Segal Jeffrey, Sacopulos Michael, Sheets Virgil, Thurston Irish, Brooks Kendra, Puccia Ryan
Medical Justice Services, Inc., Greensboro, NC 27419, United States.
J Med Internet Res. 2012 Apr 10;14(2):e50. doi: 10.2196/jmir.2005.
Increasingly, consumers are accessing the Internet seeking health information. Consumers are also using online doctor review websites to help select their physician. Such websites tally numerical ratings and comments from past patients. To our knowledge, no study has previously analyzed whether doctors with positive online reputations on doctor review websites actually deliver higher quality of care typically associated with better clinical outcomes and better safety records.
For a number of procedures, surgeons who perform more procedures have better clinical outcomes and safety records than those who perform fewer procedures. Our objective was to determine if surgeon volume, as a proxy for clinical outcomes and patient safety, correlates with online reputation.
We investigated the numerical ratings and comments on 9 online review websites for high- and low-volume surgeons for three procedures: lumbar surgery, total knee replacement, and bariatric surgery. High-volume surgeons were randomly selected from the group within the highest quartile of claims submitted for reimbursement using the procedures' relevant current procedural terminology (CPT) codes. Low-volume surgeons were randomly selected from the lowest quartile of submitted claims for the procedures' relevant CPT codes. Claims were collated within the Normative Health Information Database, covering multiple payers for more than 25 million insured patients.
Numerical ratings were found for the majority of physicians in our sample (547/600, 91.2%) and comments were found for 385/600 (64.2%) of the physicians. We found that high-volume (HV) surgeons could be differentiated from low-volume (LV) surgeons independently by analyzing: (1) the total number of numerical ratings per website (HV: mean = 5.85; LV: mean = 4.87, P<.001); (2) the total number of text comments per website (HV: mean = 2.74; LV: mean = 2.30, P=.05); (3) the proportion of glowing praise/total comments about quality of care (HV: mean = 0.64; LV: mean = 0.51, P=.002); and (4) the proportion of scathing criticism/total comments about quality of care (HV: mean = 0.14; LV: mean = 0.23, P= .005). Even when these features were combined, the effect size, although significant, was still weak. The results revealed that one could accurately identify a physician's patient volume via discriminant and classification analysis 61.6% of the time. We also found that high-volume surgeons could not be differentiated from low-volume surgeons by analyzing (1) standardized z score numerical ratings (HV: mean = 0.07; LV: mean = 0, P=.27); (2) proportion of glowing praise/total comments about customer service (HV: mean = 0.24; LV: mean = 0.22, P=.52); and (3) proportion of scathing criticism/total comments about customer service (HV: mean = 0.19; LV: mean = 0.21, P=.48).
Online review websites provide a rich source of data that may be able to track quality of care, although the effect size is weak and not consistent for all review website metrics.
越来越多的消费者通过互联网获取健康信息。消费者还利用在线医生评价网站来帮助选择医生。此类网站汇总过去患者给出的数字评分和评论。据我们所知，此前尚无研究分析在医生评价网站上拥有正面在线声誉的医生是否实际提供了通常与更好的临床结果和更优安全记录相关的更高质量的医疗服务。
对于许多手术而言，实施手术数量较多的外科医生比实施手术数量较少的医生具有更好的临床结果和安全记录。我们的目的是确定作为临床结果和患者安全指标的医生手术量是否与在线声誉相关。
我们调查了9个在线评价网站上针对高手术量和低手术量外科医生的三种手术的数字评分和评论，这三种手术分别是腰椎手术、全膝关节置换术和减肥手术。高手术量外科医生是从使用手术相关的当前手术操作术语（CPT）编码提交报销申请的最高四分位数组中随机选取的。低手术量外科医生是从使用手术相关CPT编码提交报销申请的最低四分位数组中随机选取的。理赔数据在规范健康信息数据库中进行整理，该数据库涵盖超过2500万参保患者的多个付款方。
我们样本中的大多数医生（547/600，91.2%）有数字评分，385/600（64.2%）的医生有评论。我们发现，通过分析以下内容可以独立区分高手术量（HV）外科医生和低手术量（LV）外科医生：（1）每个网站的数字评分总数（HV：均值 = 5.85；LV：均值 = 4.87，P <.001）；（2）每个网站的文本评论总数（HV：均值 = 2.74；LV：均值 = 2.30，P =.05）；（3）关于医疗质量的热烈赞扬/评论总数的比例（HV：均值 = 0.64；LV：均值 = 0.51，P =.002）；以及（4）关于医疗质量的严厉批评/评论总数的比例（HV：均值 = 0.14；LV：均值 = 0.23，P =.005）。即使将这些特征综合起来，效应量虽然显著，但仍然较弱。结果显示，通过判别分析和分类分析，有61.6%的时间可以准确识别医生的患者手术量。我们还发现，通过分析以下内容无法区分高手术量外科医生和低手术量外科医生：（1）标准化z分数数字评分（HV：均值 = 0.07；LV：均值 = 0，P =.27）；（2）关于客户服务的热烈赞扬/评论总数的比例（HV：均值 = 0.24；LV：均值 = 0.22，P =.52）；以及（3）关于客户服务的严厉批评/评论总数的比例（HV：均值 = 0.19；LV：均值 = 0.21，P =.48）。
在线评价网站提供了丰富的数据来源，可能能够追踪医疗质量，尽管效应量较弱，且并非对所有评价网站指标都一致。
