Open Access Research article

Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

Polly H Noël12*, Michael L Parchman3, Ray F Palmer2, Raquel L Romero2, Luci K Leykum12, Holly J Lanham24, John E Zeber56 and Krista W Bowers2

Author Affiliations

1 South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA

2 Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA

3 MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave # 1600, Seattle, WA 98101, USA

4 The McCombs School of Business, The University of Texas at Austin, 2110 Speedway, Stop B6000, Austin, TX 78712, USA

5 Central Texas Veterans Health Care System, 1901 S. 1st St, Temple, TX 76504, USA

6 Scott & White Healthcare Center for Applied Health Research, 2401 S. 31st St, Temple, TX 76508, USA

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BMC Family Practice 2014, 15:57  doi:10.1186/1471-2296-15-57

Published: 29 March 2014



Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received.


Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire.


Two sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales [Self-management Support (p < 0.05); Community Linkages (p < 0.02), Delivery System Design (p < 0.02), and Organizational Support (p < 0.02)] were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak.


The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.

Trial registration


Chronic care; Primary care; Patient surveys