Can Comments Improve Care? How Yelp Reviews Can Help Patients and Providers Understand Experiences of Hospital Care

Recently, there has been an increased focus on improving patient satisfaction in health care. Patient experience is one of the three pillars of the Triple Aim framework, as numerous studies have found a positive link between patient experience and downstream health outcomes, particularly with regards to self-management of chronic disease and adherence to treatment. Many reforms enacted since the passage of the ACA, such as Medicare’s Hospital Value Based Purchasing program, have sought to integrate measures of satisfaction into evaluating hospital outcomes.

Patient experience of care has traditionally been measured using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The survey has variants for a wide variety of healthcare settings, including hospitals, home health facilities, nursing homes, and even for health plans. Despite the fact that the surveys are regularly vetted to ensure relevance and applicability, many industry stakeholders worry about their ability to measure patient experience, since structured surveys do not lend themselves to explaining the source of dissatisfaction.

Many patients have turned to online review sites for narrative reviews of particular facilities and providers. Sites like Angie’s List and Healthgrades allow users to submit comments about particular providers, but the largest commercial website for hospital reviews is Yelp. Industry stakeholders interested in learning more about patient experience of care may want to augment traditional measures with online narrative reviews, but it is unclear if the reviews on sites like Yelp are an accurate proxy for hospital quality.

In a recent article in Health Affairs, Benjamin Ranard and colleagues seek to assess how narrative Yelp reviews of hospitals compare to similar measures used on the Hospital CAHPS (HCAHPS) survey. The team identified all hospitals with Yelp reviews as of July 2014, eliminating those with a high proportion of potentially fake reviews per Yelp’s algorithms. Ranard et al. then analyzed the text from the Yelp reviews to determine which groups of words occurred most frequently and grouped them based on the review’s topic (“rude doctor/nurse communication”). These topics were then matched to corresponding topics covered on the HCAHPS survey, and the hospital’s Yelp ratings were compared to its HCAHPS rating.

The researchers find that Yelp reviews cover substantially more domains of patient experience than the HCAHPS survey. Only nine of the 41 eligible topics discovered through the text analysis could be matched to HCAHPS domains, while the remaining 32 were unrelated. Further, four of the top five topics strongly associated with positive reviews are not covered by HCAHPS, primarily relating to how “caring” or “comforting” providers were. Similarly, topics such as billing and cost, which correspond with highly negative experiences, are also not covered on the survey.

The authors find that the overall Yelp ratings are similar to the overall HCAHPS rating, and this relationship becomes even stronger as the authors increase the minimum number of reviews needed to be included in the analysis. This suggests that as the number of reviews for a given hospital increases, the information becomes more reflective of patient experience.

Yelp reviews should not be the primary measure of patient satisfaction, but this evidence suggests that consumer reviews could work in tandem with surveys like HCAHPS. Even though individuals who choose to leave a Yelp review may not be a random sample of the population, this paper suggests that the information they reveal closely parallels that of the survey, especially as the sample size increases. Policymakers may want to delve deeper into the insights generated from online review sites in order to gain a sense of the main drivers of patient satisfaction, which can help hospitals move closer to the Triple Aim goals.

Article Source: Ranard, Benjamin L., Rachel M. Werner, Tadas Antanavicius, H. Andrew Schwartz, Robert J. Smith, Zachary F. Meisel, David A. Asch, Lyle H. Ungar, and Raina M. Merchant. “Yelp Reviews Of Hospital Care Can Supplement And Inform Traditional Surveys Of The Patient Experience Of Care.” Health Affairs 35(4), 2016.

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