Supplemental Items for the CAHPS Health Plan Adult Survey 5.0: People With Mobility Impairments

Population version: Adult

Download these items: English (Word, 30 KB)

Learn more about the CAHPS People With Mobility Impairments Set.

Users of the CAHPS Health Plan Survey are free to incorporate supplemental items in order to meet the needs of their organizations, local markets, and/or audiences. Some items cover events that occur with low frequency in the general population. You should include them only if your sample design is likely to yield a sufficient number of responses to those questions for statistical analysis and reporting.

Questions	Placement and Other Instructions
P-IM1. In the last 12 months, did you visit your personal doctor for care? ¹__ Yes ²__ No → If No, go to core question 17	After core question 16 Note: Use P-IM1 if using P-IM2-IM9
P-IM2. In the last 12 months, when you visited your personal doctor's office, how often were you examined on the examination table? ¹__Never ²__Sometimes ³__Usually ⁴__Always	After P-IM1 Note: Use with P-IM1
P-IM3. In the last 12 months, when you visited your personal doctor's office, how often did someone weigh you? ¹__ Never ²__ Sometimes ³__Usually ⁴__ Always	After P-IM2 Note: Use with P-IM1
P-IM4. In the last 12 months, when you visited your personal doctor's office, did you try to use the restroom? ¹__Yes ²__No → If No, go to P-IM6	After P-IM3 Note: Use with P-IM1
P-IM5. In the last 12 months, how often was it easy to move around the restroom at your personal doctor's office? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM4 Note: Use with P-IM4
P-IM6. In the last 12 months, how often did pain limit your ability to do the things you needed to do? ¹__ Never → If Never, go to P-IM8 ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM5 Note: Use with P-IM1
P-IM7. In the last 12 months, did your personal doctor ask about the impact of pain on your life? ¹__ Yes ²__No	After P-IM6 Note: Use with P-IM6
P-IM8. In the last 12 months, how often did fatigue limit your ability to do the things you needed to do? ¹__ Never → If Never, go to core question 17 ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM7 Note: Use with P-IM1
P-IM9. In the last 12 months, did your personal doctor ask about the impact of fatigue on your life? ¹__ Yes ²__ No	After P-IM8 Note: Use with P-IM8
P-IM10. In the last 12 months, did you need physical or occupational therapy? ¹__ Yes ²__ No → If No, go to P-IM12	After core question 26
P-IM11. In the last 12 months, how often was it easy to get this kind of therapy? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM10 Note: Use with P-IM10
P-IM12. In the last 12 months, did you need speech therapy? ¹__ Yes ²__ No → If No, go to P-IM14	After P-IM11
P-IM13. In the last 12 months, how often was it easy to get speech therapy? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM12 Note: Use with P-IM12
P-IM14. Mobility equipment includes things like a wheelchair, scooter, walker, or cane. In the last 12 months, have you used any mobility equipment? ¹__ Yes ²__ No → If No, go to core question 27	After P-IM13
P-IM15. In the last 12 months, did you try to get your mobility equipment repaired? ¹__ Yes ²__ No → If No, go to P-IM17	After P-IM14 Note: Use with P-IM14
P-IM16. In the last 12 months, how often was it easy to get your mobility equipment repaired? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM15 Note: Use with P-IM15
P-IM17. In the last 12 months, did you try to get or replace any mobility equipment? ¹__ Yes ²__ No → If No, go to core question 27	After P-IM16 Note: Use with P-IM14
P-IM18. In the last 12 months, how often was it easy to get or replace the mobility equipment that you needed? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After P-IM15 Note: Use with P-IM17
P-IM19. A quarter mile is about 5 city blocks or 0.4 kilometers. In the last 12 months, were you able to walk that far? ¹__ Yes ²__ No → If No, go to core question 33	After core question 32
P-IM20. In the last 12 months, did you have difficulty or need assistance walking that far? ¹__ Yes ²__ No	After P-IM19 Note: Use with P-IM19

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Supplemental Items for the CAHPS Health Plan Adult Survey 5.0: People With Mobility Impairments