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  • Measure Summary
  • NQMC:009477
  • Jan 2004

Assessment of chronic illness care: average score for the "Goal Setting" subscale on the Patient Assessment of Chronic Illness Care (PACIC) Survey.

MacColl Center for Health Care Innovation. Assessment of care for chronic conditions. Seattle (WA): MacColl Center for Health Care Innovation; 2004. 2 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Primary Measure Domain

Clinical Quality Measures: Patient Experience

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the average score for the "Goal Setting" subscale on the Patient Assessment of Chronic Illness Care (PACIC) Survey.

Patients report (1 = "None of the time," 2 = "A little of the time," 3 = "Some of the time," 4 = "Most of the time," and 5 = "Always") on the following items:

Over the past 6 months, when I received care for my chronic conditions, I was:

  • Asked to talk about my goals in caring for my condition.
  • Helped to set specific goals to improve my eating or exercise.
  • Given a copy of my treatment plan.
  • Encouraged to go to a specific group or class to help me cope with my chronic condition.
  • Asked questions, either directly or on a survey, about my health.

Note: The PACIC consists of five scales and an overall summary score. Each scale is scored by averaging the items completed within that scale, and the overall PACIC is scored by averaging scores across all 20 items.

Rationale

The increasingly well-documented gap between clinical research findings and practice (Institute of Medicine [IOM], Committee on Quality of Health Care in America, 2001; Lenfant, 2003; McGlynn et al., 2003) has spurred a number of efforts to improve the quality of chronic illness care (Bodenheimer, Wagner, & Grumbach, 2002; Wagner, Austin, & Von Korff, 1996). It also is apparent that this problem cannot be solved by simply trying to do more; instead, fundamental changes are needed in the way that care is structured and delivered. For chronic illness care, this change entails shifting from medical care that is reactive and event-driven to care that is proactive and planned.

The Patient Assessment of Chronic Illness Care (PACIC) is designed to complement the Assessment of Chronic Illness Care (ACIC) by providing a patient perspective on receipt of Chronic Care Model (CCM)-related chronic illness care. The PACIC collects patient reports of the extent to which they have received specific actions and care during the past 6 months that are congruent with various aspects of the CCM. This scale is intended to assess the receipt of patient-centered care, which emphasizes the key elements of modern self-management support (e.g., collaborative goal settings, problem-solving and follow-up) (Glasgow et al., 2002; Williams, Freedman, & Deci, 1998; Glasgow et al., 2003) and planned, proactive, and population-based care (Bodenheimer, Wagner, & Grumbach, 2002; Wagner, Austin, & Von Korff, 1996; Von Korff et al., 1997; Wagner et al., 1999). The goal was to develop a relatively brief instrument that could be used in a variety of health care settings and would be applicable to adult patients having one or more of many different chronic illnesses.

Evidence for Rationale

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002 Oct 9;288(14):1775-9. PubMed External Web Site Policy

Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. 2003 Nov;29(11):563-74. PubMed External Web Site Policy

Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckham V, Wagner EH. Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Ann Behav Med. 2002 Spring;24(2):80-7. PubMed External Web Site Policy

Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005 May;43(5):436-44. [29 references] PubMed External Web Site Policy

Institute of Medicine (IOM), Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academy Press; 2001. 360 p.

Lenfant C. Shattuck lecture--clinical research to clinical practice--lost in translation?. N Engl J Med. 2003 Aug 28;349(9):868-74. [29 references] PubMed External Web Site Policy

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003 Jun 26;348(26):2635-45. PubMed External Web Site Policy

Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997 Dec 15;127(12):1097-102. PubMed External Web Site Policy

Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511-44. [121 references] PubMed External Web Site Policy

Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B. A survey of leading chronic disease management programs: are they consistent with the literature?. Manag Care Q. 1999;7(3):56-66. PubMed External Web Site Policy

Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998 Oct;21(10):1644-51. PubMed External Web Site Policy

Primary Health Components

Patient experience; chronic illness; goal setting

Denominator Description

Number of items completed within the "Goal Setting" subscale on the Patient Assessment of Chronic Illness Care (PACIC) Survey by patients with chronic illness (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The sum of patients' ratings on the "Goal Setting" items on the Patient Assessment of Chronic Illness Care (PACIC) Survey (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Sample
A total of 283 adults reporting one or more chronic illness from a large integrated health care delivery system were studied.

Methods
Participants completed the 20-item Patient Assessment of Chronic Illness Care (PACIC) as well as measures of demographic factors, a patient activation scale, and subscales from a primary care assessment instrument so that we could evaluate measurement performance, construct, and concurrent validity of the PACIC.

Results
The PACIC consists of 5 scales and an overall summary score, each having good internal consistency for brief scales. As predicted, the PACIC was only slightly correlated with age and gender, and unrelated to education. Contrary to prediction, it was only slightly correlated (r = 0.13) with number of chronic conditions. The PACIC demonstrated moderate test-retest reliability (r = 0.58 during the course of 3 months) and was correlated moderately, as predicted (r = 0.32 to 0.60, median = 0.50, P < 0.001) to measures of primary care and patient activation.

The PACIC appears to be a practical instrument that is reliable and has face, construct, and concurrent validity.

Refer to Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC) for additional information.

Evidence for Extent of Measure Testing

Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005 May;43(5):436-44. [29 references] PubMed External Web Site Policy

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care

IOM Care Need

Living with Illness

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of items completed within the "Goal Setting"* subscale on the Patient Assessment of Chronic Illness Care (PACIC) Survey by patients with chronic illness

*Goal Setting: Acquiring information for and setting of specific, collaborative goals.

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
The sum of patients' ratings (1 = "None of the time," 2 = "A little of the time," 3 = "Some of the time," 4 = "Most of the time," and 5 = "Always") on the "Goal Setting" items on the Patient Assessment of Chronic Illness Care (PACIC) Survey

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Patient Assessment of Chronic Illness Care (PACIC)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Mean/Median

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Goal setting.

Measure Collection Name

Patient Assessment of Chronic Illness Care (PACIC) Survey

Submitter

The MacColl Center for Health Care Innovation - Nonprofit Research Organization

Developer

The MacColl Center for Health Care Innovation - Nonprofit Research Organization

Funding Source(s)

The MacColl Center for Health Care Innovation (a non-proprietary, public-interest research center within Group Health Cooperative, a nonprofit health system based in Seattle)

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2004 Jan

Measure Maintenance

None

Date of Next Anticipated Revision

None

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Source(s)

MacColl Center for Health Care Innovation. Assessment of care for chronic conditions. Seattle (WA): MacColl Center for Health Care Innovation; 2004. 2 p.

Measure Availability

Source available from the Improving Chronic Illness Care Web site External Web Site Policy.

For more information, contact the MacColl Center for Health Care Innovation at 1730 Minor Avenue, Suite 1600, Seattle, WA 98101; E-mail: info@improvingchroniccare.org; Web site: maccollcenter.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 17, 2015. The information was verified by the measure developer on June 17, 2015.

The information was reaffirmed by the measure developer on May 23, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Individuals interested in using the Patient Assessment of Chronic Illness Care (PACIC) in non-commercial quality improvement work or research are free to do so. No permission is needed for such personal or non-commercial use. Visit the Improving Chronic Illness Care Web site External Web Site Policy for more information.

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