OAS CAHPS ERF Submission Instructions for Implementing DSRS and Continuous Sampling
folder_openSurvey Specifications and Guidelinescalendar_todayPosted July 14, 2016

CMS and the OAS CAHPS Survey Coordination Team would like to provide clarification on the required information that approved survey vendors must include in the two types of Exceptions Request Form (ERF) submissions listed below:

• ERFs to use the disproportionate stratified random sampling (DSRS) method
• ERFs to perform sampling on a continuous basis (i.e. more frequently than monthly)

DSRS Exceptions Request Form Requirements

OAS CAHPS vendors may encounter HOPD or ASC clients who would like to use the DSRS method. However, the vendor must complete and submit an Exceptions Request Form via the OAS CAHPS website to obtain approval from CMS prior to implementing this sampling method for the specified CCN(s). CMS will then review the request and the Coordination Team will notify the vendor once a decision has been made.

Vendors must include the following information in the ERF for each CCN for which they are requesting to implement the DSRS sampling method. Please note that vendors may use estimated monthly figures or the last sample month’s figures when providing this information for each applicable CCN:

1. CCN and facility name
2. The names of each strata
3. The expected number of eligible patients/procedures in each strata (for a sample month)
4. The number of patients/procedures to be sampled in each strata (for a sample month)
5. Additional data validation checks to ensure the minimum number of 10 eligible patients per stratum is sampled

Below is an example describing how the above information should be provided in an ERF requesting to implement DSRS for one CCN with 2 strata:

1. CCN and facility name: 123456, OAS Example Hospital
2. The names of each strata: OAS Example Hospital South, OAS Example Hospital North
3. Expected # of eligible patients/procedures: OAS Example Hospital South = 330, OAS Example Hospital North = 415
4. # of patients/procedures would like to sample: OAS Example Hospital South = 255, OAS Example Hospital North = 310
5. Additional validation checks: Reviewed previous annual patient records to ensure that the number of eligible patients per strata would never be fewer than 10 and were fairly consistent within strata across months. Will monitor the number of eligible cases monthly to ensure that there is sufficient sample so that DSRS remains a viable sampling strategy.

Note that there is an Excel template (spreadsheet) available that vendors are encouraged to use to submit the information in the example above to the Coordination Team. This spreadsheet is titled, “DSRS Template” and is available under the Exceptions Request Form link (after login in) on the OAS CAHPS website. Please note the following:

• If vendors choose to submit an Excel file, they will be required to use this DSRS Template.
• The template allows for information for multiple CCNs to be provided but they must be entered in separate excel sheets (tabs).
• Note that vendors must submit a new template for each new request for DSRS.
• If updates are needed [for additional CCNs following the same protocol], vendors may update and resubmit an existing online ERF and DSRS Template. However, a new online ERF must be submitted if the protocol will differ.
• Also, note that you are still required to complete the online ERF for all DSRS requests, but you must submit the Excel template by sending an email to oascahps@rti.org.

If a vendor’s ERF for DSRS is approved, please be reminded that the vendor must use the DSRS XML data file layout to submit data for the facility. The vendor should review the DSRS XML header record to ensure that they have all the information that is required

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Continuous Sampling Exceptions Request Form Requirements

OAS CAHPS Survey vendors are permitted to perform continuous sampling (more frequent than monthly), with prior approval from CMS. If approached by an OAS client who would like for the vendor to implement continuous sampling, the vendor must first complete and submit via the OAS CAHPS website an Exceptions Request Form that explains the reasons and proposed procedures for continuous sampling. CMS will review the request and the Coordination Team will notify the vendor once a decision has been made.

Each of the following eligibility criteria and sample selection protocols must be comprehensively explained in the ERF:

In terms of patient and surgery/procedure eligibility:

• In general, for what size facilities (as measured by patient volume) are requesting to use continuous sampling, and how does the facility size relate to the sampling frequency (e.g., small facilities with low volume [100 or fewer eligible patients per month] can be sampled every 2 weeks, large facilities with high patient volume [more than 100 eligible patients per month] can be sampled daily).
• Explain the frequency by which the eligibility will be assessed and confirmed (daily, every few days, weekly or other periodicity). See Chapter IV of the OAS CAHPS Protocols & Guidelines Manual for the eligibility criteria. The OAS CAHPS survey is not appropriate for people who did not have an OAS CAHPS-eligible procedure/surgery, and such individuals should be removed from the sample frame before selection.
• Explain how the de-duplication and check for patients who were sampled in the previous five months will be performed for the planned sampling periodicity (daily, every few days, weekly, or other periodicity).

In terms of sampling:

• What sampling methods will be used? As stated in Chapter IV of the OAS CAHPS Protocols & Guidelines Manual, if there are two or more components within the CCN, a proportional method (SSS, PSRS, or DSRS if approved) must be used.
• When frames are assembled frequently, will there be enough cases on the frame (which includes the frames of individual strata) to perform sampling? As a reminder, for PSRS and DSRS there must be 10 eligible patients on the frame from which the sample is selected.
• What sampling rate will be used? If there are multiple components, be specific for each component within the CCN. What will be done if the frame size is small (100 or fewer eligible patients per month) and cannot support the sampling rate? (Sampling rates may differ by CCN, if so, please provide these rates in the examples requested below.)

Please include in your ERF an example of how you would implement continuous sampling for a large size CCN and a small size CCN, if available. Choose one of the CCNs (that has more than 100 eligible patients per month) as an example. If there are any CCNs that have 100 or fewer eligible patients, provide another example. Below are examples of how this information should be displayed in the ERF.
Example 1 – Large size CCN (more than 100 eligible patients per month):

• Facility Name: Hospital North
• CCN: 654321
• Number of Eligible Patients in a sample month: 1652
• Number of Eligible Patients in a sample bi-monthly period: 820
• Number of Eligible Patients in a sample week: 398
• Number of Eligible Patients in a sample day: 56
• Proposed frequency: We propose sampling patients on a weekly basis.

Example 2 – Small size CCN (100 or fewer eligible patients per month):

• Facility Name: Hospital South
• CCN: 123456
• Number of Eligible Patients in a sample month: 100
• Number of Eligible Patients in a sample bi-monthly period: 58
• Number of Eligible Patients in a sample week: 30
• Number of Eligible Patients in a sample day: 6
• Proposed frequency: We propose sampling patients on a weekly basis

Please note, existing ERFs for both DSRS and continuous sampling must be updated and re-submitted on the OAS CAHPS website for approval should any of the proposed plans/protocols change or if the vendor acquires new clients requesting either of these sampling methods.

And, finally, as a reminder, all survey vendors must have in place and implement quality control procedures on the entire sampling process to ensure the requirements for each sampling method used are being met. During OAS CAHPS site visits, the Coordination Team will review each vendor’s sampling procedures and documentation, including documentation of all quality control checks conducted by vendor staff during the sampling process.

Please contact the OAS CAHPS Survey Coordination Team via e-mail at oascahps@rti.org or call toll-free (866) 590-7468 if you have any questions regarding submitting ERFs for implementing DSRS or continuous sampling.