Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

Abstract

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC) is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM). It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK). We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions.MethodWe collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures.ResultsThere was evidence that rates of missing data were high on PACIC (9.6% - 15.9%), and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94), responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale) than ceiling effects (generally <5%). PACIC demonstrated preliminary evidence of validity in terms of measures of long-term condition care. Confirmatory factor analysis suggested that the five factor PACIC structure proposed by the scale developers did not fit the data: reporting separate factor scores may not always be appropriate.ConclusionThe importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

Psychometric Properties of the Patient Activation Measure in Multimorbid Hospitalized Patients

“…Finally, the PAM significantly related to the PACIC Patient Activation Subscale (coefficient 5 .011, p , .001; Skolasky et al, 2011). Skolasky et al (2009) evaluated construct validity using correlation of patient activation with optimism using the Life Orientation Test-Revised scale (r 5 .75, p , .001), Trait Hope Scale (r 5 .73, p , .001), and self-efficacy to participate in physical therapy (r 5 .75, p , .001), depression measured by PRIME-MD (r 5 2.13, p 5 .032), and the Multidimensional Health Locus of Control Scale (r 5 .66, p , .001) in an elective lumbar spine surgical population prior to surgery. Divergent validity was reported with low correlation between the PAM and CCI (r 5 .01, p 5 .904).…”

“…In relation to reliability, Skolasky, Mackenzie, Riley, and Wegener (2009) report internal consistency reliability measured by split-half reliability of .92 and adequate 1-week test-retest reliability (Shrout-Fleiss intraclass correlation coefficient 5 .84) in a preoperative lumbar spine surgical population prior to hospitalization. In an elderly multimorbid population, Skolasky et al (2011) report high internal consistency reliability with a Cronbach's alpha of .87 and Wong et al (2011) report a Cronbach's alpha of .86 in a primary care setting.…”

Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study

“…25,26 The content of the PACIC closely reflects elements of care planning. The scale includes 20 items in five subscales: patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; and follow-up and coordination.…”

Adaptación y validación de la versión chilena del cuestionario &#8220;Evaluación de la Atención de Enfermedades Crónicas para pacientes&#8221;

“…Es así como, la revisión de literatura revela una amplia evidencia de la utilización del modelo de cuidados crónicos 7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] y de la evaluación de los cuidados proporcionados a los usuarios con en-fermedad crónica utilizando como herramienta el cuestionario Patient Assessment of Chronic Illness Care (PACIC) [24][25][26][27][28][29][30][31][32][33][34][35][36] . Este instrumento proporciona una evaluación de la atención de enfermedades crónicas desde la perspectiva del paciente y, en particular, del apoyo al automanejo 24 .…”

“…En la actualidad se dispone de versiones traducidas a distintos idiomas [24][25][26][27][28][29][30][31][32][33][34][35] , entre las que se encuentran las versiones al español, realizadas por Barceló et al 36 y Aragones et al 26 . Estos últimos realizaron la validación del instrumento al español en hispanoparlantes residentes en Estados Unidos de Norteamérica, reportando niveles satisfactorios de confiabilidad y validez.…”