Factorial validation of the patient assessment of chronic illness care (PACIC) and PACIC short version (PACIC-S) among cardiovascular disease patients in the Netherlands

Objective: The Chronic Care Model (CCM) has achieved widespread acceptance and reflects the core elements of patient-centred care in chronic diseases such as cardiovascular diseases (CVD). In the Netherlands the extent to which CVD patients receive care congruent with the CCM is unknown. The main objectives of this study were to validate the 20-item Patient Assessment of Chronic Illness Care (PACIC) and the 11-item (PACIC-S) in the Netherlands among CVD patients and investigate the validity, reliability, and sensitivity to change of both instruments. Methods: The Dutch version of the PACIC and PACIC-S were tested among 1484 CVD patients (out of 2760; response rate 54%) enrolled in Disease Management Programmes (DMPs) at T0 and 1167 respondents (out of 2545; response rate = 46%) at T1. Five hundred-eighty-five CVD patients filled in the questionnaire at both T0 and T1. We tested the instrument by means of structural equation modeling, and examined its construct validity, reliability and sensitivity to change. Reliability of the instrument was assessed by determining the statistical coherence of the scaled items. Internal consistency of the subscales was assessed by calculating Cronbach's alphas and correlations between the PACIC and PACIC-S. We investigated the sensitivity to change of the original PACIC and the PACIC-S with paired t-tests among CVD patients in DMPs who filled in the questionnaire at both T0 and T1 (N = 585). Results: The confirmatory factor analyses revealed good indices of fit with the PACIC and PACIC-S. Internal consistency as represented by Cronbach's alphas were also good. Correlations between the PACIC and PACIC-S subscales were excellent: 0.98 at both T0 and T1. Paired t-tests results show that the PACIC and PACIC-S improved significantly over time (p < 0.01). Conclusions: The psychometric properties of the Dutch PACIC and PACIC-S were satisfactory and it is sensitive to change, rendering it a valid and reliable instrument for assessing chronic illness care among CVD patients.