Patient Assessment Of Chronic Illness Care Scores Research Articles

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BackgroundThe rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.MethodsConducted from April to November 2020 in Huai’an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.ResultsHigher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.ConclusionsThis study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

The relationship between hypertensive patients' satisfaction with hypertension care and their antihypertensive medication adherence

BackgroundHypertension is a common chronic disease that causes serious complications. Therefore, its management is critical. Many factors affect the management of hypertension, such as care satisfaction and antihypertensive medication adherence. AimThis study investigated the relationship between hypertensive patients' satisfaction with hypertension care and their antihypertensive medication adherence. Materials and MethodsThis descriptive-correlational study was conducted between October 2016 and February 2017. A total of 407 patients meeting the inclusion criteria were enrolled in the study. The data were collected using the descriptive questionnaire, the Patient Assessment of Chronic Illness Care (PACIC) to determine care satisfaction, and the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF). Blood pressure, body height, and weight were also measured. ResultsPatients had a low mean PACIC score and a good mean score on the MASES-SF. Their PACIC scores differed by age, gender, number of daily antihypertensive medications, time since last examination due to hypertension, getting information about hypertension, and blood pressure control status (p < 0.05). Their MASES-SF scores differed by perceived economic status, time since hypertension diagnosis, duration of antihypertensive medication use, time since last examination due to hypertension, and blood pressure control status. In addition, there was a weak positive and significant correlation between PACIC and MASES-SF scores (p < 0.001). ConclusionsPatients have low satisfaction with hypertension care and good antihypertensive medication adherence. As satisfaction with hypertension care increases, adherence to antihypertensive medication increases.

Correlation of Coronary Heart Disease Patient Assessments of Chronic Illness Care and Quality of Care Procedures

Purpose: Patient-centered assessment of chronic illness care is replacing the assessment of satisfaction, which does not cover all dimensions of care. Patient assessments reflect both the quality of chronic illness care and provide feedback to healthcare workers about their work. The study aim was to investigate the patient-centered assessment of coronary heart disease (CHD) patients and its correlation with the care that was delivered.&#x0D; Methods: This cross-sectional study evaluated data obtained from the patient medical records and surveyed patients using the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. A descriptive analysis of the overall and domain-specific responses to the PACIC questionnaire was conducted and the association of the results with delivery of care data in the patient records was determined by Pearson's correlation coefficient.&#x0D; Results: The study sample included 768 of 1080 CHD patients (71,1%) at 36 family medicine practices who completed the PACIC questionnaire. The mean age of the respondents was 68.3 ± 10.7 years and the overall PACIC score was 3.3 ± 0.9. The highest PACIC scores were delivery system design (3.7), patient activation (3.7), and problem solving (3.6). Follow-up received the lowest score (2.8). Quality of delivered care and PACIC scores were correlated (r = 0.10, p = 0.009).&#x0D; Conclusions: CHD patients highly rated all aspects of chronic care included in the PACIC questionnaire. They were least satisfied with the follow-up and coordination aspects of chronic care. The process indicators of care were positively correlate with patient assessment of care.

Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire.MethodsA survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores.ResultsIn total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups.A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied.ConclusionsThese results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Linking Manager's, Health Provider's and Patient's Assessment of Chronic Illness Care in Primary and Secondary Level of Care in Brazil

Background: Twenty years after the first publication of the landmark Chronic Care Model by Wagner and collaborators, it still guides interventions and evaluation aiming to improve patient chronic disease outcomes. Chronic care can be influenced by stakeholders who are user of the collected data, but health providers and patient have also a major impact on the success or failure of intervention aiming to improve quality of care. The Assessment of Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care (PACIC) are tools that have been used with success to evaluate care for a number of chronic diseases from the point of view of providers and patients respectively. In Brazil, chronic diseases are the leading cause of mortality accounting for more than 70% of deaths. Diabetes and cardiovascular diseases accounted for 13% and 5% of discounted disability-adjusted life years (DALYs) in 2007. Aim: The objective of this study was to evaluate care for diabetes and hypertension from the point of view of the patient, providers, and managers in primary and secondary care clinics of the city of Juiz de For a, Minas Gerais, Brazil. Material and Methods: Three different tools were used to evaluate care, named the Assessment of Chronic Illness Care (ACIC) and the Patient Assessment of Chronic Illness Care (PACIC) both designed and tested by the MacColl Institute for Health Improvement as well as the questionnaire Chronic Care Structure Survey designed by the Pan American Health Organization and based on the Physician Practice Connection and Readiness Survey (PPC-RS). In the evaluation participated 1,664 patients with diabetes or hypertension, as well as 323 health providers from public primary and secondary care clinics. Patients and providers were interviewed using ACIC and PACIC; and the CCSS was completed by medical managers from each clinic. Clinical data from patients were abstracted from electronic records. Results: Scores for all the three questionnaires were scaled to 100 percentage points. The evaluation of the structure for chronic care scored 49 and 94 percentage points for primary and secondary care respectively. All PACIC and ACIC scores for primary care clinics were lower than scores for the secondary care clinic. Patients and providers rated care at 45 and 48, and 73 and 68 percentage points for primary and secondary care clinics. The secondary care clinic was evaluated with very high scores by patients and providers. Among the activities explored by the PACIC questionnaire, patient considered the lowest score for activation, followed by care coordination for both primary and secondary care clinics; while providers considered that the weakest aspects were the Health Care Organization. This research showed that using the PACIC, ACIC and CCSS were helpful understanding capacity and identifying chronic care areas for improvement in primary and secondary care settings. The capacity and clinic outcomes of the secondary care clinic proved to be better than the one exhibited by the primary care clinics for the management of diabetes and hypertension.

Effects of Intensive Primary Care on High-Need Patient Experiences: Survey Findings from a Veterans Affairs Randomized Quality Improvement Trial.

Intensive primary care programs aim to coordinate care for patients with medical, behavioral, and social complexity, but little is known about their impact on patient experience when implemented in a medical home. Determine how augmenting the VA's medical home (Patient Aligned Care Team, PACT) with a PACT-Intensive Management (PIM) program influences patient experiences with care coordination, access, provider relationships, and satisfaction. Cross-sectional analysis of patient survey data from a five-site randomized quality improvement study. Two thousand five hundred sixty-six Veterans with hospitalization risk scores ≥ 90th percentile and recent acute care. PIM offered patients intensive care coordination, including home visits, accompaniment to specialists, acute care follow-up, and case management from a team staffed by primary care providers, social workers, psychologists, nurses, and/or other support staff. Patient-reported experiences with care coordination (e.g., health goal assessment, test and appointment follow-up, Patient Assessment of Chronic Illness Care (PACIC)), access to healthcare services, provider relationships, and satisfaction. Seven hundred fifty-nine PIM and 768 PACT patients responded to the survey (response rate 60%). Patients randomized to PIM were more likely than those in PACT to report that they were asked about their health goals (AOR = 1.26; P = 0.046) and that they have a VA provider whom they trust (AOR = 1.35; P = 0.005). PIM patients also had higher mean (SD) PACIC scores compared with PACT patients (2.91 (1.31) vs. 2.75 (1.25), respectively; P = 0.022) and were more likely to report 10 out of 10 on satisfaction with primary care (AOR = 1.25; P = 0.048). However, other effects on coordination, access, and satisfaction did not achieve statistical significance. Augmenting VA's patient-centered medical home with intensive primary care had a modestly positive influence on high-risk patients' experiences with care coordination and provider relationships, but did not have a significant impact on most patient-reported access and satisfaction measures.

Assessment of hypertension chronic care model: Pacic application in Bosnia and Herzegovina.

The objectives of this study were to evaluate patients’ attitudes towards hypertension treatment according to the chronic care model and to assess the implementation of hypertension clinical guidelines in family medicine. The cross-sectional study was carried out in two randomly selected primary health care centers (Bijeljina and Prijedor), respectively in Bosnia and Herzegovina, covering the period between March and April 2016. This study sample consists of 791 respondents with hypertension purposing to measure specific actions and quality of care for hypertensive patients. The Patient Assessment of Chronic Illness Care (PACIC) was used. Treatment for the indicators of hypertension was assessed by analyzing patients' medical charts according to the recommendations of clinical guidelines. More than half of the evaluated indicators of treatment for hypertension were documented in medical charts of 84.07% patients. The average overall PACIC score was 4.18 (SD 0.59), being an average of the separate scores of 4.19 (SD 0.57) in men and 4.17 (SD 0.60) in women. Subscale means of PACIC were as follows: patient activation 4.33, delivery system design 4.36; goal setting 4.03; problem solving 4.51; follow-up and co-ordination 3.67. No statistically significant correlations in the overall score and subscale scores were found by demographic characteristics. Non-smokers had a significantly higher overall score compared to smokers (p = 0.001). As implementation of the guidelines became stronger, the reported PACIC scores rose. Continuing the education of patients in order to achieve better health care outcomes is imperative.

The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis.

The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Studies of any design using the PACIC in diabetic patients. We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.

Validation of the Patient Assessment of Chronic Illness Care (PACIC) Instrument in the Republic of Srpska, Bosnia and Herzegovina

Rationale, aims and objectives: To translate, culturally adapt and preliminary validate the original English version of the PACIC questionnaire into the Serbian language, in the Republic of Srpska, Bosnia and Herzegovina and to assess the relationship between PACIC scores and clinical guidelines implementation in family medicine.Methods: A cross-sectional study was implemented in 2 primary healthcare centers. The translated PACIC questionnaire was administered to 206 consecutive patients with hypertension, diabetes mellitus and/or chronic obstructive pulmonary disease. The validity and reliability of the Serbian version of PACIC has been tested with face validity, construct validity and internal consistency. The PACIC score and its 5 subscales were tested using Kruskal-Wallis or Mann-Whitney test. The relationship of the PACIC score and guidelines implementation was analyzed by multiple linear regression.Results: The overall PACIC score indicates an implementation of the Chronic Care Model (CCM) occurred “most of the time”. Of the 5 subscales, average scores were highest on “Delivery system/decision support”. CCM in “Follow up/Coordination” occurred sometimes. Cronbach’s alpha coefficient showed a high internal consistency level for the PACIC questionnaire. Kaiser-Meyer-Olkin Measure of Sampling Adequacy is 0.917 and Bartlett’s test of sphericity is significant (p≤0.001). Four factors were identified explaining 69% of total variance.Conclusions: There was a significant relationship between the PACIC score and the implementation of the chronic disease clinical guidelines. The PACIC questionnaire is advanced as a reliable and internally consistent instrument of use in increasing the person-centeredness of care of chronic illness.

Assessment of the quality of primary care for the elderly according to the Chronic Care Model.

ABSTRACTObjective:to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. Method:cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. Results:there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the “delivery system design/decision support” was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. Conclusion:the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions.

Patient Experience of Chronic Illness Care and Medical Home Transformation in Safety Net Clinics.

To examine the relationship between medical home transformation and patient experience of chronic illness care. Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n=303) and postintervention (n=271). Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equationmethods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention. In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β=7.7, 95 percent confidence interval [CI]: -1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1-14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination). We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics.

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument.

Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. Two independent samples, patients with diabetes (n=395) and HCPs (including primary and secondary care physicians and nurses; n=287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1=never to 5=always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study.

Previous research using cross-sectional data has shown a positive relationship between patient activation and quality of care. The quantitative relationships in the same patients over time, however, remain undefined. To examine the relationship between changes in activation over time and patient-assessed quality of chronic illness care. Prospective cohort study. The study used data reported annually from 2008 (N = 3761) to 2010 (N = 3040), using self-report survey questionnaires, completed by patients with type 2 diabetes in a population-based cohort in Queensland, Australia. Principal measures were the 13-item Patient Activation Measure (PAM), and the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument. Nonparametric anova was used to determine the association between patient activation and patient-assessed quality of care in low and high patient activation groups at baseline (2008), and in 2009 and 2010, when patients had changed group membership. The Wilcoxon signed ranks test was used to compare the PACIC scores between baseline and each follow-up survey for the same patient activation level. Patient activation was positively associated with the median PACIC score within each survey year and within each of the groups defined at baseline (high- and low-activation groups; P < 0.001). Patient activation and the PACIC change in the same direction and should be considered together in the interpretation of patient care assessment. This can be carried out by interpreting PACIC scores within strata of PAM.

Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study.

The Patient Assessment of Chronic Illness Care (PACIC) was designed to measure care congruent with several elements of the chronic care model (CCM), including self-management support and delivery system design. However, support for the a priori 5-subscale structure of the PACIC in previous research has been conflicting. Thus, we aim to investigate psychometric characteristics of the PACIC including the content and stability of its construct over time. A population-based prospective cohort study of patients with type 2 diabetes was conducted in Queensland, Australia, from 2008 (N = 3,761) to 2010 (N = 3,040). Participants completed annually the 20-item PACIC as well as measures of providers' adherence to guideline-recommended self-management support activities. We used exploratory factor analysis to determine its factor structure and examined internal consistency as well as agreement between the PACIC at baseline with repeated measurements at follow-up after 1 and 2 years. We also determined a criterion-related validity using multinomial logistic regression to explore PACIC's association with providers' self-management support. A one-factor structure was deemed optimal according to our findings. High internal consistency and moderate agreement within the scales over time were observed. Higher PACIC scores predicted better providers' self-management support. In conclusion, the PACIC is a reliable, valid, and reproducible instrument for assessment of diabetes care, and we recommend its promotion and use as a single scale rather than subscales as originally proposed.

The concordance of care for age related macular degeneration with the chronic care model: a multi-centered cross-sectional study.

AimsThe aim of the study was to assess the concordance of care for age related macular degeneration with the evidence-based framework for care for chronic medical conditions known as the chronic care model. Furthermore we aimed to identify factors associated with the concordance of care with the chronic care model.MethodsMulti-centered cross-sectional study. 169 patients beginning medical treatment for age related macular degeneration were recruited and analyzed. Patients completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire, reflecting accordance to the chronic care model from a patient’s perspective, the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and Patient Health Questionnaire (PHQ-9). Visual acuity and chronic medical conditions were assessed. Nonparametric tests and correlation analyses were performed, also multivariable regression analysis.ResultsThe median PACIC summary score was 2.4 (interquartile range 1.75 to 3.25), the lowest PACIC subscale score was “follow-up/coordination” with a median of 1.8 (interquartile range 1.00 to 2.60). In multivariable regression analysis the presence of diabetes type 2 was strongly associated with low PACIC scores (coefficient = −0.85, p = 0.007).ConclusionGenerally, care for patients with age related macular degeneration by ophthalmologists is in moderate concordance with the chronic care model. Concerning follow-up and coordination of health service, large improvements are possible. Future research should answer the question how healthcare delivery can be improved effecting relevant benefits to patients with AMD.

Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

BackgroundIn primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.MethodsThis cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).ResultsThe overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.ConclusionsThis study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registrationCurrent Controlled Trials ISRCTN89818205.

Assessment of 5-year system-wide type 2 diabetes control measures in a Southeast Asian metropolis

Abstract Background: Sparse information exists regarding the progress of the chronic care model (CCM) implementation for type 2 diabetes, at system-wide level for developing countries including Thailand. Objective: We assessed the extent to which type 2 diabetes patients in Bangkok, Thailand report having received CCM-based services by using the Patient Assessment of Chronic Illness Care (PACIC). Methods: One thousand type 2 diabetes patients from 64 healthcare facilities throughout Bangkok were randomly selected, data about the extent they have received CCM-based services, their dietary, physical activity, medication-taking behaviors, body mass index (BMI), and blood sugar control status were collected by a set of structured questionnaires and medical record abstraction. Results: PACIC and self-management scores for patients receiving care from public hospitals and health centers were significantly higher than those from private hospitals. Being the primary care unit (PCU)-where the CCM implementation has been enforced since 2008 was significantly associated with higher PACIC scores for public hospitals. This was not the case for private hospitals. PCU status was significantly associated with better selfmanagement scores for patients in both public and private hospitals. However, variations in PACIC and selfmanagement scores did not reflect to BMI or glycemic control outcomes of the patients. Conclusion: There is encouraging evidence of progress of CCM implementation for type 2 diabetes patients in Bangkok, Thailand. This had also resulted in improved self-management, but not physiological or metabolic outcomes.

High-quality chronic care delivery improves experiences of chronically ill patients receiving care

ObjectiveInvestigate whether high-quality chronic care delivery improved the experiences of patients.DesignThis study had a longitudinal design.Setting and ParticipantsWe surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders.Main Outcome MeasuresPatients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery.ResultsOverall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2.ConclusionThis research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time.

Do older patients and their family caregivers agree about the quality of chronic illness care?

Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics. Cross-sectional analysis. Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247). Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw). Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P < 0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P < .05). Patient-caregiver dyads had greater agreement on objective questions than on subjective questions (Kw = 0.25 and 0.15, respectively, P > 0.05). Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.

Is patient assessment of asthma care delivery associated with publicly reported performance measures?

Objective: To determine the association between patient assessment of healthcare delivery and publicly reported asthma performance measures. Methods: We identified individuals 5–50 years old who had asthma quality measures reported to the Minnesota Community Measurement© (MCM©) by their clinic and sent them a postal survey which included within it the Patient Assessment of Chronic Illness care (PACIC), a validated measure of patient perception of the quality of healthcare delivery. We performed a multivariable analysis to examine the association between PACIC scores and achievement of asthma care quality measures. Results: The response rate for the ACS was 102/367 (28%); a non-response bias analysis revealed no differences between responders and non-responders for age, gender and asthma control. Most responders (73%) reported taking asthma medications daily and most (71%) had poorly controlled asthma. The PACIC score was not associated with any of the asthma quality measures based on the data reported to MCM© by the clinic. A higher PACIC score was, however, associated with having an asthma action plan based on patient-reported data in the ACS (p < 0.0001) but not with patient-reported asthma control or emergency department/hospitalizations for asthma. Conclusions: Patient assessment of high quality asthma care delivery was associated with patient self-report of having an asthma action plan but was not associated with any of the publicly reported asthma performance measures.