Survey Instrument

From: Masnick M, Morgan DJ, Macek MD, Sorkin JD, Brown JP, Rheingans P, Harris AD. Improving the Understanding of Publicly Reported Healthcare-Associated Infection (HAI) Data. Infect Control Hosp Epidemiol 2016. [PubMed | PDF]


This is the final version of the survey instrument used in the manuscript cited above.

Patients were randomly assigned to one of two arms: (1) the new presentation method; (2) the existing "detailed" presentation method from CMS Hospital Compare.

The same underlying data is used for both arms; only the presentation method differs. Questions are presented in the same order for both arms.

Each question asked participants to select one possible answer from a list of options. The options were the same for all questions across both arms.

Survey contents

The survey instrument was divided into 3 sections:
  1. Eligibility assessment and introduction
    This section was identical to the survey instrument used in a prior study. We have provided a PDF of the relevant pages here.

  2. Hospital comparison questions
    See below.

  3. Use/utility of hospital comparison website and demographics questions
    Again, this section was identical to the survey instrument used in a prior study. We have provided a PDF of the relevant pages here.

2) Hospital comparison survey questions

The survey questions for both arms follow below.

Questions are divided into 4 scenarios of 3 questions each:

Questions are in order from 1 to 12 below, so questions in the same scenario are grouped together. In the actual survey administered to patients, they were shuffled into the following order for all respondents:

Question 8
Question 11
Question 2
Question 4
Question 5
Question 10
Question 9
Question 3
Question 12
Question 7
Question 6
Question 1

About the new presentation method

The new presentation method uses "dot ratings" to describe the performance of a hospital:

Infection dot rating Description
○○○ 95% upper CI < 1; SIR point estimate < 0.42 (this is 1 SD for CAUTIs in the CMS Hospital Compare data)
●●○○○ 95% upper CI < 1; SIR point estimate between 0.42 and 1
●●●○○ 95% upper CI > 1; SIR point estimate < 1
●●●● 95% upper CI > 1; SIR point estimate between 1 and 2.4 (1 SD)
●●●●● 95% upper CI > 1; SIR point estimate > 2.4 (1 SD)
The confidence in the dot rating is rated as low/moderate/high:
Confidence dot rating Description
High High confidence: 1/2 of IQR or smaller; IQR = 6.63 for SIR 95% CI width for CAUTI
Moderate Moderate confidence: Between 1/2 IQR and 1 IQR
Low Low confidence: > 1 IQR

Hey! Make your window ← wider → to see the two data presentation methods side-by-side.


Question 1

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ●●○○○ High
Hospital 2 ●●○○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 8 7404 15.758 0.508 Better than the U.S. National Benchmark
Hospital 2 9 8328 17.182 0.524 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 1 (3.3%) 17 (56.7%) 18 (30%)
Hospital 2 4 (13.3%) 3 (10%) 7 (11.7%)
Either 20 (66.7%) 9 (30%) 29 (48.3%)
Not sure 5 (16.7%) 2 (6.7%) 7 (11.7%)

Question 2

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q2

  # infections compared to expected Confidence in data  
Hospital 1 ●●●● Medium
Hospital 2 ●●●● Medium


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q2

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 13 5955 9.285 1.4 No different than the U.S. National Benchmark
Hospital 2 13 5340 9.288 1.4 No different than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 5 (16.7%) 2 (6.7%) 7 (11.7%)
Hospital 2 4 (13.3%) 6 (20%) 10 (16.7%)
Either 19 (63.3%) 22 (73.3%) 41 (68.3%)
Not sure 2 (6.7%) 1 (3.3%) 3 (5%)

Question 3

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q3

  # infections compared to expected Confidence in data  
Hospital 1 ●●●●● Medium
Hospital 2 ●●●●● Medium


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q3

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 8 1567 2.352 3.401 Worse than the U.S. National Benchmark
Hospital 2 7 1392 2.089 3.351 Worse than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 2 (6.7%) 3 (10%) 5 (8.3%)
Hospital 2 3 (10%) 14 (46.7%) 17 (28.3%)
Either 22 (73.3%) 13 (43.3%) 35 (58.3%)
Not sure 3 (10%) 1 (3.3%) 4 (6.7%)

Question 4

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ○○○○ Medium
Hospital 2 ●●●○○ Medium


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 7 10936 23.077 0.303 Better than the U.S. National Benchmark
Hospital 2 6 3659 6.164 0.973 No different than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 19 (63.3%) 10 (33.3%) 29 (48.3%)
Hospital 2 6 (20%) 19 (63.3%) 25 (41.7%)
Either 1 (3.3%) (NaN%) 1 (1.7%)
Not sure 4 (13.3%) 2 (6.7%) 6 (10%)

Question 5

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ●●○○○ High
Hospital 2 ●●●○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 53 32423 81.17 0.653 Better than the U.S. National Benchmark
Hospital 2 60 29713 74.888 0.801 No different than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 19 (63.3%) 13 (43.3%) 32 (53.3%)
Hospital 2 8 (26.7%) 5 (16.7%) 13 (21.7%)
Either 1 (3.3%) 8 (26.7%) 9 (15%)
Not sure 2 (6.7%) 5 (16.7%) 7 (11.7%)

Question 6

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ●●●● High
Hospital 2 ●●●○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 51 15682 29.847 1.709 Worse than the U.S. National Benchmark
Hospital 2 46 15788 48.753 0.944 No different than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 4 (13.3%) 3 (10%) 7 (11.7%)
Hospital 2 18 (60%) 14 (46.7%) 32 (53.3%)
Either 3 (10%) 10 (33.3%) 13 (21.7%)
Not sure 5 (16.7%) 4 (13.3%) 9 (15%)

Question 7

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ●●○○○ High
Hospital 2 ●●○○○ Medium


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 14 11560 32.134 0.436 Better than the U.S. National Benchmark
Hospital 2 7 8421 15.279 0.458 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 13 (43.3%) 4 (13.3%) 17 (28.3%)
Hospital 2 8 (26.7%) 19 (63.3%) 27 (45%)
Either 5 (16.7%) 7 (23.3%) 12 (20%)
Not sure 4 (13.3%) 1 (3.3%) 5 (8.3%)

Question 8

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q2

  # infections compared to expected Confidence in data  
Hospital 1 ●●○○○ High
Hospital 2 ●●○○○ Medium


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q2

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 60 51610 93.98 0.638 Better than the U.S. National Benchmark
Hospital 2 6 5475 12.862 0.466 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 11 (36.7%) 6 (20%) 17 (28.3%)
Hospital 2 9 (30%) 16 (53.3%) 25 (41.7%)
Either 7 (23.3%) 6 (20%) 13 (21.7%)
Not sure 3 (10%) 3 (10%) 6 (10%)

Question 9

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q3

  # infections compared to expected Confidence in data  
Hospital 1 ●●○○○ Medium
Hospital 2 ●●○○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q3

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 6 4284 13.599 0.441 Better than the U.S. National Benchmark
Hospital 2 78 62316 135.192 0.577 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 7 (23.3%) 26 (86.7%) 33 (55%)
Hospital 2 13 (43.3%) 2 (6.7%) 15 (25%)
Either 5 (16.7%) 1 (3.3%) 6 (10%)
Not sure 5 (16.7%) 2 (6.7%) 7 (11.7%)

Question 10

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q1

  # infections compared to expected Confidence in data  
Hospital 1 ●●●● Low
Hospital 2 ●●○○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q1

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 2 569 1.138 1.757 No different than the U.S. National Benchmark
Hospital 2 32 20545 45.247 0.707 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 9 (30%) 21 (70%) 30 (50%)
Hospital 2 19 (63.3%) 8 (26.7%) 27 (45%)
Either (NaN%) (NaN%) (NaN%)
Not sure 2 (6.7%) 2 (6.7%) 4 (6.7%)

Question 11

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q2

  # infections compared to expected Confidence in data  
Hospital 1 ●●●○○ Low
Hospital 2 ●●●○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q2

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 1 717 1.077 0.929 No different than the U.S. National Benchmark
Hospital 2 81 44278 97.305 0.832 No different than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 9 (30%) 18 (60%) 27 (45%)
Hospital 2 14 (46.7%) 9 (30%) 23 (38.3%)
Either 6 (20%) 1 (3.3%) 7 (11.7%)
Not sure 1 (3.3%) 3 (10%) 4 (6.7%)

Question 12

New visualization

Catheter-Associated Urinary Tract Infections (CAUTI) q3

  # infections compared to expected Confidence in data  
Hospital 1 ●●●○○ Low
Hospital 2 ●●○○○ High


CMS Hospital Compare table

Catheter-Associated Urinary Tract Infections (CAUTI) q3

No. of infections reported (A)
Catheter Days
Predicted No. Infections (B)
Standardized Infection Ratio (SIR) (A/B)
Evaluation
Hospital 1 1 727 1.092 0.916 No different than the U.S. National Benchmark
Hospital 2 62 38404 82.116 0.755 Better than the U.S. National Benchmark

Standardized infection ratio (SIR) national benchmark = 1.
Lower SIRs are better. A score of (0) – meaning no CAUTIs – is best.

Prompt and response options

Which hospital would you choose based only on the CAUTI information in the blue rectangle?

 Hospital 1
 Hospital 2
 Either, because both hospitals are about the same
 Not sure


Survey responses

New method arm (n, %) Control arm (n, %) Total (n, %)
Hospital 1 11 (36.7%) 20 (66.7%) 31 (51.7%)
Hospital 2 14 (46.7%) 7 (23.3%) 21 (35%)
Either 3 (10%) 1 (3.3%) 4 (6.7%)
Not sure 2 (6.7%) 3 (10%) 5 (8.3%)