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CDC HRQOL–14 "Healthy Days Measure"

The standard 4-item set of Healthy Days core questions (CDC HRQOL– 4) has been in the State-based Behavioral Risk Factor Surveillance System (BRFSS) since 1993 (see BRFSS Website). Since 2000, the CDC HRQOL– 4 has been in the National Health and Nutrition Examination Survey (NHANES) for persons aged 12 and older. Since 2003, the CDC HRQOL– 4 has been in the Medicare Health Outcome Survey (HOS)—a NCQA HEDIS measure. Standard Activity Limitation and Healthy Days Symptoms modules have also been available since January 1995. When used together, these measures comprise the full CDC HRQOL–14 Measure. See the Health Related Quality of Life Measures in Spanish.


Healthy Days Core Module (CDC HRQOL– 4)

1. Would you say that in general your health is:

 Please Read
a. Excellent1
b. Very good2
c. Good3
d. Fair4
or
e. Poor5

  

 

 

 

 

 

 

 Do not read these responses
Don't know/Not sure7
Refused9

 

 

 

2. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

 a. Number of Days_ _
 b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

 

3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

 a. Number of Days_ _ 
b. None8 8If both Q2 AND Q3 = "None", skip next question

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

 

4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

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Activity Limitations Module

These next questions are about physical, mental, or emotional problems or limitations you may have in your daily life.

1. Are you LIMITED in any way in any activities because of any impairment or health problem?

 a. Yes1 
b. No2Go to Q1 of Healthy Days Symptoms Module

 

 


 

 Don't know/Not sure7Go to Q1 of Healthy Days Symptoms Module
Refused9Go to Q1 of Healthy Days Symptoms Module

 

 

 

2. What is the MAJOR impairment or health problem that limits your activities?

 Do Not Read. Code Only One Category.
a. Arthritis/rheumatism0 1
b. Back or neck problem0 2
c. Fractures, bone/joint injury0 3
d. Walking problem0 4
e. Lung/breathing problem0 5
f. Hearing problem0 6
g. Eye/vision problem0 7
h. Heart problem0 8
i. Stroke problem0 9
j. Hypertension/high blood pressure1 0
k. Diabetes1 1
l. Cancer1 2
m. Depression/anxiety/emotional problem1 3
n. Other impairment/problem1 4

 

 

 

 

 

 

 

 Don't know/Not sure7
Refused9

 

 

 

 

 

 

 

 

 

 

3. For HOW LONG have your activities been limited because of your major impairment or health problem?

 Do Not Read. Code using respondent's unit of time.
a. Days1 _ _
b. Weeks2 _ _
c. Months3 _ _
d. Years4 _ _

 

 

 

 


 

 Don't know/Not sure7 7 7
Refused9 9 9

 

 

 

 

4. Because of any impairment or health problem, do you need the help of other persons with your PERSONAL CARE needs, such as eating, bathing, dressing, or getting around the house?

 a. Yes1
b. No2

 

 

 

 Don't know/Not sure7
Refused9

 

 

 

5. Because of any impairment or health problem, do you need the help of other persons in handling your ROUTINE needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

 a. Yes1
b. No2

  

 

 

 Don't know/Not sure7
Refused9

 

 

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Healthy Days Symptoms Module

1. During the past 30 days, for about how many days did PAIN make it hard for you to do your usual activities, such as self-care, work, or recreation?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

2. During the past 30 days, for about how many days have you felt SAD, BLUE, or DEPRESSED?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

3. During the past 30 days, for about how many days have you felt WORRIED, TENSE, or ANXIOUS?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

4. During the past 30 days, for about how many days have you felt you did NOT get ENOUGH REST or SLEEP?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

5. During the past 30 days, for about how many days have you felt VERY HEALTHY AND FULL OF ENERGY?

 a. Number of Days_ _
b. None8 8

 

 

 

 Don't know/Not sure7 7
Refused9 9

 

 

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