Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC)

Glasgow, Russell E.; Wagner, Edward H.; Schaefer, Judith; Mahoney, Lisa; Reid, Robert J.; Greene, Sarah M.

doi:10.1097/01.mlr.0000160375.47920.8c

Cited by 691 publications

(924 citation statements)

References 22 publications

(35 reference statements)

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“…Increases in activation among participants have been achieved and sustained for up to 12 months post participation in the CDSMP 36 . Other interventions have focused specifically on skills development and have shown that training patients in how to ask questions and giving them support to do so, increases their participation in their own care, and increases their activation levels 22,[24][25][26] .…”

Section: Discussionmentioning

confidence: 91%

“…For example, there is evidence from cross-sectional studies that provider behaviors can support patient activation. Patients who report that their provider helped them in very concrete and specific ways, such as helped them to learn to monitor their condition, set goals, and/or set up and exercise program, were more activated than patients who said their provider did not help them in The predicted probabilities are computed based upon full regression models presented in online appendix 2 these ways 36,37 . While not formally evaluated, some patientcentered medical homes are measuring their patients' activation levels, and using it as a "vital sign" to help them tailor patient care plans to the patient's ability to follow through on those plans.…”

Section: A Focus On Tailoring Support To the Individual's Level Of Acmentioning

confidence: 99%

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Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

2011

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BACKGROUND: There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation-or having the knowledge, skills, and confidence to manage one's health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples. OBJECTIVE: To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population. DESIGN: Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010. PATIENTS: A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit. MAIN MEASURES: The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization. RESULTS: In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher. CONCLUSIONS: This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.KEY WORDS: patient activation; patient engagement; health care quality.

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Section: Discussionmentioning

confidence: 91%

Section: A Focus On Tailoring Support To the Individual's Level Of Acmentioning

confidence: 99%

Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

2011

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“…Patients: The PACIC survey 29 Provider: The video-SMA providers (clinical pharmacist and nurse practitioner) from Honolulu VAMC were interviewed after the intervention to elicit input about health system barriers to diabetes care, and how video-SMA may or may not have overcome those barriers. The interviews also focused on provider's attitudes and satisfaction about the video-SMA's as a mode of care delivery and whether they believe the video-SMA's helped provide better diabetes care.…”

Section: Qualitative Outcomesmentioning

confidence: 99%

The utilization of video-conference shared medical appointments in rural diabetes care

Tokuda

Lorenzo

Theriault

et al. 2016

International Journal of Medical Informatics

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Aim: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. Methods:We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014. Six groups of 4-6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient's perceptions. Results:Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usualcare (9.1±1.9 to 8.3±1.8 vs. 8.6±1.4 to 8.7±1.6, P=0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P=0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care. Conclusion:Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting.3

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“…Before randomization, in early 2006, professional interviewers conducted face-toface, in-home interviews to assess participants' functional health, quality of health care, sociodemographic characteristics and chronic medical conditions. During April to June of 2009, professional interviewers, who were masked to group assignment, conducted final computer-assisted telephone interviews that incorporated these same measures of functional health (the Short Form [SF]-36, version 2 21 and quality of care (the Patient Assessment of Chronic Illness Care 22 and components of the Primary Care Assessment Survey (PCAS) 23 ). Participants' health insurers provided data on health services utilization.…”

Section: Measurementsmentioning

confidence: 99%

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

et al. 2013

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BACKGROUND: Patients at risk for generating high health care expenditures often receive fragmented, lowquality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. OBJECTIVE: We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. DESIGN: 32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. PATIENTS: The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. INTERVENTION: A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for selfmanagement, caregiver support, and access to community-based services. MAIN MEASURES: Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. KEY RESULTS: Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference=0.27, 95 % CI=0.08-0.45) and 29 % lower use of home care (95 % CI=3-48 %). CONCLUSIONS: Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

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Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC)

Abstract: The PACIC appears to be a practical instrument that is reliable and has face, construct, and concurrent validity. The resulting questionnaire is in the public domain, and recommendations for its use in research and quality improvement are outlined.

Cited by 691 publications

References 22 publications

Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

The utilization of video-conference shared medical appointments in rural diabetes care

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

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