Modifiable and Nonmodifiable Factors Associated With Patient Satisfaction in Spine Surgery and Other Orthopaedic Subspecialties

A Retrospective Survey Analysis

Leah Steinmetz, BA; Dennis Vasquez-Montes, MS; Bradley C. Johnson, MD; Aaron J. Buckland, MBBS, FRACS; Jeffrey A. Goldstein, MD, FACS; John A. Bendo, MD; Thomas J. Errico, MD; Charla R. Fischer, MD


Curr Orthop Pract. 2019;30(6):555-560. 

In This Article

Abstract and Introduction


Background: The Press Ganey (PG) satisfaction survey is the most common measure to assess ambulatory patient satisfaction. Understanding how factors affecting spine patient satisfaction compare with other orthopedic subspecialties may allow for interventions to increase satisfaction. This study aimed to determine if patient satisfaction predictors differ between spine and nonspine orthopaedic subspecialties.

Methods: PG surveys from 2013–2017 were retrospectively analyzed. Correlation analysis was performed between each survey question, and overall experience as measured by Likelihood of Recommending the provider (LTR) and Provider Rating (PR). Regression modeling was utilized to identify differences between ambulatory patients in spine and other nonspine orthopaedic subspecialties.

Results: Overall, 16,175 orthopaedic patient surveys were analyzed, of which 1,400 surveys were from spine patients. The mean age for respondents was 55.4 yr, and 41.2% were female. Poor ratings were predicted by higher education level in both groups. Female physicians (PR OR=1.320 P=0.07, LTR OR=1.529 P=0.04) and a high school education (PR OR=1.488 P=0.05, LTR OR=1.968 P=0.01) were significant predictors of satisfaction in nonspine orthopaedic subspecialties, but not in spine patients. Provider communication, staff communication, concordant ethnicity, and age bias were predictors for PR (Spine R2=0.735, Orthopedics R2=0.665) and LTR (Spine R2:0.642, Orthopedics R2=0.599) in both groups. Provider communication was the strongest independent predictor of high satisfaction for spine (PR R2=0.728, LTR R2=0.627) and nonspine orthopaedic patients (R2=0.662, R2=0.583) followed by staff communication, ethnicity, and age.

Conclusions: Satisfaction for both spine and nonspine orthopaedic patients is driven by provider communication, followed by staff communication, ethnicity, and age.

Level of Evidence: Level IV.


Patient satisfaction surveys are important metrics in assessing healthcare quality. Patient satisfaction is used by the Centers for Medicare and Medicaid Services (CMS) to assess quality of care and reward hospitals under the Value-Based-Purchasing (VBP) program.[1] Press Ganey Associates is the largest administrator of patient satisfaction surveys in the United States, providing both inpatient and outpatient assessments. The Press Ganey Associates' Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is used to assess ambulatory care and can be tailored to individual institution need.[2–4] In addition to satisfaction queries, the CG-CAHPS survey contains questions intended to measure qualitative details domains such as communication with doctors, responsiveness of staff, and likelihood to recommend the provider.[3] Therefore, recognizing factors during the patient visit that influence overall patient satisfaction will aid orthopaedic surgeons in improving their medical practice and avoid potential reimbursements penalties.

Despite the widespread use of Press Ganey satisfaction surveys, patient factors that influence these satisfaction scores are relatively understudied.[5] Most current literature has delved into patient perceptions in the inpatient setting, but there remains a scarcity of data regarding outpatient clinical settings. Furthermore, the influences of the various domains of patient experience on overall patient satisfaction remain unknown. Therefore, the purpose of this study was to determine how the factors that influence satisfaction among patients with spinal disorders compare with patients with nonspine orthopaedic conditions. Understanding these factors may help better utilize survey results and aid physicians in providing a more positive patient experience in the age of patient-centered care.