Measuring chronic care management experience of patients with diabetes: PACIC and PACIC+ validation

Background: The patient assessment of chronic illness care (PACIC) is a promising instrument to evaluate the chronic care experiences of patients, yet additional validation is needed to improve its usefulness.

Methods: A total of 1941 patients with diabetes completed the questionnaire. Reliability coefficients and factor analyses were used to psychometrically test the PACIC and PACIC+ (i.e., PACIC extended with six additional multidisciplinary team functioning items to improve content validity). Intra-Class Correlations were computed to identify the extent to which variation in scores can be attributed to GP practices. 

Results: The PACIC and PACIC+ showed a good psychometric quality (Cronbach's alpha's > 0.9). Explorative factor analyses showed inconclusive results. Confirmative factor analysis showed that none of the factor structures had an acceptable fit (RMSEA > 0.10). In addition, 5.1 to 5.4 percent of the total variation was identified at the GP practice level. 

Conclusion: The PACIC and PACIC+ are reliable instruments to measure the chronic care management experiences of patients. The PACIC+ is preferred because it also includes multidisciplinary coordination and cooperation - one of the central pillars of chronic care management - with good psychometric quality. Previously identified subscales should be used with caution. Both PACIC instruments are useful in identifying GP practice variation.