Use of the Patient Assessment of Chronic Illness Care (PACIC) With Diabetic Patients Relationship to patient characteristics, receipt of care, and self-management RUSSELL E. GLASGOW, PHD HOLLY WHITESIDES, BS CANDACE C. NELSON, MS DIANE K. KING, MS, OTR OBJECTIVE — There is a dearth of information on the extent to which diabetic patients receive care congruent with the chronic care model (CCM) and evidence-based behavioral counseling. This study evaluates a new instrument to fill this gap. RESEARCH DESIGN AND METHODS — A heterogeneous sample of 363 type 2 dia- betic patients completed the original Patient Assessment of Chronic Illness Care (PACIC), along with additional items that allowed it to be scored according to the “5As” (ask, advise, agree, assist, and arrange) model of behavioral counseling. We evaluated relationships between survey scores and patient characteristics, quality of diabetes care, and self-management. RESULTS — Findings replicated those of the initial PACIC validation study but with a much larger sample of diabetic patients and more Latinos. Areas of CCM activities reported least often were goal setting/intervention tailoring and follow-up/coordination. The 5As scoring revealed that patients were least likely to receive assistance with problem solving and arrangement of follow-up support. Few demographic or medical characteristics were related to PACIC or 5As scores, but survey scores were significantly related to quality of diabetes care received and level of physical activity. CONCLUSIONS — The PACIC and the new 5As scoring method appear useful for diabetic patients. Its use is encouraged in future research and quality improvement studies. Diabetes Care 28:2655–2661, 2005 T he chronic care model (CCM) (1,2) is receiving widespread acceptance as a framework for developing and implementing evidence-based activities to improve care for chronic illnesses (3,4). The CCM appears applicable for a variety of chronic illnesses (5), including diabetes (6,7), and potentially for preventive services (8). However, there are few instruments to assess the level of CCM-congruent activities that patients receive. To inform quality im- provement programs, compare different health care settings, and evaluate interven- tion studies, it is necessary to have practical assessment tools to evaluate the delivery of CCM activities (9). The primary assessment procedure that has been used to date is the Assess- ment of Chronic Illness Care (10). This scale is completed by health care team members and appears particularly useful for helping teams identify gaps and gen- erate innovations. It is less practical for widespread application, however, and subject to clinician overreporting, as are many clinician report instruments. Since unobtrusive observation is not feasible for large-scale application, asking patients to report the CCM-related activities that they have received seems like a valuable method of providing CCM implementa- tion data. Recently, Glasgow et al. (11) reported preliminary data on the Patient Assess- ment of Chronic Illness Care (PACIC), a 20-item survey of the extent to which pa- tients report having received CCM-based services that they could reasonably be ex- pected to observe. That report suggests that the PACIC has reasonable psycho- metric characteristics and is appropriate for a variety of chronic conditions. This original study was conducted at an inte- grated health maintenance organization and included patients with a variety of different illnesses, 41 of whom (16%) had diabetes. This study did not have many diabetic patients, Latino respondents, or any patients from mixed-payer medical offices, however, and the present study addresses these issues. A similar situation exists concerning the “5As” (ask, advise, agree, assist, and arrange) model of behavior change. This framework is increasingly adopted, is ev- idence based (12,13), appears appropri- ate to guide quality improvement efforts, and applies to diabetes self-management (14,15). The 5As is a patient-centered model of behavioral counseling that is con- gruent with the CCM and has been fre- quently used to enhance self-management support and linkages to community re- sources, two key CCM components (5,8,14,15). There are few practical assess- ment tools to evaluate the extent to which the 5As are delivered and that do not rely on clinician reports. The present study ad- dresses this issue by adding six additional items to the original PACIC instrument, which when combined with existing PACIC items, permits scoring of five-item subscales on delivery of each of the 5As, as well as an overall 5As score. The purpose of this report is to eval- uate the appropriateness of the PACIC, and the revised 5As scoring method, for a larger sample of diabetic patients, for Latino patients, and among patients re- ceiving their primary care from a wide range of providers. Specific questions ad- dressed include the following: 1. How do the results of the PACIC in this more diverse diabetes sample com- pare to the original PACIC study? ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From Kaiser Permanente Colorado, Denver, Colorado. Address correspondence and reprint requests to Russell E. Glasgow, PhD, Kaiser Permanente Colorado, 335 Road Runner Ln., Penrose, CO 81240. E-mail: russg@ris.net. Received for publication 5 July 2005 and accepted in revised form 17 August 2005. Abbreviations: CCM, chronic care model; PACIC, Patient Assessment of Chronic Illness Care. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. © 2005 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E DIABETES CARE, VOLUME 28, NUMBER 11, NOVEMBER 2005 2655