CAHPS® Medicare In-Center Hemodialysis Survey
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  • 1. Where do you get your dialysis treatments?
  • 2. How long have you been getting dialysis at [SAMPLE FACILITY NAME]?
  • 3. In the last 3 months, how often did your kidney doctors listen carefully to you?
  • 4. In the last 3 months, how often did your kidney doctors explain things in a way that was easy for you to understand?
  • 5. In the last 3 months, how often did your kidney doctors show respect for what you had to say?
  • 6. In the last 3 months, how often did your kidney doctors spend enough time with you?
  • 7. In the last 3 months, how often did you feel your kidney doctors really cared about you as a person?
  • 8. Using any number from 0 to 10, where 0 is the worst kidney doctors possible and 10 is the best kidney doctors possible, what number would you use to rate the kidney doctors you have now?
  • 9. Do your kidney doctors seem informed and up-to-date about the health care you receive from other doctors?
  • 10. In the last 3 months, how often did the dialysis center staff listen carefully to you?
  • 11. In the last 3 months, how often did the dialysis center staff explain things in a way that was easy for you to understand?
  • 12. In the last 3 months, how often did the dialysis center staff show respect for what you had to say?
  • 13. In the last 3 months, how often did the dialysis center staff spend enough time with you?
  • 14. In the last 3 months, how often did you feel the dialysis center staff really cared about you as a person?
  • 15. In the last 3 months, how often did dialysis center staff make you as comfortable as possible during dialysis?
  • 16. In the last 3 months, did dialysis center staff keep information about you and your health as private as possible from other patients?
  • 17. In the last 3 months, did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care?
  • 18. In the last 3 months, has anyone on the dialysis center staff asked you about how your kidney disease affects other parts of your life?
  • 19. The dialysis center staff can connect you to the dialysis machine through a graft, fistula, or catheter. Do you know how to take care of your graft, fistula, or catheter?
  • 20. In the last 3 months, which one did they use most often to connect you to the dialysis machine?
  • 21. In the last 3 months, how often did dialysis center staff insert your needles with as little pain as possible?
  • 22. In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine?
  • 23. In the last 3 months, did any problems occur during your dialysis?
  • 24. In the last 3 months, how often was the dialysis center staff able to manage problems during your dialysis?
  • 25. In the last 3 months, how often did dialysis center staff behave in a professional manner?
  • 26. In the last 3 months, did dialysis center staff talk to you about what you should eat and drink?
  • 27. In the last 3 months, how often did dialysis center staff explain blood test results in a way that was easy to understand?
  • 28. As a patient you have certain rights. For example, you have the right to be treated with respect and the right to privacy. Did this dialysis center ever give you any written information about your rights as a patient?
  • 29. Did dialysis center staff at this center ever review your rights as a patient with you?
  • 30. Has dialysis center staff ever told you what to do if you experience a health problem at home?
  • 31. Has any dialysis center staff ever told you how to get off the machine if there is an emergency at the center?
  • 32. Using any number from 0 to 10, where 0 is the worst dialysis center staff possible and 10 is the best dialysis center staff possible, what number would you use to rate your dialysis center staff?
  • 33. In the last 3 months, when you arrived on time, how often did you get put on the dialysis machine within 15 minutes of your appointment or shift time?
  • 34. In the last 3 months, how often was the dialysis center as clean as it could be?
  • 35. Using any number from 0 to 10, where 0 is the worst dialysis center possible and 10 is the best dialysis center possible, what number would you use to rate this dialysis center?
  • 36. You can treat kidney disease with dialysis at a center, a kidney transplant, or with dialysis at home. In the last 12 months, did your kidney doctors or dialysis center staff talk to you as much as you wanted about which treatment is right for you?
  • 37. Are you eligible for a kidney transplant?
  • 38. In the last 12 months, has a doctor or dialysis center staff explained to you why you are not eligible for a kidney transplant?
  • 39. Peritoneal dialysis is dialysis given through the belly and is usually done at home. In the last 12 months, did either your kidney doctors or dialysis center staff talk to you about peritoneal dialysis?
  • 40. In the last 12 months, were you as involved as much as you wanted in choosing the treatment for kidney disease that is right for you?
  • 41. In the last 12 months, were you ever unhappy with the care you received at the dialysis center or from your kidney doctors?
  • 42. In the last 12 months, did you ever talk to someone on the dialysis center staff about this?
  • 43. In the last 12 months, how often were you satisfied with the way they handled these problems?
  • 44. Medicare and your State have special agencies that check the quality of care at this dialysis center. In the last 12 months, did you make a complaint to any of these agencies?
  • 45. In general, how would you rate your overall health?
  • 46. In general, how would you rate your overall mental or emotional health?
  • 47. Are you being treated for high blood pressure?
  • 48. Are you being treated for diabetes or high blood sugar?
  • 49. Are you being treated for heart disease or heart problems?
  • 50. Are you deaf or do you have serious difficulty hearing?
  • 51. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
  • 52. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
  • 53. Do you have serious difficulty walking or climbing stairs?
  • 54. Do you have difficulty dressing or bathing?
  • 55. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone, such as visiting a doctor’s office or shopping?
  • 56. What is the highest grade or level of school that you have completed?
  • 57. What language do you mainly speak at home?
  • 58. Are you of Spanish, Hispanic, or Latino origin or descent?
  • 59. What is your race? (One or more categories may be selected.)
  • 60. Did someone help you complete this survey?
  • 61. Who helped you complete this survey?
  • 62. How did that person help you? Check all that apply.

Supplemental Item Sets Hide Numbering

Click on items or set of items that you want to add.

    • QI1. In the last 3 months, did your kidney doctors keep you informed and up-to-date about your condition?
    • QI4. In the last 3 months, how often did dialysis center staff respond to these problems as soon as you wanted?
    • QI5. In the last 3 months, how often did dialysis center staff change their gloves between patients?
    • QI8. In the last 3 months, how often was the dialysis center as calm and quiet as it could be?
    • QI9. Medicare and your State have special agencies that check the quality of care at this dialysis center. Has anyone at the dialysis center ever given you information about how to make a complaint to these agencies?
    Quality Improvement
    • QI2. Sometimes dialysis center staff cover patients or use a curtain to protect a patient's privacy. In the last 3 months, did you ever need dialysis center staff to protect your privacy in this way?
    • QI3. In the last 3 months, how often did dialysis center staff cover you or use a curtain to protect your privacy?
    Quality Improvement
    • QI6. Is there a family member or friend involved with your dialysis care?
    • QI7. Do dialysis center staff include your family member or friend as much as you want?
    • PTA 1 . In the last three months, how often was the temperature at the dialysis center comfortable for you?
    • PTA 2. In the last three months, how often was your dialysis station kept clean?
    • PTA 7 . In the last three months, how often were you able to get into the dialysis center or unit easily?
    Physical Plant, Transportation and Access
    • PTA3. Some dialysis centers arrange transportation to the center for patients. This help can be a shuttle bus or van or tokens or vouchers for a bus or taxi. In the last three months, did you call the center for help with transportation?
    • PTA4. In the last three months, how often did the help with transportation meet your needs?
    Physical Plant, Transportation and Access
    • PTA5. Do you need to park at the center where you go for treatment?
    • PTA6. In the last three months, how often were you able to park in a convenient location?
    Interpreter Services
    • IN 1. An interpreter is someone who helps you talk with others who don’t speak the same language as you. During the last 3 months, did you ever need an interpreter to help you talk with your kidney doctors or dialysis center staff?
    • In 2. During the last 3 months, how often did you have problems at this dialysis center because you had to wait for an interpreter?
    • IN 3. During the last 3 months, when you needed an interpreter to help you at this dialysis center, how often did the dialysis center provide one?
    • IN 4. During the last 3 months, who usually acted as your interpreter when you needed to talk with your kidney doctors or dialysis center staff?
    • IN5. Using any number from 0 to 10, where 0 is the worst possible interpreter and 10 is the best possible interpreter, what number would you give the interpreters that the dialysis center provided most often in the last 3 months? Do not include friends and family members.