Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

Health Expect. 2009 Dec;12(4):417-29. doi: 10.1111/j.1369-7625.2009.00557.x. Epub 2009 Aug 26.


Objective: To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care.

Background: Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care.

Methods: Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus-group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments.

Results: From 37 instruments identified, the Patients' Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ-18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ-18 were highly internally consistent, but not the PSQ-18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ-18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ-18, focus-group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient.

Conclusions: Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care.

MeSH terms

  • Adult
  • Aged
  • Chronic Disease / therapy
  • Female
  • Focus Groups
  • Health Care Surveys / instrumentation*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Patient Satisfaction*
  • Quality of Health Care*