title: Patient Experience in an Era of Primary Care Transformation: Revisiting the PACIC.
abstract: BACKGROUND
  Aims and Objective: The validation study of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire suggested a 5-factor structure determined a priori, but subsequent analyses have questioned the validity of the original factor structure. This study analyzed the factor structure of the PACIC using a large and diverse patient sample, and evaluated the identified factors through the lens of recent transformational initiatives in primary care.
  
  
  METHODS
  Convenience samples of adults completed surveys in waiting rooms during clinic visits. Primary care patients with 1 or more chronic illnesses with complete PACIC responses at baseline from 39 clinics (n=1,567) and at follow-up from 36 clinics (n=1,536) participated. Exploratory and confirmatory factor analyses were conducted on baseline and follow-up patient questionnaire data from a cluster randomized controlled trial. Identified factors were evaluated in terms of item loadings, content, reliability, and the extent to which items reflected advances in the delivery of chronic illness care.
  
  
  RESULTS
  Analyses supported the use of the PACIC summary score. Although a 5-factor model was retained, factor loadings were different from the original PACIC validation study. All factors had sufficient reliability, but findings suggested potential revisions to enhance the factor structure.
  
  
  CONCLUSIONS
  It may be time to revise the PACIC to enhance the stability of the subscales (factors) and better reflect recent transformations in the delivery of chronic illness care.
authors.affiliation: University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, 7703 Floyd Curl Drive, San Antonio, TX 78229, 210-394-0360.
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.affiliation: MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101 206-287-2704.
authors.forename: Salene
authors.initials: S
authors.lastname: Jones
authors.affiliation: MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, 206-287-2704.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
keywords: chronic illness; factor analysis; patient care experience; primary care; questionnaire