Attachment 62 Attachment 62 HC Quality Supplement Section

SpecWriter Data

Form Version:

8/18/2017 2:42:29 PM

Report Type:

Full Detail

Project Database:
Language:

English

WESSQL6.MEPS_V2

Spec Label:

This is the cover page. Additional contents currently project specific.

QS - Page 1 of 19

MEPS_V2

Quality Supplement (QS) Section
(Rout

Full Detail Spec
BOX_00

Route Details:

(QS1000)

Type Class: If Then

Item Type: Route

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

Programmer
Instructions:

BOX_10

Route Details:

Placeholder for question types.

(QS1005)

Item Type: Route

Type Class: If Then

Context header display instructions:
Display RU member’s first, middle, and last name (Person.FullName)

QS - Page 2 of 19

MEPS_V2

Quality Supplement (QS) Section
(Rout

Full Detail Spec
BOX_20

Route Details:

(QS1010)

Item Type: Route

Type Class: If Then

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 Rounds 2 – 5. If it is Round 1, continue to the next
section in the questionnaire.
DCS Collection Rules:
DCS: Distribution only in Rounds 3 and 5 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).
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).

BOX_30

Route Details:

(QS1015)

Item Type: Route

Type Class: If Then

If at least one RU member where
DCSFlag=YES
OR
SAQFlag=YES
OR
SAQFlagFlwUp=YES
OR
PSAQFlag=YES
OR
PSAQFlagFlwUp=YES
Continue with QS10.
Otherwise, go to BOX_60.

QS - Page 3 of 19

MEPS_V2
Full Detail Spec

Programmer
Instructions:

Quality Supplement (QS) Section
(Rout

Determine the number of DCS’s and (P)SAQ’s required for this household: Set flags as
described for each RU member that meets the required criteria.
DCS (rounds 3 and 5)
-If Round 3 or Round 5
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 (rounds 2 and 4, core+CAHPS)
-[(If round 2 and panel year is odd (FirstPanYear=odd)) OR (If round 4 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 round 2 or 4 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 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, then set
Person.SAQFlag=YES.

QS - Page 4 of 19

MEPS_V2
Full Detail Spec

Quality Supplement (QS) Section
(Rout

SAQ Follow-up (rounds 3 and 5, core+CAHPS)
-[(If Panel 22, Round 3 or Panel 21, Round 5) or (If round 3 and panel year is odd
(FirstPanYear=odd)) OR (If round 5 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) 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 (rounds 2 and 4, core+prevention)
-[(If round 2 and panel year is even (FirstPanYear=even)) OR (If round 4 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 round 2 or 4 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 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,
then set
Person.PSAQFlag=YES.
PSAQ Follow-up (rounds 3 and 5, core+prevention)
-[(If round 3 and panel year is even (FirstPanYear=even)) OR (If round
5 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) 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.
QS - Page 5 of 19

MEPS_V2

Quality Supplement (QS) Section
(Rout

Full Detail Spec

QS10
Item Type:

(QS1020)
Question

Type Class:

Enumerated

Answer Type:

TContinue

Help Available (

BLAISE NAME: FormMatrl
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

)

Show Card (

ArrayMax:

Max value:

)

Look Up File (

)

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)}
PLEASE PULL THESE MATERIALS OUT NOW.
PRESS 1 AND ENTER TO CONTINUE.

Responses:

Display
Instructions:

CONTINUE

LOOP_10

(QS1025)

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.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main
Variable stored at MEPSSpring2018.QS_Main

QS - Page 6 of 19

MEPS_V2

Quality Supplement (QS) Section
(Rout

Full Detail Spec
LOOP_10

Route Details:

(QS1025)

Item Type: Route

Type Class: Begin Loop

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
Continue with BOX_40

QS - Page 7 of 19

MEPS_V2

Quality Supplement (QS) Section
(Rout

Full Detail Spec
BOX_40

Route Details:

(QS1030)

Item Type: Route

Type Class: If Then

Continue with QS20_01 if Person.DCSFlag=YES. 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
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.
(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 Self or Proxy (QS20_01)
Col#3 Header: Proxy Reason (QS20_02)
Col#4 Header: Proxy Other (QS20_03)
Col#5 Header: {SAQ/PSAQ} Prompt (QS20_04)
Col#6 Header: Status of {SAQ/PSAQ} (QS20_05)
Col#7 Header: Reason for Refusal (QS20_06)
Col#8 Header: Other Reason for Refusal (QS20_07)
Col#9 Header: Distribute DCS/{SAQ/PSAQ} (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) 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.

QS - Page 8 of 19

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec
QS20_01
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(QS1035)
Question
Enumerated
TDIABRESP

)

BLAISE NAME: FormType
Field kind: Datafield

ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

Show Card (

)

Look Up File (

)

{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
PROXY

1
2

QS - Page 9 of 19

QS20_08
QS20_02

(QS1070)
(QS1040)

MEPS_V2
Full Detail Spec

Programmer
Instructions:
Display
Instructions:

Quality Supplement (QS) Section
(Que

RF/DK not allowed.

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 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 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.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

QS - Page 10 of 19

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec
QS20_02
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(QS1040)
Question
Enumerated
TProxyDCS

BLAISE NAME: FormProxyResn
Field kind: Datafield

ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

)

Show Card (

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:
ENTER REASON FOR PROXY DCS.

Responses:

INSTITUTIONALIZED
OTHER

Programmer
Instructions:

RF/DK not allowed.

2
3

QS20_08
QS20_03

(QS1070)
(QS1045)

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

BLAISE NAME: FormProxyResnOS

QS20_03
Item Type:

(QS1045)
Question

Type Class:

String
Field Size: 45
{Continuous Answer.} Answers allowed: 1

Answer Type:

Help Available (
Context Header:

Field kind: Datafield

)

Show Card (

ArrayMin:

Min value:

ArrayMax:

Max value:

)

Look Up File (

{PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:
SPECIFY OTHER REASON FOR PROXY DCS:

QS20_08

Responses:

QS - Page 11 of 19

(QS1070)

)

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec

Programmer
Instructions:

RF/DK not allowed.

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

BLAISE NAME: FormCmpl
Field kind: Datafield
ArrayMin:

QS20_04
Item Type:
Type Class:

(QS1050)
Question

Answer Type:

TQUESTIONAIRERE Answers allowed: 1

Help Available (
Context Header:

Enumerated

)

Min value:

Field Size:

Show Card (

ArrayMax:

Max value:

)

Look Up File (

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

Responses:

COMPLETED /RETURNING
QUESTIONNAIRE
NEEDS REPLACEMENT
{NOT COMPLETED-NO REPLACEMENT
NECESSARY}

1

QS20_05

(QS1055)

2
3

QS20_08
BOX_50

(QS1070)
(QS1075)

QS - Page 12 of 19

)

MEPS_V2
Full Detail Spec

Programmer
Instructions:
Display
Instructions:

Quality Supplement (QS) Section
(Que

RF/DK not allowed.

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 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 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 "{SAQ/PSAQ} STATUS FROM PREVIOUS ROUND: {PREVIOUS ROUND STATUS -40}” if
Round 3 or 5 and person was prompted for an SAQ/PSAQ in Round 2 or 4 and that
SAQ/PSAQ is outstanding (Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=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.
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'.
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)”.
QS - Page 13 of 19

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec

If Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=YES and (person is NOT in the RU at
the round 3 or 5 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.

Testing/Editing
Notes:

QS20_05
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

(QS1055)
Question
Enumerated
TSAQCOMP

)

BLAISE NAME: FormCollect
Field kind: Datafield

ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

Show Card (

)

Look Up File (

{PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:
COLLECT {PERSON}’S COMPLETED {SAQ/PSAQ}.

Responses:

COMPLETED AND GIVEN TO
INTERVIEWER
{NOT COMPLETED, WILL PICK UP AT A
LATER DATE}
{NOT COMPLETED, WILL MAIL TO
OFFICE}
{MAILED TO SAQ RESPONDENT}
REFUSED TO COMPLETE (NO FORM
LEFT)
NOT COMPLETED, COLLECT UPDATED
STATUS AT RESPONDENT FORM
SECTION
OTHER

1

BOX_50

(QS1075)

2

BOX_50

(QS1075)

3

BOX_50

(QS1075)

4
5

BOX_50
QS20_06

(QS1075)
(QS1060)

6

BOX_50

(QS1075)

91

QS - Page 14 of 19

)

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec

Programmer
Instructions:
Display
Instructions:

RF/DK not allowed.

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.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

QS20_06
Item Type:
Type Class:

(QS1060)
Question

Answer Type:

TSAQREF

Help Available (
Context Header:

Enumerated

BLAISE NAME: FormRfResn
Field kind: Datafield
ArrayMin:

Min value:

Field Size:

)

Answers allowed: 1

Show Card (

ArrayMax:

Max value:

)

Look Up File (

{PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:
SELECT MAIN REASON FOR REFUSAL:

Responses:

TOO BUSY/NOT INTERESTED
TOO PERSONAL/SENSITIVE
INFORMATION
TOO MUCH OF A PHYSICAL/MENTAL
HARDSHIP
HAS ALREADY GIVEN ENOUGH
INFORMATION
WANTS MORE INFORMATION
NOT INTERESTED
NO REASON GIVEN
OTHER

1
2

BOX_50
BOX_50

(QS1075)
(QS1075)

3

BOX_50

(QS1075)

4

BOX_50

(QS1075)

5
6
7
91

BOX_50
BOX_50
BOX_50
QS20_07

(QS1075)
(QS1075)
(QS1075)
(QS1065)

QS - Page 15 of 19

)

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec

Programmer
Instructions:

RF/DK not allowed.

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

BLAISE NAME: FormRfOS
Field kind: Datafield
ArrayMin:

QS20_07
Item Type:
Type Class:

(QS1065)
Question

Answer Type:

{Continuous Answer.} Answers allowed: 1

Help Available (
Context Header:

String

Min value:

Field Size: 45

)

Show Card (

ArrayMax:

Max value:

)

Look Up File (

{PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:
ENTER OTHER REASON FOR REFUSAL:

END_LP10

Responses:

Programmer
Instructions:

(QS1080)

RF/DK not allowed.

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

QS - Page 16 of 19

)

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec
QS20_08
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(QS1070)
Question
Enumerated
TContinue

BLAISE NAME: FormPrep
Field kind: Datafield

ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

)

Show Card (

)

Look Up File (

{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}} {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} 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}
HAND PREPARED {SAQ/PSAQ} TO RESPONDENT AND SAY:
We hope {you/{PERSON}} will be able to fill out this short questionnaire about {health and health
opinions/health choices}. {You/He/She} can give it to me before I leave today, or I can pick it up later.
PRESS 1 AND ENTER TO CONTINUE.

Responses:

CONTINUE

BOX_50

QS - Page 17 of 19

(QS1075)

)

MEPS_V2
Full Detail Spec

Programmer
Instructions:

Quality Supplement (QS) Section
(Que

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 for this RU member display ‘PREPARE {MALE (BLUE)/FEMALE
(PURPLE)} {SAQ/PSAQ}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:

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 the SAQ/PSAQ, 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 'health and health opinions' when asking about the SAQ. Display 'health choices'
QS - Page 18 of 19

MEPS_V2

Quality Supplement (QS) Section
(Que

Full Detail Spec

when asking about PSAQ.

Testing/Editing
Notes:

BOX_50

Route Details:

Variable collected at MEPSSpring2018.QS_Main.AuxQS_Loop10.QS20.QS20Grid[1..3]
Variable stored at MEPSSpring2018.QS_Main.QS_Loop10[1..25].QS20.QS20Grid[1..3]

(QS1075)

Item Type: Route

Type Class: If Then

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

END_LP10

Route Details:

(QS1080)

Item Type: Route

Type Class: End Loop

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

Route Details:

(QS1085)

Item Type: Route

Type Class: If Then

Go to the next questionnaire section.

[End of QS]

QS - Page 19 of 19