CAHPS Supplemental Items
Supplemental items are optional questions that survey users can add to their standardized CAHPS instruments to meet the needs of their organizations, local markets, and/or audiences. For example, a user of the Clinician & Group Survey may want to ask patients to comment on their experiences with mental healthcare or answer additional questions about care coordination. A user of the Health Plan Survey may want to ask enrollees about their experiences with interpreter services or health education.
Supplemental Items by Topic
CAHPS supplemental items address issues of interest to certain provider types and audiences. Review the items developed for the following topics:
- Access
- Access to specialist care
- Children with chronic conditions
- Communication barriers
- Coordination of care
- Health information technology
- Health literacy
- Health promotion & education
- Improving care and services
- Information from providers
- Interpreter services
- Medical supplies
- Mental health care
- Narrative comments
- Patient-centered medical home
- People with mobility impairments
- Perceived bias
- Provider type
- Relation to policyholder
- Shared decision making
- Utilization
- Your care from specialists in the last 6 months
Supplemental Items for Specific Surveys
Only the CAHPS surveys below have specific supplemental items:
- Health Plan Survey
- Clinician & Group Survey
- Hospital Survey (HCAHPS)
- Child Hospital Survey
- Cancer Care Survey
- Home and Community-Based Services Survey
- Home Health Care Survey
- In-Center Hemodialysis Survey
CAHPS Supplemental Item Sets
Some CAHPS supplemental items that address specific topics are designed to be administered together as a set. Read descriptions of these item sets and how they are used:
- Patient Narratives.
- Patient-Centered Medical Home.
- Health Literacy.
- Health Information Technology.
- Children with Chronic Conditions.
- People with Mobility Impairments.
Uses for Supplemental Items
Supplemental items are useful for:
- Asking about domains or functions not included in the core questionnaire. For example, supplemental items ask about experiences with claims processing, health information technology, or specialists.
- Obtaining more information about different types of experiences. Supplemental items enable users to "drill down" to get details about specific aspects of care.
- Gathering information about the experiences of a specific population. For example, you can use supplemental items to ask about interpreter services for consumers who prefer a language other than.
- Examining other characteristics of respondents. For example, supplemental items can gather more information about the health status of respondents.
Some supplemental items cover events that occur with low frequency in the general population, such as the use of interpreter services. You should include them only if your sample design ensures that you will obtain enough responses to make those questions useful for your intended analysis and reporting.
Instructions When Using Supplemental Items
The lists of supplemental items include detailed instructions for placing items in specific CAHPS surveys. These instructions were designed to ensure consistency across surveys in the location and order of items and to support survey users in creating questionnaires that flow in a fashion that is consistent with how respondents think about the topics. If you plan to add your own questions, place them in a new section before the “About You” section. Adding new items prior to core items is discouraged because it creates a different context around the core items that may influence responses to the core items.
Whenever you add items, be sure to:
Reformat items: After you copy one or more supplemental items into the core questionnaire:
- Renumber the supplemental item and all subsequent items so that they are consecutive.
- Start each questionnaire with question #1 and continue sequentially.
- Do not start renumbering within sections or any other place in the survey. Use numbers only and not letters (e.g., do not use 5a, 5b, AH1, AH2).
- Revise ALL skip instructions in the questionnaire to make sure they point the respondent to the correct item number. Make sure you have already renumbered the survey items consecutively, then update the skip instructions to match the new survey item numbering.
- Skip instructions may be different from what is indicated in the item based on other supplemental items that are used.
- Skip instructions should be formatted consistently.
- Skip instructions in the formatted items often refer to “[core question] #x” where x represents an item number from the core survey. Be sure to delete “core question” and make sure the item number in the skip instructions is correct after renumbering.
- Fix the formatting of the items to fit into the two-column format if the survey will be mailed.
Maintain item order: Some supplemental items are designed to be asked together (as a set) and in the specified order. The CAHPS team strongly recommends keeping the set intact and not changing the order of items. If you choose to ask a subset of those items, please confirm that the flow of questions will make sense to a respondent.
Similarly, take care not to omit any screener questions that are designed to confirm that the items are relevant to the respondent (for example, if the item asks about experiences with care from a specialist, a screener question may ask whether the respondent saw a specialist).
Add subheadings if needed: Depending on which questions you choose, you may need to insert an appropriate subheading. The format of any new subheadings should be consistent with that of existing subheadings.
For support with adapting and inserting items into your survey:
- Visit Your CAHPS Survey Tool, which can generate a PDF of a customized survey.
- Contact the CAHPS User Network at cahps1@westat.com or 1-800-492-9261.
