Understanding the causal relationship between patient-reported interpersonal and technical quality of care for depression.
OBJECTIVE
Patient ratings of their health care experience have become increasingly important as indicators of interpersonal quality of care. Currently the link between technical and interpersonal quality of care indicators is not well understood. The goal of this study was to examine the temporal relationship between technical quality of care for depression and interpersonal quality of care by examining their association over time.


METHODS
A cross-lagged (longitudinal) path analytic model was estimated to examine the causal relationship between two measures of interpersonal quality of care and technical quality of care among 697 respondents participating in the 18 and 24 month assessments of Partners in Care (PIC). Measures of age, gender, number of chronic diseases, indicators of anxiety and depression, recent service utilization, and stability of the doctor-patient relationship were included as covariates.


RESULTS
After controlling for study design and relevant patient characteristics, one significant cross-lagged effect was found: that from one measure of interpersonal quality (patient satisfaction) to technical quality (standardized coefficient = 0.18), but not from quality to satisfaction.


CONCLUSIONS
Results of these analyses indicate that patients who report high satisfaction with care are more likely to receive higher technical quality depression care 6 months later as compared with those who are less satisfied. This implies that one pathway to improving technical quality of care may be through increasing patients' satisfaction.
RAND Health Program, 1700 Main Street, Santa Monica, CA 90407, USA. maria_orlando@rand.org
Maria
M
Orlando
Lisa S
LS
Meredith
D000328:Adult; D001007:Anxiety; D015984:Causality; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000145:classification*; D011795:Surveys and Questionnaires; D014481:United States