Use of the Patient Assessment of Chronic Illness Care (PACIC) With Diabetic Patients

Abstract

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...

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