Murphy Gregory P, Awad Mohannad A, Osterberg E Charles, Gaither Thomas W, Chumnarnsongkhroh Thanabhudee, Washington Samuel L, Breyer Benjamin N
Zuckerberg San Francisco General Hospital, Department of Urology, University of California, San Francisco, San Francisco, CA, United States.
Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia.
J Med Internet Res. 2017 Aug 22;19(8):e254. doi: 10.2196/jmir.7488.
Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.
The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.
A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5).
A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender.
Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute difference was quite small. Physician rating websites have utility but are imperfect proxies for competence. Further research on physician Web-based ratings is warranted to understand what they measure and how they are associated with quality.
基于网络的医生评分系统是帮助患者评估医生的常用工具。这些网站能帮助患者查找有关医生执照、办公时间、纪律处分记录以及评分和评价的信息。患者评分较高是否与更高的医疗质量相关尚不清楚。
本研究的目的是通过比较被缓刑医生与匹配对照组医生在网站上的评分，来描述医生缓刑对消费者评分的影响。
对加利福尼亚州医疗委员会1989年12月至2015年9月期间被缓刑医生的数据进行回顾性分析。违规行为分为九类。使用加利福尼亚州消费者事务部网站，按照邮政编码和专业以2:1的比例将非缓刑对照组与缓刑案例进行匹配。从vitals.com、healthgrades.com和ratemds.com记录基于网络的评价（评分范围为1 - 5）。
共有410名医生因866项违规行为被缓刑。每个医生的平均（标准差[SD]）评分数量，案例组为5.2（7.8），对照组为4（6.3）（P = 0.003）。当汇总所有三个评分网站时，缓刑医生的平均评分为3.7（1.6），而对照组为4.0（1.0）（P < 0.001）。发现医疗记录、不胜任、处方疏忽和欺诈方面的违规行为评分显著较低。相反，案例组和对照组在专业精神、药物或酒精、犯罪、性行为不端和个人疾病方面的评分相似。在单变量分析中，发现缓刑与较低评分相关，比值比 = 1.5（95% CI 1.0 - 2.2）。当纳入年龄和性别时，这种关联在多变量模型中不显著。
被缓刑医生的基于网络的评分较低，表明患者可能察觉到了差异。尽管有这些统计结果，但绝对差异相当小。医生评分网站有其作用，但作为能力的替代指标并不完美。有必要对基于网络的医生评分进行进一步研究，以了解它们衡量的是什么以及它们与质量是如何关联的。
