Patient-doctor bond linked to better quality care

Atlas and his co-authors, who report on their study in the Annals of Internal Medicine, were surprised by the variation in connectedness that they found across the 13 practices, ranging from 46 percent to 71 percent of patients. The different settings share clinical and administrative systems, including electronic health records, and have the same management structure.

"That's a huge difference," Atlas said. "That has important health policy implications if you think about paying physicians or practices based on the quality of care they provide."

Physicians have objected to pay-for-performance programs that compensate them based on how many of their patients get recommended care. Last year the Massachusetts Medical Society sued the state's Group Insurance Commission alleging its ranking of physicians based on cost and quality measures hurt physicians and patients because it was based on a flawed methodology. Physicians were sometimes punished for the cost of care for patients they did not treat, the suit alleged.

The willingness or ability of patients to establish a relationship with their doctors may play a role in connectedness, too, Atlas said, in which case holding the physician or practice accountable may not work. Patients facing socioeconomic or language barriers as they navigate the healthcare system may be less likely to connect with their physicians.

"The doctor may be doing a great job, but it may be a much more challenging population," Atlas said.

In an editorial, Dr. Andrew B. Bindman of the University of California, San Francisco, says the measure of patient-physician connectedness would be more valuable if it included not just screening for certain diseases but also improved health and lower costs.

"Clearly, we need to learn more about the role that patient preferences and provider behavior play in forming (or undermining) productive health care relationships," he writes.

Atlas said what they have learned about connectedness can affect how healthcare is delivered.

"If patients can't come in during 9 to 5, we have to figure out a new way. The face-to-face office visit is just one model of care," he said. "We are using this information to understand where we are doing well and where we can do better."