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Are Better Ratings of the Patient-Provider Relationship Associated With Higher Quality Care for Depression?

Meredith, Lisa S. PhD; Orlando, Maria PhD; Humphrey, Nicole MHSA; Camp, Patti MS, and; Sherbourne, Cathy D. PhD

Original Articles

Background . The interpersonal patient-provider relationship (PPR) is an essential part of health care quality, particularly for patients with depression, yet little is known neither about how to measure this relationship nor about its association with quality of care.

Objectives . To evaluate properties of patient rating measures, understand the relation between 2 types of ratings, and determine the association of ratings with quality depression care.

Setting and Participants . 1,104 patients with current depressive symptoms and lifetime or 12-month disorder identified through screening 27,332 consecutive primary care visitors in 6 managed care organizations participating in Partners in Care (PIC).

Design . Cross-sectional analysis of 18-month data (collected in 1998) after the start of PIC depression quality improvement (QI) interventions (in which clinics were randomized to 1 of 2 QI interventions or usual care).

Measures . Patient ratings of the interpersonal relationship with the primary care provider and satisfaction with health care, and quality of depression care indicators.

Analysis . Factor analysis and multitrait scaling to evaluate the psychometric properties of multiitem constructs and analysis of covariance to evaluate associations between patient ratings and quality.

Results. Patient ratings had high internal consistency and met criteria for discriminant validity tapping unique aspects of care. Patients receiving quality care, especially for medication use, had significantly higher ratings of the interpersonal relationship (by 22% to 27% of a SD) and were more satisfied (by 26% to 34% of a SD) than patients who did not receive quality care.

Conclusions. Ratings of the interpersonal relationship and satisfaction measure distinct aspects of care and are positively associated with quality care for depression.

From RAND (Research, Analysis, and Development), Santa Monica, California.

Supported by a grant from the Robert Wood Johnson Foundation under their Strengthening the Patient-Provider Relationship in a Changing Health Care Environment initiative (PPRI 034894). The original study and data collection was supported by a grant from the Agency for Health Care Policy and Research (R01-HS08349). Additional funding for follow-up was provided by grants from the National Institute for Mental Health (P50-MH54623) and the John D. and Catherine T. MacArthur Foundation (96-42901A-HE).

Address all correspondence to Lisa S. Meredith, PhD, Behavioral Scientist, RAND Health Program, 1700 Main Street, Santa Monica, CA 90407. E-Mail:

Received April 4, 2000; initial review May 15, 2000; accepted November 27, 2000.

© 2001 Lippincott Williams & Wilkins, Inc.