title: Association between patient-reported measures of psychological distress and patient satisfaction scores after spine surgery.
abstract: 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 following spine surgery.
  
  
  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.
authors.affiliation: Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker: Ryan.spiker@hsc.utah.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: Abtahi
authors.affiliation: Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker: Ryan.spiker@hsc.utah.edu.
authors.forename: D S
authors.initials: DS
authors.lastname: Brodke
authors.affiliation: Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker: Ryan.spiker@hsc.utah.edu.
authors.forename: B D
authors.initials: BD
authors.lastname: Lawrence
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108.
authors.forename: C
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker: Ryan.spiker@hsc.utah.edu.
authors.forename: W R
authors.initials: WR
authors.lastname: Spiker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000523:psychology / Q000601:surgery*; D013315:Stress, Psychological / Q000209:etiology*; D055815:Young Adult