Strong patient-provider relationships drive healthier outcomes

Oct. 19, 2015 / By L. Gordon Moore, MD

Maybe there is a way to measure quality so that metrics better represent outcomes that matter.

Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care through a series of case studies in the past two years. Their article in Harvard Business Review describes the finding that good outcomes are related to the strength of relationship between the primary care provider and patient. This finding is strong and consistent across all primary care exemplars in their study.ⁱ

This is interesting because it addresses a fundamental paradox in health care delivery:

“[P]rimary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources and have less health inequality.”ⁱⁱ

As I’ve written in the past , the current approach to quality measurement is so unwieldy that more than 50 percent of primary care clinicians believe it is harming their ability to deliver good care.ⁱⁱⁱ

The good news is that we are able to consistently measure the strength of the relationship between the patient and the primary care provider.

We can identify proxies for relationships in insurance claims. Continuity of care can be calculated using the Bice-Boxerman coefficient and relates to good outcomes for people and populations.^iv

We can measure strength of relationship from the patients’ perspective, providing insight on timely access to care, wasted time in the office practice, effectiveness of communication and more.

All of these factors translate to better population outcomes in important ways.^v

• Good access, strong relationship over time, continuity of care and care coordination are fundamental attributes of good primary care.
• Good primary care is the foundation of high performing health systems.
• People who receive good primary care have better health outcomes at a lower cost with fewer disparities based on race, ethnicity and income.

I know it is possible to measure these things because we do it now. We should be emphasizing those measures that more directly relate to the outcomes we want and putting aside those that appear to create more problems than they solve.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at 3M Health Information Systems.

Documentation compliance tools. Applied to helping physicians focus on what’s important: patient care.

ⁱ https://hbr.org/2015/10/strong-patient-provider-relationships-drive-healthier-outcomes

ⁱⁱ Homa, Laura, Johnie Rose, Peter S. Hovmand, Sarah T. Cherng, Rick L. Riolo, Alison Kraus, Anindita Biswas, et al. “A Participatory Model of the Paradox of Primary Care.” The Annals of Family Medicine 13, no. 5 (September 1, 2015): 456–65. doi:10.1370/afm.1841.

ⁱⁱⁱ Commonwealth Fund, and Henry J. Kaiser Family Foundation. “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment. Findings from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers.” Issue Brief (Commonwealth Fund) 24 (August 2015): 1–13.

^iv Bice, T. W., and S. B. Boxerman. “A Quantitative Measure of Continuity of Care.” Medical Care 15, no. 4 (April 1977): 347–49.

^v Macinko, James, Barbara Starfield, and Leiyu Shi. “Quantifying the Health Benefits of Primary Care Physician Supply in the United States.” International Journal of Health Services: Planning, Administration, Evaluation 37, no. 1 (2007): 111–26.