一项评估美国医院在线评分与医疗服务临床质量指标之间关联的横断面研究：一项观察性研究的结果。
A cross-sectional study assessing the association between online ratings and clinical quality of care measures for US hospitals: results from an observational study.
作者信息
Emmert Martin, Meszmer Nina, Schlesinger Mark
机构信息
2014-15 Harkness & Robert Bosch Fellow in Healthcare Policy and Practice; Department of Health Policy and Management, Yale University, School of Public Health, 47 College Street, New Haven, CT, 06520, USA.
Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403, Nuremberg, Germany.
出版信息
BMC Health Serv Res. 2018 Feb 5;18(1):82. doi: 10.1186/s12913-018-2886-3.
BACKGROUND
Little is known about the usefulness of online ratings when searching for a hospital. We therefore assess the association between quantitative and qualitative online ratings for US hospitals and clinical quality of care measures.
METHODS
First, we collected a stratified random sample of 1000 quantitative and qualitative online ratings for hospitals from the website RateMDs. We used an integrated iterative approach to develop a categorization scheme to capture both the topics and sentiment in the narrative comments. Next, we matched the online ratings with hospital-level quality measures published by the Centers for Medicare and Medicaid Services. Regarding nominally scaled measures, we checked for differences in the distribution among the online rating categories. For metrically scaled measures, we applied the Spearman rank coefficient of correlation.
RESULTS
Thirteen of the twenty-nine quality of care measures were significantly associated with the quantitative online ratings (Spearman p = ±0.143, p < 0.05 for all). Thereof, eight associations indicated better clinical outcomes for better online ratings. Seven of the twenty-nine clinical measures were significantly associated with the sentiment of patient narratives (p = ±0.114, p < 0.05 for all), whereof four associations indicated worse clinical outcomes in more favorable narrative comments.
CONCLUSIONS
There seems to be some association between quantitative online ratings and clinical performance measures. However, the relatively weak strength and inconsistency of the direction of the association as well as the lack of association with several other clinical measures may not enable the drawing of strong conclusions. Narrative comments also seem to have limited potential to reflect the clinical quality of care in its current form. Thus, online ratings are of limited usefulness in guiding patients towards high-performing hospitals from a clinical point of view. Nevertheless, patients might prefer different aspects of care when choosing a hospital.
背景
在寻找医院时，人们对在线评级的有用性知之甚少。因此，我们评估了美国医院的定量和定性在线评级与临床护理质量指标之间的关联。
方法
首先，我们从RateMDs网站收集了1000个医院定量和定性在线评级的分层随机样本。我们采用综合迭代方法制定了一个分类方案，以捕捉叙述性评论中的主题和情感。接下来，我们将在线评级与医疗保险和医疗补助服务中心公布的医院层面质量指标进行匹配。对于名义尺度指标，我们检查了在线评级类别之间分布的差异。对于度量尺度指标，我们应用了Spearman等级相关系数。
结果
29项护理质量指标中有13项与定量在线评级显著相关（Spearman p = ±0.143，所有p < 0.05）。其中，八项关联表明在线评级越高，临床结果越好。29项临床指标中有七项与患者叙述的情感显著相关（p = ±0.114，所有p < 0.05），其中四项关联表明在更积极的叙述性评论中临床结果更差。
结论
定量在线评级与临床绩效指标之间似乎存在某种关联。然而，关联强度相对较弱、方向不一致以及与其他一些临床指标缺乏关联，可能无法得出强有力的结论。叙述性评论目前形式下反映临床护理质量的潜力似乎也有限。因此，从临床角度来看，在线评级在引导患者选择高性能医院方面的作用有限。尽管如此，患者在选择医院时可能会偏好护理的不同方面。
Zotero 插件