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

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

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants

“…The first is because this paper focuses on intermediate and final outcomes in patients, not in professionals. The second is that although the two instruments are complementary [19], they both measure the level of integrated care and thus, they correlate [20]. …”

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

“…Therefore, the developers did not incorporate the Computer Information Systems or other domains of the CCM into the PACIC that were considered to be not apparent to patients. This most likely has contributed to recent findings by our team that patient experiences as measured by the PACIC are not predicted by clinician and staff assessments of how they deliver chronic illness care as measured by the Assessment of Chronic Illness Care (ACIC) survey [29]. …”

Development and psychometric evaluation of a measure to evaluate the quality of integrated care: the Patient Assessment of Integrated Elderly Care

“…44 However, when interpreting the results of the PAIEC it is of importance to take into account the degree of integration of the, still evolving, services as offered, because this probably will influence the PAIEC scores. 45 To be able to estimate the degree of integration, it is important to incooperate, for example, the perspectives of professionals and managers 46 using the closely related Assessment of Chronic Illness Care questionnaire, 47 or to apply other measurement instruments. 48 In conclusion, we designed and validated the PAIEC, an adapted version of the PACIC wherein items and response options were modified to fit the population of elderly people while the essence of the measurement instrument remained unaffected.…”