Association Between Patient-Reported Measures of Psychological Distress and Patient Satisfaction Scores in a Spine Surgery Patient Population

Background: Patient satisfaction has become an important component of the delivery of health care in the United States. Previous studies have shown that patient satisfaction is influenced by patient-specific characteristics. The goal of this study was to determine whether psychological distress influences outpatient satisfaction scores in a spine surgery patient population. Methods: We retrospectively reviewed the records from all outpatient clinical encounters at a single academic spine surgery center between February 2011 and January 2013. Any patient who completed both a patient satisfaction survey and a Distress and Risk Assessment Method (DRAM) questionnaire for the same clinical encounter was included in the study. Statistical analysis was performed to determine whether patient satisfaction scores were influenced by psychological distress. Results: During the study period, 103 patients who met the inclusion criteria were identified. On the basis of their responses to the DRAM questionnaire, fifty-six were classified as normal (no evidence of distress), twenty-two as at risk, thirteen as distressed depressive, and twelve as distressed somatic. The mean overall patient satisfaction scores (and standard deviation) were 90.2 +/- 10.9 in the normal group, 94.7 +/- 8.2 in the at-risk group, 87.5 +/- 16.2 in the distressed-depressive group, and 75.7 +/- 22.4 in the distressed-somatic group (p = 0.003). The mean score for the patients' satisfaction with their provider was 94.2 +/- 12.0 in the normal group, 94.2 +/- 9.5 in the at-risk group, 90.6 +/- 24.0 in the distressed-depressive group, and 74.9 +/- 26.2 in the distressed-somatic group (p = 0.011). Conclusions: These results indicate a significant association between patient satisfaction and psychological distress as measured with the DRAM questionnaire. Distressed patients gave significantly lower scores for overall satisfaction and satisfaction with their provider compared with patients categorized as normal. These results suggest that psychological factors may influence patients' perception of the medical care provided to them.