Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
Health Qual Life Outcomes. 2011 Jul 4;9:49. doi: 10.1186/1477-7525-9-49.
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 34-item ACIC while maintaining adequate validity, reliability, and sensitivity to change.
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.
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).
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.
在荷兰，慢性病患者接受与《慢性关怀模式》相符的关怀的程度尚不清楚。本研究的主要目的是：(1) 在各种疾病管理方案中验证《慢性病关怀评估》（ACIC）在荷兰的适用性；(2) 在保持充分的有效性、可靠性和对变化的敏感性的前提下，缩短 34 项的 ACIC。
在 22 个疾病管理方案中，有 218 名专业人员对荷兰版的 ACIC 进行了测试。我们通过结构方程模型来检验该工具，并对其有效性、可靠性和对变化的敏感性进行了检验。
在删除 13 个项目后，验证性因子分析显示，结果为 21 项的 ACIC（ACIC-S）具有良好的拟合指数。内部一致性以克朗巴赫 α 表示，从“临床信息系统”分量表的“可接受”到“医疗服务提供系统的组织”分量表的“优秀”不等。ACIC 和 ACIC-S 分量表之间的相关性也很好，范围从 0.87 到 1.00，表明对 CCM 的核心领域有较好的涵盖。七个分量表之间呈显著正相关，表明这些分量表在概念上是相关的，但也是不同的。配对 t 检验结果显示，在实施疾病管理方案的地区，原始仪器的 ACIC 评分随着时间的推移都显著提高（所有成分均 p<0.0001）。
我们的结论是，ACIC 和 ACIC-S 的心理测量特性良好，ACIC-S 是评估慢性病护理的一种有前途的替代工具。
