These authors contributed equally to this workPurpose: This study aimed to evaluate outpatient satisfaction in tertiary hospitals in Shiyan, China, to predict which items had highest priorities for outpatient satisfaction, and to identify population groups on which the medical institutions should focus. Patients and Methods: A cross-sectional survey was conducted at three tertiary hospitals in Shiyan city of China, from March to June 2018. An 18-item outpatient satisfaction questionnaire was applied. We conducted matrix analysis to describe the distribution of satisfaction score and the degree of influence of the items. Outpatient satisfaction was classified into the lowest and highest groups according to the 80/20 rule. Logistic regression model was used to identify demographic factors which might influence outpatient satisfaction. Results: A total of 2109 valid questionnaires were completed. The "waiting time", "diagnosis and treatment time" and "medical charges" items showed relatively higher degrees of influence but earned lower levels of satisfaction. Outpatients with a college level or above educational background (AOR=1.36, 95% CI=1.03-1.79) and with a family per-capita monthly income (FPMI)>7000 CNY (AOR=3.30, 95% CI=1.60-6.81) were more prevalent in the lowest satisfaction group. Outpatients with college level or above education background (COR=0.77, 95% CI=0.60-0.99), FPMI of 3001-5000 CNY (AOR=0.76, 95% CI=0.60-0.96), non-local residents (AOR=1.48, 95% CI=1.07-2.04), and urban workers with medical insurance (AOR=1.74, 95% CI=1.27-2.39) were more prevalent in the highest satisfaction group. Conclusion: The survey indicated that "long time to wait for treatment", "short treatment time", and "medical charges too expensive" were the top three aspects that need to be improved with priority by medical institutions. Education level, income level, residence and type of health insurance were the sociodemographic characteristics that significantly affect the outpatient satisfaction in tertiary hospitals. These factors need to be paid more attention by healthcare professionals to improve the patients' satisfaction.