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Request for Proposal

Emergency Department Patient Experience of Care (EDPEC) Survey

1. Introduction

The Health Quality Council of Alberta (HQCA) is an independent organization legislated under the Health Quality Council of Alberta Act with a mandate to promote and improve patient safety and health service quality across the province of Alberta. Through partnerships and collaboration, the HQCA is committed to achieving excellence in all dimensions of quality and safety across Alberta’s health system.

1.1. Background

As part of its mandate to measure and monitor the healthcare system, the HQCA is undertaking an initiative to report emergency department (ED) performance data to stakeholders and the public on an ongoing quarterly basis. This project is intended to produce timely and reliable information with which to monitor the quality of the emergency department, recognize success, and direct improvement opportunities.

One aspect of this project involves surveying Albertans about their experience of care at the province’s busiest urban and regional emergency departments. A modified version of the Emergency Department Patient Experience of Care (EDPEC) survey (created by the RAND Corporation) will be used.

The HQCA’s EDPEC survey involves two separate instruments intended for use among specific patient populations. The full Discharged to Community Instrument includes 50 closed-ended questions. Similarly, the full Admitted Stand Alone Instrument includes 44 closed-ended questions. Copies of these instruments (intended for adult respondents) can be found in Appendix C (pediatric versions of these surveys will be provided to the successful vendor).

1.2. Project

The HQCA is seeking a vendor to conduct ongoing EDPEC surveying by phone. For future consideration, an electronic or web-based version of this survey may be offered; vendor capabilities in this area of data collection would be considered an asset.

The survey will be conducted using a semi-continuous process. The HQCA will draw samples of ED patients every two weeks from the entire population of patients who visited the ED. ED patients will be surveyed approximately two weeks post discharge (from ED or hospital).

Samples will be stratified by discharge disposition (i.e., admitted to hospital versus discharged to community), ensuring respondents receive the appropriate version of the survey. Samples consisting of 80 to 100 completed surveys per site (see Appendix A for a list of included sites) per month are required by the HQCA; resulting in 15,360 to 19,200 patients surveyed per year.

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The expected raw response rate (based on previous mail-based ED patient experience surveys and the response rate of the HCAHPS phone survey protocol) is between 55 and 65 per cent.

2. Scope of work

The successful vendor will be expected to conduct a mixed-mode (primarily phone, and potentially an electronic or web-based process in the future) survey of ED patients according to specified protocols and procedures (Appendix B), capture the data from this survey, and generate a data file according to the HQCA’s specifications. Related analysis and reporting will be conducted by the HQCA and is not part of this RFP.

2.1. Project deliverables

2.1.1. The vendor will be responsible for programming and testing of the survey script and calling protocol into a CATI system; training and management of survey interviewers, and management of any issues that may arise in the interview and survey process. The final CATI script must be approved by the HQCA, with provision of a full test data extract complete with code responses for all possible response choices and question flows.

2.1.2. Surveys will be entered directly into a CATI system by the interviewer.

2.1.3. The vendor will provide a fully labeled SPSS (version 21 or later) data file as specified in Appendix B. This data file must include all survey questions including any open ended responses (coded), any derived variables, and the study ID (to connect to the administrative data file) on a monthly basis (that is, after the completion of two survey waves).

2.1.4. An additional data file of open ended items must be provided for all records on a monthly basis (after two waves), and must include the study ID number and variable number for all open-ended items. Text comments must be captured verbatim.

2.1.5. A survey administrative data file of all sampled records (full sample frame) will be provided for documentation of the survey process. Required variables and disposition codes for this data file are provided in Appendix D, and these include the study ID. This file must be provided to the HQCA on a monthly basis (that is, after the completion of two waves).

2.1.6. A methodology report must be provided to the HQCA at the end of each year of surveying. This report will document a) the final survey dispositions of all sampled patients by site and disposition-specific survey instrument; b) any deviations from the protocol; and c) any issues that arose in the course of conducting the survey.

2.2. Time frames

The HQCA has an aggressive timeline for this project. We anticipate going into the field by January 25, 2016. This is a multi-year, ongoing survey, with a completion date not yet determined.

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3. Methodology

The survey methodology is fully documented in Appendix B. The HQCA expects minimal deviations from this protocol. For the purpose of this document, the survey instruments/scripts provided are considered to be part of the protocol. Final formatted versions will be provided to the successful vendor prior to going into the field.

4. Fee proposal

4.1. The fee proposal shall include the total fees and recoverable expenses, including a detailed breakdown of professional fees, staff hours for each component of the project, per unit material costs, travel, and other expenses for the following components:

4.1.1. Project deliverables are as listed in section 2.1 and section 3.0 above, as well as Appendix B.

4.2. Also included should be an anticipated payment schedule with each fee item attached to a specific deliverable.

4.3. The vendor shall provide the cost for the projected yearly sample of 15,360 to 19,200 emergency department patients. The proposal must address in detail how costs will be adjusted to reflect the actual number of patients included in the survey process. Costs should be provided for a range of sample sizes and presented in table format.

5. Proposal format

5.1. Vendor understanding of the HQCA and the requirements for the Emergency Department Patient Experience of Care (EDPEC) Survey Project.

5.2. Project approach and methodology including a detailed outline of the approach to be used including processes, methods, workflow, tasks, data collection methodology, and project timeline.

5.3. Vendor’s relevant experience to include previous related projects, deliverables, and timeframes.

5.3.1. References – a list of three references of clients who can attest to the firm’s ability to complete the required work.

5.4. Engagement team to include a description of the personnel assigned, including resumes, availability, qualifications, responsibilities, and an estimate of hours by activity for each individual. Include the structure of the team for the project.

5.5. Detailed fee proposal as noted above.

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6. Proposal evaluation and response rules

6.1. All submissions shall be firm proposals and may not be withdrawn for a period of sixty (60) days following the last day to accept proposals. Proposals and documents submitted by the vendor will remain the property of the HQCA and will not be returned.

6.2. Acceptance/Rejection of Responses:

6.2.1. The HQCA reserves the right to cancel this RFP at any time and to reissue it for any reason without incurring liability and with no vendor having any claim against the HQCA as a consequence.

6.2.2. The HQCA reserves the right to reject any or all proposals; the lowest fee proposal will not necessarily be awarded a contract.

6.2.3. All vendors submitting proposals will be advised of the contract award.

6.3. Evaluation – the HQCA will establish a selection committee that will evaluate all proposals that are submitted by the deadline.

Evaluation criteria will include:

6.3.1. Vendor experience and capability

6.3.1.1. Relevant survey experience in the past three (3) years 6.3.1.2. Best practice/current thinking 6.3.1.3. Capacity to do the work

6.3.2. Project Team

6.3.2.1. Overall experience of team members 6.3.2.2. Experience specific to this type of project 6.3.2.3. Ability to complete project on time and meet deliverables

6.3.3. Methodology

6.3.3.1. Proposed tools and methodology, including recognition of any difficulties associated with the project, and plans to address such difficulties

6.3.3.2. Demonstrated understanding of the project requirements

6.3.4. Vendor privacy policies and procedures

6.3.4.1. Demonstrated ability to comply with Alberta privacy legislation (Health Information Act, and Freedom of Information and Protection of Privacy Act)

6.3.5. Fee proposal

6.3.6. References

6.4. Any and all addenda to this proposal call will be issued in writing and sent to all firms having received documents from the HQCA prior to the closing deadline.

6.5. The selected vendor will be required to enter into a contract with the HQCA.

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6.6. Closing of Proposal:

6.6.1. Firms may not submit new price proposals after the specified deadline.

6.6.2. Amendments to submitted proposals must be received in writing prior to the deadline date.

6.6.3. All addenda issued during the time of the Request, and in closing, the addenda will become part of the contract along with the response to the proposal.

6.7. Interviews – vendors may be required to attend an interview to discuss the responses to the Request for Proposal. The HQCA will notify the selected vendors for an interview if required.

6.8. Deadline for submission

6.8.1. Vendors are to deliver their responses no later than Monday January 4, 2016 by 4:30 pm MST by email to:

Dianne.Schaeffer@hqca.ca

Note: It is the responsibility of the vendor to confirm receipt of emailed materials.

All proposals received after this time will be rejected.

6.8.2. Each proposal shall show the full legal name and business address of the vendor, including street address if it differs from the mailing address and shall be signed with the signature of the person/persons authorized to bind the vendor and shall be dated.

6.8.3. All costs/expenses will be the sole responsibility of the vendor submitting the proposal. Each response must be duly signed and sealed and will be deemed irrevocable for 60 days after the deadline date. Fax copies will not be accepted.

6.9. All proposals must be clearly marked “Request for Proposal for Emergency Department Patient Experience of Care (EDPEC) Survey”.

6.10. Vendors must identify any terms and conditions of this Request with which they are unable to comply. It will be assumed that the vendor accepts all terms and conditions unless otherwise noted and that all terms and conditions will form part of the contract.

7. Confidentiality and use of information

7.1. All proposals received are confidential and shall be treated as such. All documents submitted to the HQCA are subject to the protection and disclosure provisions of the Alberta Freedom of Information and Protection of Privacy Act (FOIPPA) and the Health Information Act (HIA). While these Acts allow a person a right of access to records in the HQCA’s custody or control, it also prohibits the HQCA from disclosing personal or business information where disclosure would be harmful to business interests or would be an unreasonable invasion of personal privacy. Applicants are encouraged to identify what portions of their submissions are confidential and what harm could reasonably be expected from its disclosure.

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7.2. The Acts named above can be obtained through the Alberta Queen’s Printer Bookstore or website: http://www.qp.alberta.ca

7.3. The selected vendor is required to manage identifiable health information in compliance with the HIA and FOIPPA, as an agent under contract with the HQCA. Specific confidentiality and privacy requirements are included in the service contract. These requirements will apply to all sub-contractors, and all subcontractors engaged by the vendor must be identified clearly to the HQCA.

7.4. All disclosures of health information and survey data to a location other than the principle location of the vendor must be disclosed to the HQCA in detail in the proposal and require HQCA approval prior to transfer of data.

7.5. The records stipulated in this Agreement as being required to be maintained or submitted by the vendor may be subject to the protection and access provisions of FOIPPA and HIA. Should the HQCA receive a request for any of these records, it would be the vendor’s responsibility to provide the records, at their expense, to the HQCA within five (5) calendar days from official notification by the HQCA.

The purpose for collection of the personal information required to be provided in the Agreement is to enable the HQCA to ensure the accuracy and reliability of the proposal. Any questions about the collection of your personal information should be directed to Charlene McBrien-Morrison at (403) 297-8274, or email charlene.morrison@hqca.ca.

8. Professional liability insurance

8.1. The Vendor shall, at its own expense and without limiting its liabilities herein, insure its operations under a contract of General Liability Insurance, in accordance with the Alberta Insurance Act, in an amount not less than $2,000,000.00 inclusive per occurrence, insuring against bodily injury, personal injury, and property damage including loss of use thereof and shall provide evidence of such insurance to the HQCA upon request.

8.2. Throughout the term of this Agreement the Vendor shall maintain professional liability insurance in an amount of not less than $2,000,000.00 and shall provide evidence of such insurance to the HQCA upon request.

8.3. The Vendor shall maintain automobile liability insurance on all vehicles owned, operated or licensed in the name of the Contractor in an amount not less than $2,000,000.00 and the Contractor shall provide evidence of such insurance to the HQCA upon request.

9. Clarifications

9.1. Clarifications regarding this RFP can be requested by email to: Benjamin.Higgins@hqca.ca. Please include “Emergency Department Patient Experience of Care Survey RFP” in the title line.

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10. Project Timeline

The closing date and time for proposals is Monday, January 4, 2016 by 4:30 p.m. MST.

Activity Deadline RFP issued December 10, 2015 Proposals due January 4, 2016, 4:30 pm MST. Analysis and evaluation of proposals January 5-6, 2016 Successful vendor contacted January 8, 2016 Contract signed with successful firm Week of January 11-15, 2016 Sample data and contact info sent to vendor Week of January 18-22 Survey in field January 25, 2016 or sooner

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Appendix A: Included Emergency Department Sites

Community Site Name

Lethbridge Chinook Regional Hospital

Medicine Hat Medicine Hat Regional Hospital

Calgary Alberta Children’s Hospital

Calgary Foothills Medical Centre

Calgary Peter Lougheed Centre

Calgary Rockyview General Hospital

Calgary South Health Campus

Red Deer Red Deer Regional Hospital

Edmonton Grey Nun’s Community Hospital

Edmonton Misericordia Community Hospital

Edmonton Stollery Children’s Hospital

Edmonton Sturgeon Community Hospital

Edmonton Royal Alexandra Hospital

Edmonton University of Alberta Hospital

Fort McMurray Northern Lights Regional Health Centre

Grande Prairie Queen Elizabeth II Hospital

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Appendix B: Survey Process and Protocol

B.1. Survey tools

Draft versions of the survey instruments are provided in Appendix C. The final survey instruments may vary from the initial versions provided and will be sent to the vendor prior to going into the field with the survey. Any modifications made to the survey tools by the HQCA will not add notably to length or number of items. Only very minor changes to formatting of the survey tools are acceptable by the vendor (e.g., to accommodate different software), and must be approved by the HQCA. Major changes are not permitted. Questions and wording may not be altered.

The survey instruments provided have been designed following Consumer Assessment of Healthcare Providers and Systems (CAHPS) principles for use with patients who have visited the emergency department. Minimal revision work was performed and a small number of additional items were included to capture the unique Alberta context.

B.2. Respondent eligibility

General inclusion criteria

• Emergency department patients who visited one of the 16 selected emergency departments (Appendix A) during the two-week sample period of interest

• Patients selected from the 14 adult emergency department sites are 16 years of age or older

• Patients selected from the two pediatric emergency department sites are 15 years of age or younger

General exclusion criteria

• Patients who left without being seen or treated • Patients who died in the context of their emergency department stay • Patients without contact information • Privacy-sensitive cases, such as domestic abuse1

B.3. Pediatric Provisions

Patients 15 years of age or younger who visited a children’s hospital will be provided with a slightly modified version of the adult surveys, designed to collect responses from a family member (proxy) on behalf of the child who was the patient. Parents of sampled pediatric emergency department patients will be instructed that if their child is mature enough to answer the questions, they may complete the questionnaire (with support as needed); however, if their child is unable to complete the survey on their own, the person who visited the emergency department with the child should complete the survey from the child’s point of view.

B.4. Sample

The survey will be conducted using a semi-continuous process. The HQCA will draw samples of ED patients every two weeks. ED patients will be sampled from the entire population of patients who visited the ED during the preceding two-week interval. ED patients will be surveyed approximately two weeks post discharge (from ED or hospital).

1 More information regarding privacy-sensitive cases will be provided to the successful vendor.

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Samples will be stratified by discharge disposition (i.e., admitted to hospital versus discharged to community), ensuring respondents receive the appropriate version of the survey. In order to ensure that the HQCA does not survey the same patients selected for AHS’ HCAHPS survey (reducing respondent burden), the HQCA will receive the HCAHPS sample from AHS staff and, for any cases that are sampled in both survey processes, replace them in the HQCA sample. Importantly, the HQCA will replace these patients with the next randomly selected admitted patient to prevent the proportion of admitted patients from being reduced (as there are many more discharges than admissions).

Samples consisting of between 80 and 100 completed surveys per site (see Appendix A for a list of included sites) per month are required by the HQCA; this works out to be between 15,360 and 19,200 patients surveyed per year. A cost adjustment table must be provided by the vendor to specify exact costs should sample size be increased or decreased.

B.5. Survey Protocol

This survey will use phone as the modality. The expected raw response rate (based on previous mail-based ED patient experience surveys and the response rate of the HCAHPS phone survey protocol) is between 55 and 65 per cent.

To ensure a high participation rate, telephone numbers of sampled patients will be dialed between six and nine times or until a final disposition (such as a completed interview or a final refusal) is obtained. Telephone numbers will be called on various days and at different times of the day and week in order to increase the likelihood of securing an interview. Up to two scheduled call backs at respondent request should be allowed as part of protocol. Specifics of the survey protocol can be negotiated with the successful vendor.

Vendor requirements

B.5.1. Each sampled respondent must have a unique Study ID, to be tracked throughout the entire process which links all survey data with all required administrative data.

B.5.2. Final CATI script must be approved by the HQCA, with provision of a full test data extract complete with coded responses for all possible response choices and question flows.

B.5.3. The survey scripts provided in Appendix C may be used, or a form may be designed by the vendor as long as layout is the same or nearly the same as Appendix C. Final versions must be approved by the HQCA.

B.5.4. Provision of a no charge phone number to respond to basic questions from potential respondents (simple clarification about meaning of items, instructions, or procedures).

B.5.5. Procedure to triage and refer more complex questions to the designated HQCA contact if required.

B.6. Record level tracking and documentation of survey process and dispositions

B.6.1. The survey process must be documented with the variables provided in Appendix D (as a minimum).

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B.6.2. Current disposition of the respondent must be kept up to date such that responders are not phoned after they have already completed the survey. Record dispositions must be up to date prior to each stage of the process.

B.7. Data Capture

B.7.1. Completed survey responses will be entered directly into a CATI system by the interviewer during the interview process.

B.7.2. Data resulting from different survey instruments must be identified according to a “source” variable which specifies how the survey data was collected (i.e., DISCH- phone, ADM_FULL-phone).

B.7.3. Variable names should reflect question number and, where possible, should be based on, and identical with, the full ‘Discharged to Community Instrument’.

B.7.4. Some variables unique to the specific survey instruments will have different unique variable names; but across survey instruments, same items must have the same variable name and data format.

B.7.5. Variable names and response choice coding must be approved by the HQCA prior to start of field. Ideally, a mock or blank data file would be generated for review.

B.8. Data files

B.8.1. A full record-level data file representing the full survey administration process (Appendix D) must be provided to the HQCA on a monthly basis (that is, after the completion of two waves). This may be provided as an Access database, DBF, Excel, or SPSS. All field names and codes must be labeled or annotated.

B.8.2. The survey data files must be provided as an SPSS data file, with full labels for all variables and values. These survey data files must be provided to the HQCA on a monthly basis (that is, after the completion of two waves) and according to the HQCA secure data transfer requirements.

B.8.3. Open ended responses must be provided verbatim, in a file format which does not truncate the length of the response. The unique Study ID must be provided for all open ended responses. File format to be negotiated.

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Appendix C: Survey Instruments/Scripts

Phone script introduction:

INTRO

Hello, may I speak with <FIRST NAME> <LAST NAME>?

PERSON CONFIRMED

Hello, my name is ________. I am calling on behalf of the Health Quality Council of Alberta. We are conducting a confidential survey about the experience of people who have recently visited an emergency department in Alberta.

Have you recently visited an emergency department? YES, NO

IF YES – PROCEED, IF NO TERMINATE

The results of this study will be used to improve the quality, safety, and performance of emergency department care in Alberta. Your experience is very important to us and will be used to improve care. Any information you provide to us will be confidential and anonymous.

OPTIONAL READ: The Health Quality Council of Alberta is an independent organization legislated under the Health Quality Council of Alberta Act. Its mandate is to promote and improve patient safety and health service quality on a province-wide basis. HQCA is a provincial custodian under the Health Information Act of Alberta, and any information collected is protected under this legislation.

OPTIONAL READ: If respondent asks about area code (if non-Alberta), or non-HQCA on call display: <VENDOR NAME> has been contracted by the Health Quality Council of Alberta to conduct this survey. <VENDOR NAME> is obligated to follow the requirements of the Health Information Act of Alberta.

I would like to interview you and I'm hoping that now is a good time for you. The survey will take approximately 15 minutes to complete depending on your answers. Before we start, I'd like to assure you that your participation is voluntary and you cannot be identified by any of the information we collect from you during the survey. If there are any questions that you do not wish to answer, please feel free to point these out to me and we'll go on to the next question. You of course have the right to end the interview at any time.

OPTIONAL READ: If you have any questions about the survey, you can call [TOLL-FREE NUMBER]. Should you wish to speak with someone to verify the survey process, to ask questions, or to provide comments about the survey, please provide the following contact information: Tim Cooke at the Health Quality Council of Alberta: In Calgary at: (403) 297-8276]

May we proceed with the interview now? YES (continue) NO (Reschedule Script) (Detailed Dispositions) Please remember, the following questions are about your most recent visit to the emergency department.

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EDPEC Survey 2.0—Discharged to Community Instrument

Please answer the questions about the care you got from the hospital emergency department on or around the date named below.

ALL OF THE QUESTIONS IN THIS SURVEY WILL ASK ABOUT THIS

EMERGENCY DEPARTMENT VISIT ONLY.

If you want to know more about this survey, please call [TOLL FREE NUMBER]. All calls to that number are free.

[NAME OF EMERGENCY DEPARTMENT/DATE OF VISIT LABEL]

ID # _________

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SURVEY INSTRUCTIONS

Taking part in this survey is voluntary Who should complete the questionnaire? We are surveying people who have recently visited an Emergency Department. If you have not recently visited an emergency department, please fill-in this bubble and return the blank questionnaire using the postage-paid envelope. Completing the questionnaire

• Use a black or blue pen to fill out the survey. • Please print your answers to write in questions. • For each question, please fill-in one bubble completely, like this example: . • To indicate an answer selected in error, clearly draw a line through the bubble like

this and fill-in another bubble. • You are sometimes told to skip over some questions in this survey. When this

happens you will see an arrow with a note that tells you what question to answer next, like this:

Yes → If Yes, go to Question 1

Your answers will be confidential. Your data is protected under the Health Information Act of Alberta and will only be used or disclosed in non-identifying form. The information is collected under the authority of the Health Quality Council of Alberta Regulation, section 7(2)(d) and will be used to identify areas of improvement in emergency departments.

COPYRIGHT INFORMATION This questionnaire is based on the EDPEC Survey 2.0 – Discharged to Community Instrument provided by the RAND Corporation (USA). Use of this copyrighted material by any other individual or organization for any other purpose requires written permission from the Care Quality Commission.

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GOING TO THE EMERGENCY DEPARTMENT

1. Thinking about this visit, what was the main reason why you went to the emergency department? o An accident or injury o A new health problem o An ongoing health condition or

concern

2. Why did you choose to go to the emergency department, instead of somewhere else such as a doctor's office? FILL-IN ALL THAT APPLY o The emergency department was the

only choice available at the time. o The emergency department was the

most convenient place to go. o I (we) thought the emergency

department was the best place for my medical problem.

o I was told to go to the emergency department rather than somewhere else.

o Other: ________________________

3. For this visit, did you go to the emergency department in an ambulance? o Yes o No

4. When you first arrived at the emergency department, how long was it before someone talked to you about the reason why you were there? o Less than 5 minutes o 5 to 15 minutes o More than 15 minutes

5. Using any number from 0 to 10, where 0 is not at all important and 10 is extremely important, when you first arrived at the emergency department, how important was it for you to get care right away? o 0 Not at all important o 1 o 2 o 3 o 4 o 5 o 6 o 7 o 8 o 9 o 10 Extremely important

DURING YOUR EMERGENCY DEPARTMENT VISIT

6. During this emergency department visit, did you get care within 30 minutes of getting to the emergency department? o Yes o No

7. During this emergency department visit, did the doctors or nurses ask about all of the medicines you were taking? o Yes, definitely o Yes, somewhat o No

8. During this emergency department visit, were you given any medicine that you had not taken before? o Yes o Don’t Know o No → If No, go to Question 11

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9. Before giving you any new medicine, did the doctors or nurses tell you what the medicine was for? o Yes, definitely o Yes, somewhat o No

10. Before giving you any new medicine, did the doctors or nurses describe possible side effects to you in a way you could understand? o Yes, definitely o Yes, somewhat o No

11. During this emergency department visit, did you have any pain?2 o Yes, definitely o Yes, somewhat o No → If No, go to Question 14

12. During this emergency department visit, did you get medicine for pain?1 o Yes, definitely o Yes, somewhat o No

13. During this emergency department visit, did the doctors and nurses do everything they could to help you with your pain?1 o Yes, definitely o Yes, somewhat o No

14. During this emergency department visit, did you have a blood test, x-ray, or any other test? o Yes o No → If No, go to Question 16

2 CMS is conducting additional testing and analysis of these items and alternative wording for future versions of the EDPEC Survey.

15. During this emergency department visit, did doctors and nurses give you as much information as you wanted about the results of these tests? o Yes, definitely o Yes, somewhat o No

16. An interpreter is someone who helps you talk with others who do not speak your language. During this emergency department visit, did you need an interpreter? o Yes o No → If No, go to Question 18

17. During this emergency department visit, when you needed an interpreter did you get one? o Yes o No

PEOPLE WHO TOOK CARE OF YOU

Please answer the following questions about the people who took care of you during your emergency department visit.

18. Did the nurses treating and assessing you introduce themselves? o Yes, all of them introduced

themselves o Some of them introduced themselves o Very few or none of them introduced

themselves o Can't remember

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19. During this emergency department visit, how often did nurses treat you with courtesy and respect? o Never o Sometimes o Usually o Always

20. During this emergency department visit, how often did nurses listen carefully to you? o Never o Sometimes o Usually o Always

21. During this emergency department visit, how often did nurses explain things in a way you could understand? o Never o Sometimes o Usually o Always

22. During this emergency department visit, did nurses spend enough time with you? o Yes, definitely o Yes, somewhat o No

23. Did the doctors treating and assessing you introduce themselves? o Yes, all of them introduced

themselves o Some of them introduced themselves o Very few or none of them introduced

themselves o Can't remember

24. During this emergency department visit, how often did doctors treat you with courtesy and respect? o Never o Sometimes o Usually o Always

25. During this emergency department visit, how often did doctors listen carefully to you? o Never o Sometimes o Usually o Always

26. During this emergency department visit, how often did doctors explain things in a way you could understand? o Never o Sometimes o Usually o Always

27. During this emergency department visit, did doctors spend enough time with you? o Yes, definitely o Yes, somewhat o No

LEAVING THE EMERGENCY DEPARTMENT

28. Before you left the emergency department, did you understand what your main health problem was? o Yes o No

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29. Before you left the emergency department, did you understand what symptoms or health problems to look out for when you left the emergency department? o Yes o No

30. Before you left the emergency department, did a doctor or nurse tell you that you should take any new medicines that you had not taken before? o Yes o No → If No, go to Question 32

31. Before you left the emergency department, did a doctor or nurse tell you what the new medicines were for? o Yes, definitely o Yes, somewhat o No

32. Before you left the emergency department, did someone tell you to make an appointment with a doctor to follow-up about your problem? o Yes o No → If No, go to Question 34

33. Before you left the emergency department, did someone ask if you would be able to get this follow-up care? o Yes o No

OVERALL EXPERIENCE

Please answer the following questions about your visit to the emergency department named on the front of the survey. Do not include any other emergency department visits in your answers.

34. Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during this emergency department visit? o 0 Worst care possible o 1 o 2 o 3 o 4 o 5 o 6 o 7 o 8 o 9 o 10 Best care possible

35. Would you recommend this emergency department to your friends and family? o Definitely no o Probably no o Probably yes o Definitely yes

YOUR HEALTH CARE

36. In the last 6 months, how many times have you visited any emergency department to get care for yourself? Please include the emergency department visit you have been answering questions about in this survey. o 1 time o 2 times o 3 times o 4 times o 5 to 9 times o 10 or more times

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37. Not counting the emergency department, is there a doctor’s office, clinic, or other place you usually go if you need a check-up, want advice about a health problem, or get sick or hurt? o Yes o No → If No, go to Question 39

38. How many times in the last 6 months did you visit that doctor’s office, clinic, health center, or other place to get care or advice about your health? o None o 1 time o 2 times o 3 times o 4 times o 5 to 9 times o 10 or more times

ABOUT YOU

There are only a few questions left.

39. In general, how would you rate your overall health? o Excellent o Very good o Good o Fair o Poor

40. EQ-5D

(Note to interviewer: please read the following to the respondent)

We are trying to find out what you think about your health. I will first ask you some simple questions about your health TODAY. I will then ask you to rate your health on a measuring scale. I will explain what to do as I go along but please interrupt me if you do not understand something or if things are not clear to you. Please also remember that there are no right or wrong answers. We are interested here only in your personal view.

First I am going to read out some questions. Each question has a choice of five answers. Please tell me which answer best describes your health TODAY. Do not choose more than one answer in each group of questions.

(Note to interviewer: it may be necessary to remind the respondent regularly that the timeframe is TODAY. It may also be necessary to repeat the questions verbatim.)

MOBILITY

First I'd like to ask you about mobility. Would you say that: o 1 You have no problems in walking

about? o 2 You have slight problems in

walking about? o 3 You have moderate problems in

walking about? o 4 You have severe problems in

walking about? o 5 You are unable to walk about?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

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SELF-CARE

Next I'd like to ask you about self-care. Would you say that: o 1 You have no problems washing or

dressing yourself? o 2 You have slight problems washing

or dressing yourself? o 3 You have moderate problems

washing or dressing yourself? o 4 You have severe problems washing

or dressing yourself? o 5 You are unable to wash or dress

yourself?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

USUAL ACTIVITIES

Next I'd like to ask you about your usual activities, for example work, study, housework, family or leisure activities. Would you say that: o 1 You have no problems doing your

usual activities? o 2 You have slight problems doing

your usual activities? o 3 You have moderate problems doing

your usual activities? o 4 You have severe problems doing

your usual activities? o 5 You are unable to do your usual

activities?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

PAIN / DISCOMFORT

Next I'd like to ask you about pain or discomfort. Would you say that: o 1 You have no pain or discomfort? o 2 You have slight pain or discomfort? o 3 You have moderate pain or

discomfort? o 4 You have severe pain or

discomfort? o 5 You have extreme pain or

discomfort?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

ANXIETY / DEPRESSION

Finally I'd like to ask you about anxiety or depression. Would you say that: o 1 You are not anxious or depressed? o 2 You are slightly anxious or

depressed? o 3 You are moderately anxious or

depressed? o 4 You are severely anxious or

depressed? o 5 You are extremely anxious or

depressed?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

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41. EQ VAS

(Note for interviewer: if possible, it might be useful to send a visual aid (i.e. the EQ VAS) before the telephone call so that the respondent can have this in front of him or her when completing the task)

Now, I would like to ask you to say how good or bad your health is TODAY.

I'd like you to try to picture in your mind a scale that looks rather like a thermometer. Can you do that? The best health you can imagine is marked 100 (one hundred) at the top of the scale and the worst health you can imagine is marked 0 (zero) at the bottom.

EQ VAS: TASK

I would now like you to tell me the point on this scale where you would put your health today.

(Note to interviewer: mark the scale at the point indicating the respondent’s ‘health today’)

42. What is your age? o 18 to 24 o 25 to 34 o 35 to 44 o 45 to 54 o 55 to 64 o 65 to 74 o 75 or older

43. Are you male or female? o Male o Female

44. What language do you mainly speak at home? o English o Other:________________________

45. What is the highest level of schooling that you have completed? o Grade school or some high school o Completed high school o Post-secondary technical school

(including Trade School) o Some university or college o Completed college diploma o Completed university degree o Post-grad degree (Masters or PhD)

46. People living in Canada come from many different cultural and racial backgrounds. Are you …? o White/Caucasian o Aboriginal/Native

Canadian/Inuit/Metis o Chinese o Latin American o Black o Asian o Other: ________________________

47. Which one of the following categories best describes the total annual income, before taxes, of all members of your household? o Less than $25,000 o $25,000 to just under $50,000 o $50,000 to just under $75,000 o $75,000 to just under $100,000 o $100,000 to just under $150,000 o $150,000 to just under $200,000 o $200,000 or more

48. Did someone help you complete this survey? o Yes o No → Thank you.

Please return the completed survey in the postage-paid envelope.

22

49. How did that person help you? Mark one or more. o Read the questions to me o Wrote down the answers I gave o Answered the questions for me o Translated the questions into my

language o Helped in some other way

(please print) ___________________________

50. Was the person who helped you with you at any time during this emergency department visit? o Yes o No

Thank you.

Please return the completed survey in the postage-paid envelope.

23

EDPEC Survey 2.0—Admitted Stand Alone Instrument

Please answer the questions about the care you got from the hospital emergency department on or around the date named below.

ALL OF THE QUESTIONS IN THIS SURVEY WILL ASK ABOUT THIS

EMERGENCY DEPARTMENT VISIT ONLY. PLEASE DO NOT THINK ABOUT CARE YOU RECEIVED AFTER YOU WERE ADMITTED TO THE HOSPITAL.

If you want to know more about this survey, please call [TOLL FREE NUMBER]. All calls to that number are free.

ID # _________

[NAME OF EMERGENCY DEPARTMENT/DATE OF VISIT LABEL]

24

SURVEY INSTRUCTIONS

Taking part in this survey is voluntary Who should complete the questionnaire? We are surveying people who have recently visited an emergency department. If you have not recently visited an emergency department, please fill-in this bubble and return the blank questionnaire using the postage-paid envelope. Completing the questionnaire

• Use a black or blue pen to fill out the survey. • Please print your answers to write in questions. • For each question, please fill-in one bubble completely, like this example: . • To indicate an answer selected in error, clearly draw a line through the bubble like

this and fill-in another bubble. • You are sometimes told to skip over some questions in this survey. When this happens

you will see an arrow with a note that tells you what question to answer next, like this:

Yes → If Yes, go to Question 1

Your answers will be confidential. Your data is protected under the Health Information Act of Alberta and will only be used or disclosed in non-identifying form. The information is collected under the authority of the Health Quality Council of Alberta Regulation, section 7(2)(d) and will be used to identify areas of improvement in emergency departments.

COPYRIGHT INFORMATION This questionnaire is based on the EDPEC Survey 2.0 – Admitted Stand Alone Instrument provided by the RAND Corporation (USA). Use of this copyrighted material by any other individual or organization for any other purpose requires written permission from the Care Quality Commission.

25

GOING TO THE EMERGENCY DEPARTMENT

1. Thinking about this visit, what was the main reason why you went to the emergency department? o An accident or injury o A new health problem o An ongoing health condition or

concern

2. Why did you choose to go to the emergency department, instead of somewhere else such as a doctor's office? FILL-IN ALL THAT APPLY o The emergency department was the

only choice available at the time. o The emergency department was the

most convenient place to go. o I (we) thought the emergency

department was the best place for my medical problem.

o I was told to go to the emergency department rather than somewhere else.

o Other: ________________________

3. For this visit, did you go to the emergency department in an ambulance? o Yes o No

4. When you first arrived at the emergency department, how long was it before someone talked to you about the reason why you were there? o Less than 5 minutes o 5 to 15 minutes o More than 15 minutes

5. Using any number from 0 to 10, where 0 is not at all important and 10 is extremely important, when you first arrived at the emergency department, how important was it for you to get care right away? o 0 Not at all important o 1 o 2 o 3 o 4 o 5 o 6 o 7 o 8 o 9 o 10 Extremely important

DURING YOUR EMERGENCY DEPARTMENT VISIT

6. During this emergency department visit, did you get care within 30 minutes of getting to the emergency department? o Yes o No

7. During this emergency department visit, did the doctors or nurses ask about all of the medicines you were taking? o Yes, definitely o Yes, somewhat o No

8. During this emergency department visit, were you given any medicine that you had not taken before? o Yes o Don’t Know o No → If No, go to Question 11

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9. Before giving you any new medicine, did the doctors or nurses tell you what the medicine was for? o Yes, definitely o Yes, somewhat o No

10. Before giving you any new medicine, did the doctors or nurses describe possible side effects to you in a way you could understand? o Yes, definitely o Yes, somewhat o No

11. During this emergency department visit, did you have any pain?3 o Yes, definitely o Yes, somewhat o No → If No, go to Question 14

12. During this emergency department visit, did you get medicine for pain?1 o Yes, definitely o Yes, somewhat o No

13. During this emergency department visit, did the doctors and nurses do everything they could to help you with your pain?1 o Yes, definitely o Yes, somewhat o No

3 CMS is conducting additional testing and analysis of these items and alternative wording for future versions of the EDPEC Survey.

14. An interpreter is someone who helps you talk with others who do not speak your language. During this emergency department visit, did you need an interpreter? o Yes o No → If No, go to Question 16

15. During this emergency department visit, when you needed an interpreter did you get one? o Yes o No

PEOPLE WHO TOOK CARE OF YOU IN THE EMERGENCY

DEPARTMENT

Please answer the following questions about the people who took care of you while you were in the emergency department. Do not include doctors, nurses, or hospital staff who took care of you after you were admitted to the hospital and moved to another part of the hospital for more care.

16. Did the nurses treating and assessing you introduce themselves? o Yes, all of them introduced

themselves o Some of them introduced themselves o Very few or none of them introduced

themselves o Can't remember

17. During this emergency department visit, how often did nurses treat you with courtesy and respect? o Never o Sometimes o Usually o Always

27

18. During this emergency department visit, how often did nurses listen carefully to you? o Never o Sometimes o Usually o Always

19. During this emergency department visit, how often did nurses explain things in a way you could understand? o Never o Sometimes o Usually o Always

20. During this emergency department visit, did nurses spend enough time with you? o Yes, definitely o Yes, somewhat o No

21. Did the doctors treating and assessing you introduce themselves? o Yes, all of them introduced

themselves o Some of them introduced themselves o Very few or none of them introduced

themselves o Can't remember

22. During this emergency department visit, how often did doctors treat you with courtesy and respect? o Never o Sometimes o Usually o Always

23. During this emergency department visit, how often did doctors listen carefully to you? o Never o Sometimes o Usually o Always

24. During this emergency department visit, how often did doctors explain things in a way you could understand? o Never o Sometimes o Usually o Always

25. During this emergency department visit, did doctors spend enough time with you? o Yes, definitely o Yes, somewhat o No

LEAVING THE EMERGENCY DEPARTMENT

26. Once you found out you would have to stay in the hospital, were you kept informed about how long it would be before you went to another part of the hospital? o Yes, definitely o Yes, somewhat o No

27. Before you left the emergency department, did you understand why you needed to stay in the hospital? o Yes, definitely o Yes, somewhat o No

28

OVERALL EXPERIENCE

Please answer the following questions about your visit to the emergency department named on the front of the survey. Do not include any other emergency department visits or care you got after you were admitted to the hospital and moved to another part of the hospital for more care.

28. Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during this emergency department visit? o 0 Worst care possible o 1 o 2 o 3 o 4 o 5 o 6 o 7 o 8 o 9 o 10 Best care possible

29. Would you recommend this emergency department to your friends and family? o Definitely no o Probably no o Probably yes o Definitely yes

YOUR HEALTH CARE

30. In the last 6 months, how many times have you visited any emergency department to get care for yourself? Please include the emergency department visit you have been answering questions about in this survey. o 1 time o 2 times o 3 times o 4 times o 5 to 9 times o 10 or more times

31. Not counting the emergency department, is there a doctor’s office, clinic, or other place you usually go if you need a check-up, want advice about a health problem, or get sick or hurt? o Yes o No → If No, go to Question 33

32. How many times in the last 6 months did you visit that doctor’s office, clinic, health center, or other place to get care or advice about your health? o None o 1 time o 2 times o 3 times o 4 times o 5 to 9 times o 10 or more times

29

ABOUT YOU

There are only a few questions left.

33. In general, how would you rate your overall health? o Excellent o Very good o Good o Fair o Poor

34. EQ-5D

(Note to interviewer: please read the following to the respondent)

We are trying to find out what you think about your health. I will first ask you some simple questions about your health TODAY. I will then ask you to rate your health on a measuring scale. I will explain what to do as I go along but please interrupt me if you do not understand something or if things are not clear to you. Please also remember that there are no right or wrong answers. We are interested here only in your personal view.

First I am going to read out some questions. Each question has a choice of five answers. Please tell me which answer best describes your health TODAY. Do not choose more than one answer in each group of questions.

(Note to interviewer: it may be necessary to remind the respondent regularly that the timeframe is TODAY. It may also be necessary to repeat the questions verbatim.)

MOBILITY

First I'd like to ask you about mobility. Would you say that: o 1 You have no problems in walking

about? o 2 You have slight problems in

walking about? o 3 You have moderate problems in

walking about? o 4 You have severe problems in

walking about? o 5 You are unable to walk about?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

SELF-CARE

Next I'd like to ask you about self-care. Would you say that: o 1 You have no problems washing or

dressing yourself? o 2 You have slight problems washing

or dressing yourself? o 3 You have moderate problems

washing or dressing yourself? o 4 You have severe problems washing

or dressing yourself? o 5 You are unable to wash or dress

yourself?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

30

USUAL ACTIVITIES

Next I'd like to ask you about your usual activities, for example work, study, housework, family or leisure activities. Would you say that: o 1 You have no problems doing your

usual activities? o 2 You have slight problems doing

your usual activities? o 3 You have moderate problems doing

your usual activities? o 4 You have severe problems doing

your usual activities? o 5 You are unable to do your usual

activities?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

PAIN / DISCOMFORT

Next I'd like to ask you about pain or discomfort. Would you say that: o 1 You have no pain or discomfort? o 2 You have slight pain or discomfort? o 3 You have moderate pain or

discomfort? o 4 You have severe pain or

discomfort? o 5 You have extreme pain or

discomfort?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

ANXIETY / DEPRESSION

Finally I'd like to ask you about anxiety or depression. Would you say that: o 1 You are not anxious or depressed? o 2 You are slightly anxious or

depressed? o 3 You are moderately anxious or

depressed? o 4 You are severely anxious or

depressed? o 5 You are extremely anxious or

depressed?

(Note to interviewer: mark the appropriate box on the EQ-5D questionnaire)

35. EQ VAS

(Note for interviewer: if possible, it might be useful to send a visual aid (i.e. the EQ VAS) before the telephone call so that the respondent can have this in front of him or her when completing the task)

Now, I would like to ask you to say how good or bad your health is TODAY.

I'd like you to try to picture in your mind a scale that looks rather like a thermometer. Can you do that? The best health you can imagine is marked 100 (one hundred) at the top of the scale and the worst health you can imagine is marked 0 (zero) at the bottom.

EQ VAS: TASK

I would now like you to tell me the point on this scale where you would put your health today.

(Note to interviewer: mark the scale at the point indicating the respondent’s ‘health today’)

31

36. What is your age? o 18 to 24 o 25 to 34 o 35 to 44 o 45 to 54 o 55 to 64 o 65 to 74 o 75 or older

37. Are you male or female? o Male o Female

38. What language do you mainly speak at home? o English o Other:________________________

39. What is the highest level of schooling that you have completed? o Grade school or some high school o Completed high school o Post-secondary technical school

(including Trade School) o Some university or college o Completed college diploma o Completed university degree o Post-grad degree (Masters or PhD)

40. People living in Canada come from many different cultural and racial backgrounds. Are you …? o White/Caucasian o Aboriginal/Native

Canadian/Inuit/Metis o Chinese o Latin American o Black o Asian o Other: ________________________

41. Which one of the following categories best describes the total annual income, before taxes, of all members of your household? o Less than $25,000 o $25,000 to just under $50,000 o $50,000 to just under $75,000 o $75,000 to just under $100,000 o $100,000 to just under $150,000 o $150,000 to just under $200,000 o $200,000 or more

42. Did someone help you complete this survey? o Yes o No → Thank you.

Please return the completed survey in the postage-paid envelope.

43. How did that person help you? Mark one or more. o Read the questions to me o Wrote down the answers I gave o Answered the questions for me o Translated the questions into my

language o Helped in some other way

(please print) ___________________________

44. Was the person who helped you with you at any time during this emergency department visit? o Yes o No

32

Thank you.

Please return the completed survey in the postage-paid envelope.

33

Appendix D: Required Variables Record by Record Documentation of Process

Variable Description Study_ID Unique patient identifier consistent between all surveys and data Phone1_dt Date/time of first phone attempt (initiated by Vendor) Disp1 Disposition after first phone call Phone2_dt Date/time of second phone attempt (initiated by Vendor) Disp2 Disposition after second phone call Phone3_dt Date/time of third phone attempt (initiated by Vendor) Disp3 Disposition after third phone call Phone4_dt Date/time of fourth phone attempt (initiated by Vendor) Disp4 Disposition after fourth phone call Phone5_dt Date/time of fifth phone attempt (initiated by Vendor) Disp5 Disposition after fifth phone call Phone6_dt Date/time of sixth phone attempt (initiated by Vendor) Disp6 Disposition after sixth phone call Phone7_dt Date/time of seventh phone attempt (initiated by Vendor) Disp7 Disposition after seventh phone call Phone8_dt Date/time of eighth phone attempt (initiated by Vendor) Disp8 Disposition after eighth phone call Phone9_dt Date/time of ninth phone attempt (initiated by Vendor) Disp9 Disposition after ninth phone call Phone_C Date of phone contact initiated by respondent Disp_F Final disposition Disp_F_dt Date of final disposition/completion over the phone Comment Open comment on record

Disp_code Description INVPHON invalid phone number LANG language or communication barrier REF refused COMP_P completed by phone CB Call-back scheduled at a specific time PROT_C protocol complete (interview not yet completed) (Final only) PROT_I protocol incomplete (indeterminate) (Final only) OTH other disposition (must annotate) OTH_TXT open text for other disposition

Note: CB (when made) can be recorded as one of the call attempts in the protocol.