Are better ratings of the patient-provider relationship associated with higher quality care for depression?

BACKGROUND. The interpersonal patient-provider relationship (PPR) is an ess ential part of health care quality, particularly for patients with depressi on, 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 t he relation between 2 types of ratings, and determine the association of ra tings with quality depression care. SETTING AND PARTICIPANTS. 1,104 patients with current depressive symptoms a nd lifetime or 12-month disorder identified through screening 27,332 consec utive primary care visitors in 6 managed care organizations participating i n 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 tin whi ch clinics were randomized to 1 of 2 QI interventions or usual care). MEASURES. Patient ratings of the interpersonal relationship with the primar y care provider and satisfaction with health care, and quality of depressio n care indicators. ANALYSIS. Factor analysis and multitrait scaling to evaluate the psychometr ic properties of multiitem constructs and analysis of covariance to evaluat e 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 q uality care, especially for medication use, had significantly higher rating s of the interpersonal relationship (by 22% to 27% of a SD) and were more s atisfied (by 26% to 34% of a SD) than patients who did not receive quality care. CONCLUSIONS. Ratings of the interpersonal relationship and satisfaction mea sure distinct aspects of care and are positively associated with quality ca re for depression.