OBJECTIVE -There is a dearth of information on the extent to which diabetic patients receive care congruent with the chronic care model (CCM) and evidence-based behavioral counseling. This study evaluates a new instrument to fill this gap. RESEARCH DESIGN AND METHODS-A heterogeneous sample of 363 type 2 diabetic patients completed the original Patient Assessment of Chronic Illness Care (PACIC), along with additional items that allowed it to be scored according to the "5As" (ask, advise, agree, assist, and arrange) model of behavioral counseling. We evaluated relationships between survey scores and patient characteristics, quality of diabetes care, and self-management.RESULTS -Findings replicated those of the initial PACIC validation study but with a much larger sample of diabetic patients and more Latinos. Areas of CCM activities reported least often were goal setting/intervention tailoring and follow-up/coordination. The 5As scoring revealed that patients were least likely to receive assistance with problem solving and arrangement of follow-up support. Few demographic or medical characteristics were related to PACIC or 5As scores, but survey scores were significantly related to quality of diabetes care received and level of physical activity.CONCLUSIONS -The PACIC and the new 5As scoring method appear useful for diabetic patients. Its use is encouraged in future research and quality improvement studies. Diabetes Care 28:2655-2661, 2005T he chronic care model (CCM) (1,2) is receiving widespread acceptance as a framework for developing and implementing evidence-based activities to improve care for chronic illnesses (3,4). The CCM appears applicable for a variety of chronic illnesses (5), including diabetes (6,7), and potentially for preventive services (8). However, there are few instruments to assess the level of CCM-congruent activities that patients receive. To inform quality improvement programs, compare different health care settings, and evaluate intervention studies, it is necessary to have practical assessment tools to evaluate the delivery of CCM activities (9).The primary assessment procedure that has been used to date is the Assessment of Chronic Illness Care (10). This scale is completed by health care team members and appears particularly useful for helping teams identify gaps and generate innovations. It is less practical for widespread application, however, and subject to clinician overreporting, as are many clinician report instruments. Since unobtrusive observation is not feasible for large-scale application, asking patients to report the CCM-related activities that they have received seems like a valuable method of providing CCM implementation data. Recently, Glasgow et al. (11) reported preliminary data on the Patient Assessment of Chronic Illness Care (PACIC), a 20-item survey of the extent to which patients report having received CCM-based services that they could reasonably be expected to observe. That report suggests that the PACIC has reasonable psychometric characteristics and is appropri...

OBJECTIVE -There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care settings. This report presents 12-month follow-up results from a computer-assisted, patient-centered intervention to improve the level of recommended services patients received from a variety of primary care settings.RESEARCH DESIGN AND METHODS -A total of 886 patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on two primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed from the National Committee on Quality Assurance/ American Diabetes Association Provider Recognition Program (PRP). Secondary outcomes were evaluated using the Problem Areas in Diabetes 2 quality of life scale, lipid and HbA 1c levels, and the Patient Health Questionnaire-9 depression scale. RESULTS -The program was well implemented and significantly improved both the number of laboratory assays and patient-centered aspects of diabetes care patients received compared with those in the control condition. There was overall improvement on secondary outcomes of lipids, HbA 1c , quality of life, and depression scores; between-condition differences were not significant.CONCLUSIONS -Staff in small, mixed-payer primary care offices can consistently implement a patient-centered intervention to improve PRP measures of quality of diabetes care. Alternative explanations for why these process improvements did not lead to improved outcomes, and suggested directions for future research are discussed.

This relatively low-intensity intervention appealed to a large, generally representative sample of patients, was well implemented, and produced improvement in targeted behaviours. Implications of this practical clinical trial for dissemination are discussed.

Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality of diabetes care. Staff in primary care offices can consistently deliver an intervention of this nature, but most physicians were unwilling to participate in this translation research study.

The DVD appears to have merit as an efficient and appealing alternative to brief classroom-based diabetes education, and the hybrid design is recommended to provide estimates of programme reach.