Scoring the PACIC

The PACIC's 20 items were derived from a larger pool of 46 items generated by a national pool of experts on chronic illness care and the Chronic Care Model. A pilot test was done with a separate, earlier sample of 130 patients, and the 20 items were aggregated into five a priori scales based on the key components of the CCM. These subscales were:

  • Patient Activation (items 1-3)
  • Delivery System Design/Decision Support (items 4-6)
  • Goal Setting (items 7-11)
  • Problem-solving/Contextual Counseling (items 12-15)
  • Follow-up/Coordination (items 16-20)

Each scale is scored by averaging the items completed within that scale, and the overall PACIC is scored by averaging scores across all 20 items. These scales emphasize patient-healthcare team interactions and, in particular, aspects of self-management support (e.g., goal setting, problem-solving). Because we did not feel that the majority of patients would be able to report on issues that are generally not visible to them, such as clinical information systems or organization of health care, the 5 PACIC scales don't map perfectly onto the 6 CCM components. The various scales of the PACIC, as well as the overall score, appear to be both internally consistent and moderately stable over the three month test-retest interval.

The PACIC consists of five scales and an overall summary score, each having good internal consistency for brief scales. As demonstrated in the following May 2005 article (and as predicted), the PACIC was only slightly correlated with age and gender, and unrelated to education. Contrary to prediction, it was only slightly correlated (r = 0.13) with number of chronic conditions. The PACIC demonstrated moderate test-retest reliability (r = 0.58 during the course of 3 months) and was correlated moderately, as predicted (r = 0.32-0.60, median = 0.50, P < 0.001) to measures of primary care and patient activation. This questionnaire is in the public domain, and recommendations for its use in research and quality improvement are outlined here.

The PACIC is strongly user- and situation-dependent, so the best way to interpret it in your setting is to refer to the published research articles (below).

Citation for the PACIC paper:

Glasgow RE, Wagner EH, Schaefer J, Mahoney LD,  Reid RJ, Greene SM. Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care  2005; 43(5):436-44. [Link]

Scoring the PACIC+
The '5As' is a patient-centered model of behavioral counseling that is congruent with the CCM and has been frequently used to enhance self-management support and linkages to community resources. The study below evaluates the extent to which the 5As are delivered (without reliance on clinician reports) by adding six items to the original instrument (the PACIC+). When combined with existing PACIC items, this permits scoring of five-item subscales on delivery of each of the '5As', as well as an overall 5As score.

"Use of the Patient Assessment of Chronic Illness Care (PACIC) With Diabetic Patients" (PACIC+) was developed in 2005 and evaluates the appropriateness of the PACIC and the revised '5As' scoring method for a larger population, including a wider sample of diabetics, Latino patients, and those patients receiving primary care from a wider range of providers. Specific questions addressed in the article include the following:

  • How do the results of the PACIC in this more diverse diabetes sample compare to the original PACIC study?
  • Does the new '5As' scoring method provide useful data?
  • How do PACIC and '5As' scores relate to: patient characteristics; quality of diabetes-specific care received; and self-management behaviors of healthy eating and physical activity?

Citation for the PACIC+ paper:

Glasgow RE, Whitesides H, Nelson CC, King DK.  Use of the Patient Assessment of Chronic Illness Care (PACIC) With Diabetic Patients: Relationship to patient characteristics, receipt of care, and self-management. Diabetes Care 2005; 28 (11):2655-61. [Link]