Patient Assessment Of Chronic Illness Care Research Articles

EVALUATION OF CHRONIC PATIENT NURSING CARE BY THE PATIENTS: A UNIVERSITY HOSPITAL CASE

This study aims to identify satisfaction levels of adult chronic patients regarding the care they received at the hospital. The descriptive and cross-sectional study was conducted at Cukurova University Faculty of Medicine Balcali Hospital between 01.08.2016-31.10.2016. The sample consisted of 910 patients. The data was collected with “Personal Information Form” and Patient Assessment of Chronic Illness Care (PACIC). The data were analyzed via IBM 20.0 program. Ethical committee approval, permission from the institution and verbal consent from the patients were obtained for the study. The average age of the participants was 50.88±16.55. The average hospitalization duration was 9.22±11.55 days. It was indicated that 38% of the respondents have cardiovascular diseases, 94.6% use a kind of medication,91.7% have their medications on time, 85.5% take recommended dosages, 45.5% know the name and the number of the medication they take. The average score for chronic patient care evaluation scale was 3.11±0.74. When the subscales of the scale are analyzed, it was found that the average score for patient participation subscale is 3.75±0.93, decision-making support subscale is 3.46±3.33, target-setting subscale is 2.95±0.78, problem-solving subscale is 3.28±0.97 and monitoring/coordination subscale is 2.51±1.03. Significant correlations were found between the respondents’ education level and health education with their evaluations of chronic care. It was indicated that the patients’ satisfaction with the nursing care is medium, the highest average scores are in decision-making subscale while the average score for monitoring/coordination subscale is the lowest. In order to raise the satisfaction levels of chronic patients regarding nursing care, chronic patient care should be prioritized in organized education and on-the-job training for nurses. By emphasizing the importance of monitoring and coordinating the patients, better management of chronic diseases can be achieved. Article DOI: https://dx.doi.org/10.20319/lijhls.2017.32.3850 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

Evaluación de los cuidados recibidos por pacientes con enfermedades crónicas

ObjectiveThe aim of this study is to assess the care received by chronic patients from their point of view and objectify the factors related with a better assessment of care. DesignCross-sectional descriptive study realized between September 2014 and April 2015. LocationNine Health Centers of Navarra (6 urban and 3 rural), Spain. ParticipantsSampling opportunity of 196 patients aged over 65years presenting at least one chronic disease. Main measuresOutcome variable: Evaluation of the care received through the Patient Assessment of Chronic Illness Care (PACIC) test (score 1 to 5, higher values indicate better perception about quality of care). Explanatory variables: quality of life employing the EQ5D instrument, Katz index and Gijón's socio-family evaluation scale. Other variables studied were: sex, age, education, Charlson index and number of chronic diseases. The association between the PACIC numerical value with the rest of the variables was calculated. ResultsThe assessment of the care received according to the PACIC was higher with more chronic diseases (rho: 0.196; p=0.006), with less autonomy (mild or no disability: mean 2.9; SD: 0.6 vs. moderate or severe disability: mean 3.3; SD: 0.2; P=.003), in those with worse quality of life (EQ5D5L Index value rho: −0.227; P=.001. EQ VAS rho: −0.145; P=.043), and in those with a more favorable social situation (rho: −0.167; P=.022). ConclusionsThe perception of chronic patients about the received care is better with an increased number of chronic diseases and with less autonomy and quality of life. The social environment influences the care perception of the patient, being this worse in environments with higher social risk.

Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

BackgroundIt is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity.MethodsThis systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting.ResultsA narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees.ConclusionsCollaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies.

Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire

The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended.

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management – Findings from the International BRIGHT Study

ObjectivesThe objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). BackgroundThe International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. MethodsWe conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. ResultsTwenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (β = 5.2, P = 0.042). ConclusionMajority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM.

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.

Case management to increase quality of life after cancer treatment: a randomized controlled trial

BackgroundCase management has been shown to be beneficial in phases of cancer screening and treatment. After treatment is completed, patients experience a loss of support due to reduced contact with medical professionals. Case management has the potential to offer continuity of care and ease re-entry to normal life. We therefore aim to investigate the effect of case management on quality of life in early cancer survivors.MethodsBetween 06/2010 and 07/2012, we randomized 95 patients who had just completed cancer treatment in 11 cancer centres in the canton of Zurich, Switzerland. Patients in the case management group met with a case manager at least three times over 12 months. Patient-reported outcomes were assessed after 3, 6 and 12 months using the Functional Assessment of Cancer Therapy (FACT-G) scale, the Patient Assessment of Chronic Illness Care (PACIC) and the Self-Efficacy scale.ResultsThe change in FACT-G over 12 months was significantly greater in the case management group than in the control group (16.2 (SE 2.0) vs. 9.2 (SE 1.5) points, P = 0.006). The PACIC score increased by 0.20 (SE 0.14) in the case management group and decreased by 0.29 (SE 0.12) points in the control group (P = 0.009). Self-Efficacy increased by 3.1 points (SE 0.9) in the case management group and by 0.7 (SE 0.8) points in the control group (P = 0.049).ConclusionsCase management has the potential to improve quality of life, to ease re-entry to normal life and to address needs for continuity of care in early cancer survivors.Trial registrationThe study has been submitted to the ISRCTN register under the name “Case Management in Oncology Rehabilitation” on the 12th of October 2010 and retrospectively registered under the number ISRCTN41474586 on the 24th of November 2010.

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.

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in S\xe3o Paulo, Brazil

BackgroundRates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil.MethodsNineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients’ reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients’ reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs’ fidelity to and experiences with the intervention.ResultsPatients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/−19) to 68 (+/−21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (−16.1 mg/dL, p = .005) and triglyceride levels (−38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals.ConclusionIn resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters.Trial registrationNCT02994095 12/14/2016 Registered retrospectively.

The Patient Assessment of Chronic Illness Care produces measurements along a single dimension: results from a Mokken analysis

BackgroundAs the worldwide prevalence of chronic illness increases so too does the demand for novel treatments to improve chronic illness care. Quantifying improvement in chronic illness care from the patient perspective relies on the use of validated patient-reported outcome measures. In this analysis we examine the psychometric and scaling properties of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire for use in the United Kingdom by applying scale data to the non-parametric Mokken double monotonicity model.MethodsData from 1849 patients with long-term conditions in the UK who completed the 20-item PACIC were analysed using Mokken analysis. A three-stage analysis examined the questionnaire’s scalability, monotonicity and item ordering. An automated item selection procedure was used to assess the factor structure of the scale. Analysis was conducted in an ‘evaluation’ dataset (n = 956) and results were confirmed using an independent ‘validation’ (n = 890) dataset.ResultsAutomated item selection procedures suggested that the 20 items represented a single underlying trait representing “patient assessment of chronic illness care”: this contrasts with the multiple domains originally proposed. Six items violated invariant item ordering and were removed. The final 13-item scale had no further issues in either the evaluation or validation samples, including excellent scalability (Ho = .50) and reliability (Rho = .88).ConclusionsFollowing some modification, the 13-items of the PACIC were successfully fitted to the non-parametric Mokken model. These items have psychometrically robust and produce a single ordinal summary score. This score will be useful for clinicians or researchers to assess the quality of chronic illness care from the patient's perspective.

Diabetes care: comparison of patients’ and healthcare professionals’ assessment using the PACIC instrument

Introduction: Studies have shown that the implementation of interventions based on the Chronic Care Model (CCM) plays an important role in the quality of diabetes care. The Patient Assessment of Chronic Illness Care (PACIC) is a validated instrument to measure the extent to which care is congruent with the recommendations of the CCM. The aim of this study was to compare the evaluation of diabetes care, according to the PACIC, as reported by patients with diabetes and healthcare professionals.Methods: This study took place in the canton of Vaud, one of the 26 Swiss cantons, which has circa 700’000 inhabitants (10% of the Swiss population) and is located in the French speaking part of Switzerland. Two independent samples, one of non-institutionalized adult patients with diabetes (n=395) and one of healthcare professionals (i.e. primary care physicians, diabetologists, primary care nurses and diabetes specialized nurses; n=287), were asked to complete the PACIC-5A and the modified-PACIC-5A, respectively. The PACIC-5A (26 questions scored on a five-point scale: 1=never to 5=always) was originally developed as a questionnaire to be answered by patients. It was adapted so as to allow healthcare providers to respond to the PACIC-5A questions (modified-PACIC-5A). For example, the question “Over the past 6 months, when I received care for my chronic conditions, I was asked to talk about my goals in caring for my condition” was adjusted to “When caring for a person with a chronic illness, how often do you ask them to talk about their own goals in caring for their condition.” In both groups, means and standard deviations were calculated, for each question separately and for the global score computed over the first 20 questions. Comparisons of results across the two groups were also performed, using a t-test for two independent samples. Means for the four subgroups of healthcare professionals were also calculated for exploratory purposes.Results: Mean age of patients was 65.5 years, 63% were male, and 84.6% reported type 2 diabetes. The healthcare professionals group comprised 34.5% of physicians (mean age: 52 years) and 65.5% of nurses (mean age: 44 years). Patients’ and healthcare professionals’ global scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively (_p-value 0.0001_). Healthcare professionals reported higher scores for all questions except one – “organization of care satisfaction” – for which the mean scores were identical in the two groups. While the score differences between patients and healthcare professionals varied between 1 and 2 for most questions (&gt; 1 SD), one question – “given a copy of my treatment plan” – showed a differencehigher than 2 (&gt; 2 SD) and a few others presented differences smaller than 1. Among healthcare professionals, scores from specialized nurses and diabetologists were overall higher than those from primary care physicians and nurses for most of the questions. In addition, specialized nurses and diabetologists reported scores higher than 4 (out of a maximum of 5) for 81% and 58% of the questions, respectively, compared to only 27% for primary care physicians and 23% for primary care nurses. Patients with diabetes never reported such high scores.Discussion: These results suggest that healthcare professionals, in particular diabetes specialized nurses and diabetologists, tend to report better quality of diabetes care, as measured by the PACIC, than is reported by patients. Whether these results correspond to over-evaluation by healthcare professionals, under-evaluation by patients, or a combination of both phenomenons remains unknown. Since patients’ outcomes and well-being are the main target of provided care, their perspective is crucial when aiming to improve care for chronic diseases.Conclusion: This study showed that patients and healthcare professionals didn’t report care received or provided in a similar way. Closer collaboration between patients and healthcare professionals, targeting more patient-centered diabetes care, may decrease evaluation differences. Further research, examining results from pairs of patients and healthcare professionals, are needed to confirm our findings.

Patient Experience in an Era of Primary Care Transformation: Revisiting the PACIC

Aims and Objective: The validation study of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire suggested a 5-factor structure determined a priori, but subsequent analyses have questioned the validity of the original factor structure. This study analyzed the factor structure of the PACIC using a large and diverse patient sample, and evaluated the identified factors through the lens of recent transformational initiatives in primary care. Convenience samples of adults completed surveys in waiting rooms during clinic visits. Primary care patients with 1 or more chronic illnesses with complete PACIC responses at baseline from 39 clinics (n=1,567) and at follow-up from 36 clinics (n=1,536) participated. Exploratory and confirmatory factor analyses were conducted on baseline and follow-up patient questionnaire data from a cluster randomized controlled trial. Identified factors were evaluated in terms of item loadings, content, reliability, and the extent to which items reflected advances in the delivery of chronic illness care. Analyses supported the use of the PACIC summary score. Although a 5-factor model was retained, factor loadings were different from the original PACIC validation study. All factors had sufficient reliability, but findings suggested potential revisions to enhance the factor structure. It may be time to revise the PACIC to enhance the stability of the subscales (factors) and better reflect recent transformations in the delivery of chronic illness care.

Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study.

BackgroundThe management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perceive their care is patient-centred. We will assess concordance with the CCM using the Patient Assessment of Chronic Illness Care (PACIC) survey in study patients. We will also explore perception of how patient-centered the care provided by chiropractors is for those with chronic health conditions according to patients and chiropractors.Methods/designWe will use a sequential mixed methods design with quantitative priority. In the quantitative component patients will complete a written questionnaire providing sociodemographic, health status, and health care interaction information, all of which will serve as the independent variables. Patients will also complete a modified version of the PACIC; the average overall score will be the dependent variable. In the qualitative component semi-structured interviews and focus groups with patients and chiropractors will be conducted. A pilot study will be conducted to determine if the modified PACIC will perform adequately in measuring concordance with the CCM for chiropractic care. Pilot testing will also allow for assessment of the interview and focus groups guides. Variables found to be significantly associated will be included in a multivariate linear regression analysis to identify significant predictors of the dependent variable. Qualitative data will be analyzed using an inductive thematic analysis to provide meaning to the quantitative results.DiscussionThere is a paucity of research describing the extent to which chiropractic care for patients with chronic health conditions is concordant with the CCM. This study will examine this relationship and the perceptions and experiences of patients and chiropractors regarding how patient-centered chiropractic care is for these patients.

Perceptions of Chronic Illness Care Among Veterans With Multiple Chronic Conditions.

Given the burden of multiple chronic conditions (MCCs) in the Veterans Affairs (VA) Health Care System, understanding perspectives of Veterans with MCC is essential to evaluate chronic care and ensure that care and quality improvement efforts align with patient needs. The purpose of this study was to use the Patient Assessment of Chronic Illness Care (PACIC) instrument to examine perceptions of chronic care among Veterans with MCC. We conducted a nation-wide, cross-sectional mailed survey. Study inclusion criteria were Veteran patients with MCC who receive care from eight VA facilities. The survey included questions on patient demographics, recent hospital or doctor visits, and the PACIC instrument. Chronic condition and health care utilization data were extracted from VA administrative databases. The sample (n = 3,519) was mostly male; average age was 68.1 years. Mean PACIC summary score was 3.05 (standard deviation [SD] = 1.12). Respondents achieved higher scores (favorable perceptions) in the Delivery System Design and Patient Activation subscales, and lowest scores (unfavorable perceptions) in the Follow-up/Coordination subscale. Characteristics associated with higher scores included non-white race, recent VA doctor visit, and high school or less education. Perceptions of chronic care were high; however, quality improvements are needed to enhance care continuity and coordination.

Influence of patient-assessed quality of chronic illness care and patient activation on health-related quality of life.

To examine the association of the Patient Assessment of Chronic Illness Care (PACIC) with health-related quality of life (HRQoL) and the modulating effect of patient activation on this association. A population-based prospective cohort study of people with Type 2 diabetes in Queensland, Australia, using data from self-report questionnaires, collected annually from 2008 (n = 3761) to 2010 (n = 3040). Predictors were the 20-item PACIC (dichotomized at the score of 3), and the 13-item Patient Activation Measure (PAM), dichotomized into activation Levels 1 and 2 versus Levels 3 and 4. Analyses were restricted to participants whose PACIC and PAM categories did not change over 2 years of follow-up. Outcome variables were EQ-5D index and EQ VAS dichotomized at the uppermost quartile, and EQ-5D index also dichotomized at the median. An inverse probability weighted Poisson regression with a log-link function and a binary response variable for each outcome was used to obtain risk ratios (RRs), and the interaction between PACIC and PAM was statistically modelled, taking into consideration patient characteristics and the respective baseline outcome variable. The positive association between the PACIC and EQ VAS was seen only in participants with low activation (adjusted RR: 3.91; 95% CI: 1.40-10.95; P = 0.009), and not in those with high activation, indicating the non-synergistic interaction effect of the PACIC and PAM. This association was not found with EQ-5D index. Chronic care received consistently over time can positively affect health status, and benefit patients with low activation.

Patient assessment of diabetes care in a pay-for-performance program.

Few studies address quality of care in pay-for-performance (P4P) programs from the perspective of patients' perceptions. This study aimed to examine and compare the patient assessment of diabetes chronic care as perceived by diabetic patients enrolled and not enrolled in a P4P program from the patients' self-reported perspectives. A cross-sectional study with case and comparison group design. A large-scale survey was conducted from February to November 2013 in 18 healthcare institutions in Taiwan. A total of 1458 P4P (n = 1037) and non-P4P (n = 421) diabetic patients participated in this large survey. The Chinese version of the Patient Assessment of Chronic Illness Care (PACIC) instrument was used and patients' clinical outcome data (e.g. HbA1c, LDL) were collected. None. Five subscales from the PACIC were measured, including patient activation, delivery system design/system support, goal setting/tailoring, problem solving/contextual and follow-up/coordination. Patient clinical outcomes were also measured. Multiple linear regression and logistic regression models were used and controlled for patient demographic and health institution characteristics statistically. After adjusting for covariates, P4P patients had higher overall scores on the PACIC and five subscales than non-P4P patients. P4P patients also had better clinical processes of care (e.g. HbA1c test) and intermediate outcomes. Patients who participated in the program likely received better patient-centered care given the original Chronic Care Model. Better perceptions of diabetic care assessment also better clinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care in a P4P program.

Assessment of Health Care Quality in Chronic Neurological Diseases: Stroke, Multiple Sclerosis and Epilepsy

Objective: The aim of this study is to assess the quality of care in chronic neurological diseases, and to analyze the correlation between patients’ dependency and the quality of care. Methods: The study is designed as a descriptive and cross-sectional one. It was conducted among 184 patients who had visited neurology clinics of Ataturk University, Turkey, from March 2014 to July 2014. Data was collected by using a Self-made questionnaire, PACIC (Patient Assessment of Chronic Illness Care) and Barthell Index (BI). For data evaluation, percentage distribution, mean, independent samples t test, variance analysis and Pears on correlation analysis were utilized. Results: Overall mean score of PACIC scale was found to be 3.05 ± 0.57. The lowest mean score was obtained in follow-up/coordination subscale (2.73 ± 0.86) among sub-scales of the scale, the highest mean score was found to be in patient activation subscale (3.20 ± 0.74). The mean score for BI was 66.60 ± 38.22. The mean score of PACIC varied significantly according to age, marital status, education, disease diagnosis, co morbid conditions and hospitalization duration and hospital experience. Conclusion: It was found that the satisfaction of patients in terms of chronic disease is at a moderate level, and the highest score was taken in the patient activation subscale, and the lowest score was taken in the follow-up subscale. Moreover, the quality of health care perceptions of independent patients was better.

Exploring the variation in implementation of a COPD disease management programme and its impact on health outcomes: a post hoc analysis of the RECODE cluster randomised trial.

This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Interviews were held to obtain detailed information regarding the facilitators and barriers to implementation. Multilevel models were used to investigate the association between variation in implementation and change in outcomes. The teams implemented, on average, eight of the 19 interventions, and the specific package of interventions varied widely. Important barriers and facilitators of implementation were (in)sufficient motivation of healthcare provider and patient, the high starting level of COPD care, the small size of the COPD population per team, the mild COPD population, practicalities of the information and communication technology (ICT) system, and hurdles in reimbursement. Level of implementation as measured with our own scale and the ACIC was not associated with health outcomes. A higher level of implementation measured with the PACIC was positively associated with improved self-management capabilities, but this association was not found for other outcomes. There was a wide variety in the implementation of RECODE, associated with barriers at individual, social, organisational and societal level. There was little association between extent of implementation and health outcomes.

PRM203 - Performance Score Extraction from Panel Data for Multi-Criteria Decision Analysis (Mcda) Using a Regression-Based Approach

Objectives: Key to effectively implementing MCDA is to ensure the performance matrix offers a valid comparison across alternatives. We propose to bring econometric methods into the field of MCDA by estimating performance scores from patient-level panel data while matching on observable patient characteristics between different treatment alternatives. The aim of this study is to demonstrate the application of these methods to a case study using outcomes of disease management programs for Cardio-Vascular Risk Management (CVRM: n= 9) and Chronic Obstructive Pulmonary Disease (COPD: n= 4), prospectively monitored over a twoyear period. Methods: Performance scores were grouped according to the triple aim framework for the three aims of integrated care: 1) improving population health outcomes, 2) improving patient experience and 3) reducing costs. Included indicators were the EuroQol-5D, Short-Form-36, smoking and physical activity levels, the PACIC (Patient Assessment of Chronic Illness Care) and various cost measurements. Estimation was done by means of the average predicted outcomes from a generalised linear model. To increase comparability between programs a multinomial generalisation of propensity score matching (PSM) was applied. Results: Differences between the estimated treatment effects were expected based on the comprehensiveness of their interventions, e.g. estimated smoking rate was 28% in our most comprehensive COPD program, compared to 38% in our least significant program. PSM influenced the results, especially for costs and to a lesser extent for different dimensions of the EuroQol-5D. Overall, CVRM programs were more susceptible to changes resulting from PSM, which may be attributed to the higher number of programs. Conclusions: The proposed econometric methods offer a novel way to estimate performance scores from outcomes data in disease management programs. The estimated performance matrix offers useful distinctiveness between criteria and programs as an input for follow-up studies which further explore the performance matrix or attach relative weights to each performance indicator to allow a formal MCDA.

CoDiab-VD: protocol of a prospective population-based cohort study on diabetes care in Switzerland.

BackgroundDiabetes represents an increasing health burden worldwide. In 2010, the Public Health Department of the canton of Vaud (Switzerland) launched a regional diabetes programme entitled “Programme cantonal Diabète” (PcD), with the objectives to both decrease the incidence of diabetes and improve care for patients with diabetes. The cohort entitled CoDiab-VD emerged from that programme. It specifically aimed at following quality of diabetes care over time, at evaluating the coverage of the PcD within this canton and at assessing the impact of the PcD on care of patients with diabetes.Methods/DesignThe cohort CoDiab-VD is a prospective population-based cohort study. Patients with diabetes were recruited in two waves (autumn 2011 - summer 2012) through community pharmacies. Eligible participants were non-institutionalised adult patients (≥18 years) with diabetes diagnosed for at least one year, residing in the canton of Vaud and coming to a participating pharmacy with a diabetes-related prescription. Women with gestational diabetes, people with obvious cognitive impairment or insufficient command of French were not eligible. Self-reported data collected, included the following primary outcomes: processes-of-care indicators (annual checks) and outcomes of care such as HbA1C, (health-related) quality of life measures (Short Form-12 Health Survey – SF-12, Audit of Diabetes-Dependent Quality of Life 19 – ADDQoL) and Patient Assessment of Chronic Illness Care (PACIC). Data on diabetes, health status, healthcare utilisation, health behaviour, self-management activities and support, knowledge of, or participation to, campaigns/activities proposed by the PcD, and socio-demographics were also obtained. For consenting participants, physicians provided few additional pieces of information about processes and laboratory results.Participants will be followed once a year, via a mailed self-report questionnaire. The core of the follow-up questionnaires will be similar to the baseline one, with the addition of thematic modules adapting to the development of the PcD. Physicians will be contacted every 2 years.DiscussionCoDiab-VD will allow obtaining a broad picture of the care of patients with diabetes, as well as their needs regarding their chronic condition. The data will be used to evaluate the PcD and help prioritise targeted actions.Trial registrationThis study is registered with ClinicalTrials.gov, identifier NCT01902043, July 9, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0991-0) contains supplementary material, which is available to authorized users.