BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) survey is a widely used instrument to assess the patient experience with healthcare delivery. PURPOSE: This study aims to evaluate the factorial structure of PACIC from the patient perspective. METHODS: A postal survey was mailed to 4,796 randomly selected adults with diabetes from 34 primary care clinics. Internal consistencies of PACIC subscales were assessed by Cronhach's alpha. Factorial structure was evaluated by confirmatory and exploratory factor analyses. RESULTS: Based on responses of 2,055 patients (43 % response rate), exploratory factor analysis discerned a 4-factor, not 5-factor, model dominated by patient evaluation of healthcare services (explaining 74 % of the variance). The other 3 factors addressed patient involvement (goal setting, participating in the healthcare team) and social support for self-management. CONCLUSIONS: The underlying factorial structure of PACIC, which reflects the patient perspective, is dynamic, patient-centered, and differs from the original 5-factor model that was more aligned with views of healthcare delivery stakeholders.