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Are Low Patient Satisfaction Scores Always Due to the Provider?

Determinants of Patient Satisfaction Scores During Spine Clinic Visits

Bible, Jesse E. MD; Shau, David N. MD; Kay, Harrison F. MD; Cheng, Joseph S. MD; Aaronson, Oran S. MD; Devin, Clinton J. MD

doi: 10.1097/BRS.0000000000001453

Study Design. A prospective study.

Objective. The aim of this study was to investigate the impact of various components on patient satisfaction scores

Summary of Background Data. Patient satisfaction has become an important component of quality assessments. However, with many of these sources collecting satisfaction data reluctant to disclose detailed information, little remains known about the potential determinants of patient satisfaction.

Methods. Two hundred patients were contacted via phone within 3 weeks of new patient encounter with 11 spine providers. Standardized patient satisfaction phone survey consisting of 25 questions (1–10 rating scale) was administered. Questions inquired about scheduling, parking, office staff, teamwork, wait-time, radiology, provider interactions/behavior, treatment, and follow-up communication. Potential associations between these factors and three main outcome measures were investigated: (1) provider satisfaction, (2) overall clinic visit satisfaction, and (3) quality of care.

Results. Significant associations (P < 0.0001) with provider satisfaction, overall clinic visit satisfaction, and perceived overall quality of care were found with appointment scheduling, parking, office staff, teamwork, wait time, radiology, provider interactions/behavior, treatment, and follow-up communication. Nurse-practitioner/resident involvement was positively associated with scores (P ≤ 0.03). A “candy-man” effect was not noted, as pain medication prescribing did not play a significant role in satisfaction (P > 0.05).

In multivariate regression analysis, explanation of medical condition/treatment (P = 0.002) and provider empathy (P = 0.04) were significantly associated with provider satisfaction scores, while the amount of time spent with the provider was not. Conversely, teamwork of staff/provider and follow-up communication were significantly associated with both overall clinic visit satisfaction and quality of care (P ≤ 0.03), while provider behaviors or satisfaction were not.

Conclusion. Satisfaction with the provider was associated with better explanations of the spine condition/treatment plan and provider empathy, but was not a significant factor in either overall clinic visit satisfaction or perceived quality of care. Patients’ perception of teamwork between staff and providers along with reliable follow-up communication were found to be significant determinants of overall patient satisfaction and perceived quality of care.

Level of Evidence: 3

Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA

Vanderbilt Orthopaedic Institute, Vanderbilt University Medical CenterNashville, TN

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.

Address correspondence and reprint requests to Jesse E. Bible, MD, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, 30 Hope Drive—EC089, Hershey, PA 17033; E-mail:

Received 30 September, 2015

Revised 9 November, 2015

Accepted 7 December, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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