Improving Chronic Illness Care
Improving Chronic Illness Care

Evidence Supporting the PACIC

 
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 '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. 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" 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?
Articles
Aragones A, Schaefer EW, Stevens D, Gourevitch MN, Glasgow RE, Shah NR. Validation of the Spanish translation of the Patient Assessment of Chronic Illness Care (PACIC) survey. Prev Chronic Dis. 2008 Oct;5(4):A113. Epub 2008 Sep 15. [Link]
 
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]
  • The PACIC has 5 subscales & was moderately correlated to hypothesized scales.  It produced similar means and standard deviations across six different chronic diseases and showed moderately stable test-retest validity.
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]  
  • When the PACIC was retested among a larger, more diverse population of patients, the original findings were confirmed.
Vrijhoef HJ, Berbee R, Wagner EH, Steuten L.  Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments. Health Expect. 2009 Aug 26. [Link]