Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

Polly H Noël,Michael L Parchman,John E Zeber,Krista W Bowers,Ray F Palmer,Holly J Lanham,Raquel L Romero,Luci K Leykum

doi:10.1186/1471-2296-15-57

Abstract

BackgroundLittle is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received.MethodsAnalysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire.ResultsTwo sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales [Self-management Support (p < 0.05); Community Linkages (p < 0.02), Delivery System Design (p < 0.02), and Organizational Support (p < 0.02)] were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak.ConclusionsThe ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.Trial registrationNCT00482768

Highlights

Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care
Our findings indicate that the Assessment of Chronic Illness Care (ACIC) summary score was not associated with Patient Assessment of Chronic Illness Care (PACIC) summary scores or the majority of PACIC subscale scores
The findings suggest that patients’ global perceptions of their chronic illness care, as assessed by the PACIC, and their receipt of care promoting patient activation, goal-setting, problem-solving, and care coordination, are associated with key elements of chronic illness care, such as self-management support, delivery system design, and organizational support provided in the primary care clinics where they receive their care, as assessed by the clinicians and other staff in these practices

Summary

Introduction

Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. The Chronic Care Model (CCM) has become a widely accepted framework for organizing and delivering patientcentered, evidence-based care for patients with chronic illnesses within the primary care setting [1]. A basic premise of the CCM is that health care settings where these elements are robust are likely to have prepared, proactive practice teams, and informed, engaged patients who become active members of their health care teams and accept shared responsibility for their chronic illness care [2]. To date, little is known as to whether primary care teams’ perceptions of how well they deliver care consistent with the CCM corresponds with their patients’ own experience of chronic illness care

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