active cell. Otherwise, display cell as inactive.

RF/DK not allowed.

Display Instructions: 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."


QS20_05 (QS1054)

BLAISE NAME: FormPrep

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

Question Text:

{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}}/{PERSON}} {{get/gets}/gets} for diabetes. {{You/He/She}/You} can give it to me before I leave today, or I can pick it up later.}

{PREPARE {SAQ/PSAQ/CSAQ} FOR {PERSON} USING THE INFORMATION BELOW:

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

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

DOB: {MM/DD/YYYY}

We hope {you/{PERSON}} will complete a paper survey about {health and health opinions/health choices/experiences with cancer}. {{You/He/She} can give it to me before I leave today, or I can pick it up later./ I will (ship it/drop it off) soon.}

{IF REQUESTED, SHARE MEPSDOCS WEBSITE AND PIN FOR {PERSON}: {M3PIN}}

PRESS 1 AND ENTER TO CONTINUE.

HELP:F1

Programmer Instructions: Display QS20_05 as an active cell if: current row is for DCS (QS20Form= ‘1’ (DCS))

current row is for SAQ initial request (Person.SAQFlag=YES)

current row is for PSAQ (QS20Form= ‘3’ (PSAQ))

current row is for CSAQ (QS20Form= ‘6’ (CSAQ))

replacement SAQ is needed (QS20_04 is coded ‘2’ (NEEDS REPLACEMENT))

Otherwise, display cell as inactive.

RF/DK not allowed.

Display Instructions: When asking about DCS for this RU member display "PREPARE {SELF/PROXY} DIABETES…{{You/He/She}/You} can give it to me before I leave today, 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", "you/{PERSON}", "you/{PERSON}", "get/gets" and "You/He/She" if QS20_01 is coded ‘1’ (SELF). Display "PROXY", "you or someone else in the family", "{Person}", "gets" and "You" if QS20_ 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 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.

When asking about SAQ/PSAQ/CSAQ for this RU member display "PREPARE {SAQ/PSAQ/CSAQ} FOR {PERSON}… I will (ship it/drop it off) soon.}" 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". 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. If current row is for SAQ, display "SAQ" and "health and health opinions". If current row is for PSAQ, display "PSAQ" and "health choices". If current row is for CSAQ, display "CSAQ" and "experiences with cancer". If current InterviewSession.SessionMode is coded ‘1’ (IN-PERSON), display "{You/He/She} can give it to me before I leave today, or I can pick it up later." If current InterviewSession.SessionMode is coded ‘2’ (BY TELEPHONE) or ‘3’ (BY VIDEO (CAVI)), display "I will (ship it/drop it off) soon." If Person.M3PIN<>empty, display "IF REQUESTED, SHARE MEPSDOCS WEBSITE AND PIN FOR {PERSON}: {M3PIN}}". Otherwise, use a null display. For "M3PIN", display Person.M3PIN.


QS20_06 (QS1055)

BLAISE NAME: FormCollect

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

Question Text:

RECORD THE STATUS OF {PERSON}’S {SAQ/PSAQ/DCS/CSAQ}:

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_07 (QS1060)

NOT COMPLETED, WILL COLLECT AFTER INTERVIEW 6 BOX_50 (QS1075)

OTHER 91 QS20_06OS (QS1057)

Programmer Instructions: Display QS20_06 as an active cell if QS20_04 is coded ‘1’ (COMPLETED/RETURNING QUESTIONNAIRE) or QS20_05 is coded ‘1’ (CONTINUE). Otherwise, display cell as inactive.

If current row is for SAQ (QS20Form= ‘2’ (SAQ)), save the answer to this item as Person.SAQ_CAPI_Status.

If current row is for PSAQ (QS20Form= ‘3’ (PSAQ)), save the answer to this item as Person.PSAQ_CAPI_Status.

If current row is for DCS (QS20Form= ‘1’ (DCS)), save the answer to this item as Person.DCS_CAPI_Status.

If current row is for CSAQ (QS20Form= ‘6’ (CSAQ)), save the answer to this item as Person.CSAQ_CAPI_Status.

RF/DK not allowed.

Display Instructions: If current row is for SAQ (QS20Form= ‘2’ (SAQ)), display "SAQ". If current row is for PSAQ (QS20Form= ‘3’ (PSAQ)), display "PSAQ". If current row is for DCS (QS20Form= ‘1’ (DCS)), display "DCS. If current row is for CSAQ (QS20Form= ‘6’ (CSAQ), display "CSAQ".


QS20_06OS (QS1057)

BLAISE NAME: FormCollectOS

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

Question Text:

SPECIFY OTHER STATUS

Responses: 1 BOX_50 (QS1075)

Programmer Instructions: If QS20_06 is coded ‘91’ (OTHER), display QS20_06OS as an active cell. Otherwise, display cell as inactive. Refused and Don’t Know disallowed.

Display Instructions:


QS20_07 (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_08 (QS1065)

Programmer Instructions: If QS20_06 is coded ‘5’ (REFUSED TO COMPLETE), display QS20_07 as an active cell. Otherwise, display cell as inactive.

RF/DK not allowed.

Display Instructions:


QS20_08 (QS1065)

BLAISE NAME: FormRfOS

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

Question Text:

ENTER OTHER REASON FOR REFUSAL:

Responses: 1 BOX_50 (QS1075)

Programmer Instructions: If QS20_07 is coded ‘91’ (OTHER), display QS20_08 as an active cell. Otherwise, display cell as inactive.

RF/DK not allowed.

Display Instructions:


BOX_50 (QS1075)

Route Details: If person has other eligible SAQs in the grid, continue to the next row.

If all rows 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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