Study: Discretionary patient ratings for healthcare orgs could be useful

Results from a study published March 12 online in the Archives of Internal Medicine demonstrated a relationship between patients’ website ratings of hospitals and some objective measures of clinical quality, including mortality and infection rates.

Although controversial, particularly among healthcare professionals, web-based hospital or physician rating sites represent a potentially important development in public reporting, wrote Felix Greaves, PhD, from the department of primary care and public health at Imperial College London, and colleagues. “Patients rarely use conventional publicly reported metrics when choosing their healthcare provider and often find these difficult to understand.”

The researchers performed a cross-sectional study of all (166) English National Health Service (NHS) acute hospital trusts in England, using data from 10,274 patient web-based ratings posted on the NHS Choices website from Jan. 1, 2009, to Dec. 31, 2010, obtained from the English Department of Health.

Hospital trust–level indicators of clinical outcomes (five measures) and healthcare-acquired infections (two measures) were compared with web-based patient ratings using the Spearman rank correlation coefficient. When comparing patient ratings with infection rates, all 166 acute care hospital trusts in England were used. When comparing ratings with other clinical outcomes, a reduced list of 146 hospital trusts was used that excluded trusts that only care for children or specific specialties.

The mean and median number of ratings per hospital was 62 and 46, respectively (range, 1 to 290). Of those who offered a view about recommending the hospital (9,349 ratings), 68 percent would recommend the hospital to a friend. Positive recommendations of hospitals were significantly associated with lower hospital standardized mortality ratios, lower mortality from high-risk conditions and lower readmission rates.

Additionally, positive recommendations were not associated with mortality rates among surgical inpatients with serious treatable complications or mortality from low-risk conditions. Mean and median ratings of hospital cleanliness were 3.6 (range, 2.6 to 5) on a scale from 1 (dirty) to 5 (exceptionally clean). Better ratings of hospital cleanliness were associated with lower C. difficile infection rates.

“Our results suggest that discretionary patient ratings, obtained through a website, may be a more useful tool than previously considered for both patients and healthcare workers,” the authors concluded. “The use of web-based patient ratings has become common in other industries such as hotels and restaurants, and consumers value these rankings in making choices. We believe that the information provided by these web sites, although flawed, represents a potentially important development in the measurement of healthcare quality."

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