Assessing chronic illness care for diabetes in primary care clinics.

BACKGROUND The Chronic Illness Care model suggests that six structural dimensions of primary care teams are important in improving the quality of diabetes care. A study was conducted to assess the degree to which these dimensions, as represented in the Assessment of Chronic Illness Care (ACIC) survey, are implemented in primary care practices and to examine their relationship with selected quality of care process measures for Type 2 diabetes. METHODS The survey was completed in 20 primary care clinics (30 patients in each clinic) by caregivers, administrative, staff, and an external observer. RESULTS Overall, administrative staff were more likely to rate their clinics higher on each structural dimension in the ACIC survey than caregivers or the external observer. The observer's and the caregivers' assessments were more consistently correlated with quality of care measures than were the administrative staff assessments. Decision support, and to a lesser degree delivery system design and self-management, were most frequently correlated with quality of care measures. DISCUSSION Redesigning primary care practices to improve the quality of diabetes care requires accurate assessment of the structures of care directly related to quality measures. A version of the ACIC tool tailored to diabetes management can be used to examine structural dimensions inprimary care clinics but may be more valid if completed by caregivers or an independent observer than by administrative staff.