Do online ratings matter? Investigating the correlation between online physician and hospital ratings and patient outcomes.
Author: Orly Bogler
Supervisors: Dr. Chaim Bell and Dr. Jessica Liu
Online ratings are increasingly being used by consumers to rate and comment on their healthcare providers (1). In Canada and the US, websites such as ratemds.com, vitals.com, and healthgrades.com have increased in popularity in recent years. Consumers have the ability to rate their healthcare experience and provide comments on their thoughts on the quality of care they received. However, there is little data available on whether or not online ratings correlate to established healthcare outcomes.
In general, there are few studies investigating the ability of patients to accurately appraise their healthcare quality. Most of the existing literature pertains to patient satisfaction or patient complaints and their correlation with lawsuits and mortality, with variable findings (2-4). However, there is relatively little exploration into the area of online ratings. Some studies have described ratings for specific subspecialties and geographical locations (5-9). Others have explored patient and physician awareness and use of rating websites (1, 10-12). Recently, studies have looked at the association between online ratings and physician-specific and hospital-level outcomes such as readmission rates and mortality, with mixed results (13-19).
Our work will contribute to the growing body of research surrounding online ratings by examining the association between online physician ratings and physician-specific percutaneous coronary intervention (PCI) mortality. We will also explore the association between Canadian hospital ratings and hospital-level PCI mortality and 30-day readmission rates.
By better understanding the relationship between online ratings with quality of care, we can help patients navigate an increasingly complex healthcare system and direct the appropriate use of online rating tools. Choosing a hospital or healthcare provider may, in some ways, be similar to choosing a restaurant or a hotel. Additionally, this type of work compliments the trend in healthcare to improve transparency and provides incentive and feedback for physicians to improve their practice.
There are limitations to using online websites. Reviews are not vetted; posts may be biased, and criticisms of the rating websites include the potential for physicians or hospitals to pay to manipulate their ratings. Additionally, reviews may be more reflective of the quality of customer service, such as by rating the cleanliness or punctuality of the clinic, rather than health quality outcomes such as patient mortality (13, 20). However, generating more research about online ratings will inform consumers to approach ratings carefully, and may encourage rating companies to modify their websites, such as by including more established performance metrics and improving the websites’ legitimacy (21).
With our population’s growing online presence, rating websites will only increase in popularity, creating data that is at the disposal of patients, providers, and researchers. I now understand the importance of using these datasets in research to influence patient outcomes or choices. Moreover, using patient-generated reports as part of a research investigation highlights the importance of the patient’s involvement in the circle of care. It is far more common to use solicited patient surveys, but by using unsolicited patient-generated data, our research attempts to understand patient care, in patients’ own words, by using an unsolicited platform for physician and hospital feedback that the public is using.
- Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734-5.
- Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):1126-33.
- Glickman SW, Boulding W, Manary M, Staelin R, Roe MT, Wolosin RJ, et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(2):188-95.
- Hickson GB, Federspiel CF, Blackford J, Pichert JW, Gaska W, Merrigan MW, et al. Patient complaints and malpractice risk in a regional healthcare center. South Med J. 2007;100(8):791-6.
- Emmert M, Meier F. An analysis of online evaluations on a physician rating website: Evidence from a German public reporting instrument. J Med Internet Res. 2013;15.
- Hao H. The development of online doctor reviews in China: An analysis of the largest online doctor review website in China. J Med Internet Res. 2015;17(6):e134.
- Terlutter R, Bidmon S, Röttl J. Who uses physician-rating websites? Differences in sociodemographic variables, psychographic variables, and health status of users and nonusers of physician-rating websites. J Med Internet Res. 2014;16.
- Emmert M, Meier F, Heider A, Dürr C, Sander U. What do patients say about their physicians? An analysis of 3000 narrative comments posted on a German physician rating website. Health Policy. 2014;118.
- Liu JJ, Matelski JJ, Bell CM. Scope, breadth, and differences in online physician ratings related to geography, specialty, and year: Observational retrospective study. J Med Internet Res. 2018;20(3):e76.
- Holliday AM, Kachalia A, Meyer GS, Sequist TD. Physician and patient views on public physician rating websites: A cross-sectional study. J Gen Intern Med. 2017;32(6):626-31.
- Emmert M, Sauter L, Jablonski L, Sander U, Taheri-Zadeh F. Do physicians respond to web-based patient ratings? An analysis of physicians’ responses to more than one million web-based ratings over a six-year period. J Med Internet Res. 2017;19(7):e275.
- McLennan S, Strech D, Reimann S. Developments in the frequency of ratings and evaluation tendencies: A review of German physician rating websites. J Med Internet Res. 2017;19(8):e299.
- Daskivich TJ, Houman J, Fuller G, Black JT, Kim HL, Spiegel B. Online physician ratings fail to predict actual performance on measures of quality, value, and peer review. J Am Med Inform Assoc. 2018;25(4):401-7.
- Emmert M, Meszmer N, Schlesinger M. A cross-sectional study assessing the association between online ratings and clinical quality of care measures for US hospitals: Results from an observational study. BMC Health Serv Res. 2018;18(1):82.
- Gao GG, McCullough JS, Agarwal R, Jha AK. A changing landscape of physician quality reporting: Analysis of patients’ online ratings of their physicians over a 5-year period. J Med Internet Res. 2012;14.
- Okike K, Peter-Bibb TK, Xie KC, Okike ON. Association between physician online ratings and quality of care. J Med Internet Res. 2016;18(12):e324.
- Emmert M, Adelhardt T, Sander U, Wambach V, Lindenthal J. A cross-sectional study assessing the association between online ratings and structural and quality of care measures: Results from two German physician rating websites. BMC Health Serv Res. 2015;15(1):414.
- Liu JJ, Matelski J, Cram P, Urbach DR, Bell CM. Association between online physician ratings and cardiac surgery mortality. Circ Cardiovasc Qual Outcomes. 2016;9(6):788-91.
- Segal J, Sacopulos M, Sheets V, Thurston I, Brooks K, Puccia R. Online doctor reviews: Do they track surgeon volume, a proxy for quality of care? J Med Internet Res. 2012;14(2):e50.
- Ellimoottil C, Leichtle SW, Wright CJ, Fakhro A, Arrington AK, Chirichella TJ, et al. Online physician reviews: The good, the bad, and the ugly. Bull Am Coll Surg. 2013;98(9):34-9.
- Lee V. Transparency and trust — Online patient reviews of physicians. N Engl J Med. 2017;376(3):197-9.