Development and validation of a short version of the Assessment of Chronic Illness Care (ACIC) in Dutch Disease Manageme
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RESEARCH
Open Access
Development and validation of a short version of the Assessment of Chronic Illness Care (ACIC) in Dutch Disease Management Programs Jane M Cramm*, Mathilde MH Strating, Apostolos Tsiachristas and Anna P Nieboer
Abstract Background: In the Netherlands the extent to which chronically ill patients receive care congruent with the Chronic Care Model is unknown. The main objectives of this study were to (1) validate the Assessment of Chronic Illness Care (ACIC) in the Netherlands in various Disease Management Programmes (DMPs) and (2) shorten the 34item ACIC while maintaining adequate validity, reliability, and sensitivity to change. Methods: The Dutch version of the ACIC was tested in 22 DMPs with 218 professionals. We tested the instrument by means of structural equation modelling, and examined its validity, reliability and sensitivity to change. Results: After eliminating 13 items, the confirmatory factor analyses revealed good indices of fit with the resulting 21-item ACIC (ACIC-S). Internal consistency as represented by Cronbach’s alpha ranged from ‘acceptable’ for the ‘clinical information systems’ subscale to ‘excellent’ for the ‘organization of the healthcare delivery system’ subscale. Correlations between the ACIC and ACIC-S subscales were also good, ranging from .87 to 1.00, indicating acceptable coverage of the core areas of the CCM. The seven subscales were significantly and positively correlated, indicating that the subscales were conceptually related but also distinct. Paired t-tests results show that the ACIC scores of the original instrument all improved significantly over time in regions that were in the process of implementing DMPs (all components at p < 0.0001). Conclusion: We conclude that the psychometric properties of the ACIC and the ACIC-S are good and the ACIC-S is a promising alternate instrument to assess chronic illness care. Keywords: chronic care, measurement, quality, chronic illness, disease management
Introduction The increasing prevalence of the chronically ill due to population aging and longevity [1] has resulted in deficiencies in the organization and delivery of care [2-4]. Accumulated evidence shows under-diagnosis, undertreatment, and failure to use primary and secondary prevention measures [5,6] among the chronically ill. There is also evidence that interventions and quality improvements in organizational and clinical processes of primary care can improve such care [7-12]. The literature strongly suggests that changing processes and outcomes in chronic illness requires multicomponent interventions [12-14]. * Correspondence: [email protected] Institute of Health Policy & Management (iBMG). Erasmus University Rotterdam, The Netherlands
Disease management programs (DMPs) aim to improve effectiveness and efficiency of chronic care delivery [15]. In the literature there are basically two types of disease management models: (1) commercial DMPs and (2) primary care DMPs aiming to improve quality of chronic care based on the Chronic Care Model (CCM) [16]. Commerci
