How Online Quality Ratings Influence Patients' Choice of Medical Providers: Controlled Experimental Survey Study

Decision Making of Healthcare Consumers Based on Factors Associated with Online Review and Ratings

The study deals with understanding of the factors associated with online ratings and reviews that help the healthcare consumers in better decision making. Data was collected from 303 participants using mixed methods. The results indicate the factors that help in decision making which includes use of ratings as a reference, impact of positive and negative ratings, whether these ratings depict the actual worth of healthcare service provider and the relevance of these websites in decision making. This study concludes that there is significant relevance of online rating and review websites on healthcare consumers in selecting a healthcare provider.

Differential Effect of Patient- and Provider-Level Factors on Patient Satisfaction Scores in Academic General Internal Medicine Clinics

OBJECTIVE

Determine whether patient-level or provider-level factors have greater influence on patient satisfaction scores in an academic general internal medicine clinic.

METHODS

Two years of data (2017-2019) from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) surveys from ambulatory internal medicine clinic visits in an academic health center located in the Midwest United States were used. Patient satisfaction was measured using the overall provider satisfaction score (0-10), dichotomized with 9-10 defined as satisfactory and 0-8 as unsatisfactory. Provider-level independent variables included age, sex, race/ethnicity, provider type, service type, clinical effort, academic rank, and years since graduation. Patient-level factors included age, sex, race/ethnicity, education, and Epic Risk Score. Generalized mixed-effects logistic regression models were used to investigate associations between top-box satisfaction score and patient- and provider-level factors, accounting for the nesting of patients within providers.

RESULTS

Thirty-three providers and 4597 patients were included in the analysis. Male providers (OR, 1.57; 95% CI, 1.00, 2.47), minority group 2 (OR, 3.54; 95% CI, 1.24, 10.07) and minority group 3 (OR, 6.04; 95% CI, 1.45, 25.12), faculty (OR, 3.83; 95% CI, 1.56, 9.36), and primary care providers (OR, 5.60; 95% CI, 1.62, 19.34) had increased odds of having a top-box rating compared with females, minority group 1, advanced practice providers, and perioperative providers respectively. Age was the only patient independent correlate of top-box rating with a 3% increased odds of top-box rating for every year increase in age (OR, 1.03; 95% CI 1.02, 1.03).

CONCLUSIONS

In this academic general internal medicine clinic, top-box satisfaction scores were more strongly associated with provider-level factors, including provider race/ethnicity, provider type, and service type, as opposed to patient-level factors. Further research is needed to confirm these findings and identify potential system-level interventions.

Alternative cancer clinics' use of Google listings and reviews to mislead potential patients

Background

Alternative cancer clinics, who provide treatment associated with earlier time to death, actively seek to create favorable views of their services online. An unexplored means where alternative cancer clinics can shape their appeal is their Google search results.

Methods

We retrieved the Google listing and Google reviews of 47 prominent alternative cancer clinics on August 22, 2022. We then conducted a content analysis to assess the information cancer patients are faced with online.

Results

Google listings of alternative treatment providers rarely declared the clinic was an alternative clinic versus a conventional primary cancer treatment provider (12.8% declared; 83.0% undeclared). The clinics were highly rated (median, 4.5 stars of 5). Reasons for positive reviews included treatment quality (n = 519), care (n = 420), and outcomes (n = 316). 288 reviews presented the clinics to cure or improve cancer. Negative reviews presented alternative clinics to financially exploit patients with ineffective treatment (n = 98), worsen patients' condition (n = 72), provide poor care (n = 41), and misrepresent outcomes (n = 23).

Conclusions

The favorable Google listing and reviews of alternative clinics contribute to harmful online ecosystems. Reviews provide compelling narratives but are an ineffective indicator of treatment outcomes. Google lacks safeguards for truthful reviews and should not be used for medical decision-making.

Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study

BACKGROUND

Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc.

OBJECTIVE

The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc.

METHODS

A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data.

RESULTS

The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings.

CONCLUSIONS

Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care.

Calculation of Overall Hospital Quality Star Ratings With and Without Inclusion of the Peer Grouping Step

Importance

The Centers for Medicare & Medicaid Services (CMS) Overall Star Rating is widely used by patients and consumers, and there is continued stakeholder curiosity surrounding the inclusion of a peer grouping step, implemented to the 2021 Overall Star Rating methods.

Objective

To calculate hospital star rating scores with and without the peer grouping step, with the former approach stratifying hospitals into 3-, 4-, and 5-measure group peer groups based on the number of measure groups with at least 3 reported measures.

Design, Setting, and Participants

This cross-sectional study used Care Compare website data from January 2023 for 3076 hospitals that received a star rating in 2023. Data were analyzed from April 2023 to December 2023.

Exposure

Peer grouping vs no peer grouping.

Main Outcomes and Measures

The primary outcome was the distribution of star ratings, with 1 star being the lowest-performing hospitals and 5 stars, the highest. Analyses additionally identified the number of hospitals with a higher, lower, or identical star rating with the use of the peer grouping step compared with its nonuse, stratified by certain hospital characteristics.

Results

Among 3076 hospitals that received a star rating in 2023, most were nonspecialty (1994 hospitals [64.8%]), nonteaching (1807 hospitals [58.7%]), non-safety net (2326 hospitals [75.6%]), non-critical access (2826 hospitals [91.9%]) hospitals with fewer than 200 beds (1822 hospitals [59.2%]) and located in an urban geographic designations (1935 hospitals [62.9%]). The presence of the peer grouping step resulted in 585 hospitals (19.0%) being assigned a different star rating than if the peer grouping step was absent, including considerably more hospitals receiving a higher star rating (517 hospitals) rather than a lower (68 hospitals) star rating. Hospital characteristics associated with a higher star rating included urbanicity (351 hospitals [67.9%]), non-safety net status (414 hospitals [80.1%]), and fewer than 200 beds (287 hospitals [55.6%]). Collectively, the presence of the peer grouping step supports a like-to-like comparison among hospitals and supports the ability of patients to assess overall hospital quality.

Conclusions and Relevance

In this cross-sectional study, inclusion of the peer grouping in the CMS star rating method resulted in modest changes in hospital star ratings compared with application of the method without peer grouping. Given improvement in face validity and the close association between the current peer grouping approach and stakeholder needs for peer-comparison, the current CMS Overall Star Rating method allows for durable comparisons in hospital performance.

Improving the accessibility of health care for internal migrants in China: Achieving the aim of equalization

Although equitable access to healthcare is considered key to the health of internal migrants, more concerted efforts are needed to improve the accessibility of healthcare in low- and middle-income countries. The software CiteSpace was used to analyze scientific literature on healthcare utilization among internal migrants in China since 2000. We focused on factors influencing access to healthcare, including geographical, economic, sociocultural, and institutional aspects. The government is urged to play a role in ensuring equal access to healthcare through policies, resource distribution, and information technology. Improving the accessibility of healthcare for internal migrants and achieving egalitarian goals is of great significance to promoting public health and fostering social equity and inclusivity.

How Virtual Triage Can Improve Patient Experience and Satisfaction: A Narrative Review and Look Forward

Objective

To complete a review of the literature on patient experience and satisfaction as relates to the potential for virtual triage (VT) or symptom checkers to enhance and enable improvements in these important health care delivery objectives.

Methods

Review and synthesis of the literature on patient experience and satisfaction as informed by emerging evidence, indicating potential for VT to favorably impact these clinical care objectives and outcomes.

Results/Conclusions

VT enhances potential clinical effectiveness through early detection and referral, can reduce avoidable care delivery due to late clinical presentation, and can divert primary care needs to more clinically appropriate outpatient settings rather than high-acuity emergency departments. Delivery of earlier and faster, more acuity level-appropriate care, as well as patient avoidance of excess care acuity (and associated cost), offer promise as contributors to improved patient experience and satisfaction. The application of digital triage as a front door to health care delivery organizations offers care engagement that can help reduce patient need to visit a medical facility for low-acuity conditions more suitable for self-care, thus avoiding unpleasant queues and reducing microbiological and other patient risks associated with visits to medical facilities. VT also offers an opportunity for providers to make patient health care experiences more personalized.

Impact of the COVID-19 pandemic on staff turnover at long-term care facilities: a qualitative study

OBJECTIVE

The objective of this research was to explore the lived experiences of long-term care facilities' staff during the COVID-19 pandemic and examine if and how the pandemic played a role in their decision to leave their jobs.

DESIGN

Qualitative study using thematic analysis of semistructured interviews. Interview transcripts were analysed using coding techniques based in grounded theory.

PARTICIPANTS

A total of 29 staff with various roles across 21 long-term care facilities in 12 states were interviewed.

RESULTS

The pandemic influenced the staff's decision to leave their jobs in five different ways, namely: (1) It significantly increased the workload; (2) Created more physical and emotional hazards for staff; (3) Constrained the facilities and their staff financially; (4) Deteriorated morale and job satisfaction among the staff and (5) Increased concerns with upper management's commitment to both general and COVID-19-specific procedures.

CONCLUSIONS

Staff at long-term care facilities discussed a wide variety of reasons for their decision to quit their jobs during the pandemic. Our findings may inform efforts to reduce the rate of turnover in these facilities.

Which surgeon demographic factors influence postoperative complication rates after total knee arthroplasty at U.S. News and World Report top-ranked orthopedic hospitals?

Introduction

Complication rates are used to evaluate surgical quality-of-care and determine health care reimbursements. The U.S. News & World Report (USNWR) hospital rankings are a highly-referenced source for top hospitals. The objective of this study was to determine the surgeon demographics of those practicing at USNWR Top Ranked Orthopedic Hospitals and if any influence complication rates after total knee arthroplasty (TKA).

Methods

The 2009–2013 USNWR ‘Orthopedic’ hospital rankings were identified. A database of TKA surgeons with postoperative complication rates was compiled utilizing publicly available data from the Centers for Medicare and Medicaid Services (2009–2013). Using an internet search algorithm, demographic data were collected for each surgeon and consisted of: fellowship training, years in practice, age, gender, practice setting, medical degree type, residency reputation, case volume, and geographic region of hospital. Logistic regression was used to assess the relationship between surgeon demographics and postoperative complication rates. A P value of < 0.008 was considered significant.

Results

From 2009 to 2013, 660 orthopedic surgeons performed TKA at 80 different USNWR Top-Ranked Hospitals. Mean TKA case volume was 172 (Range, 20–1323) and age of surgeon was 50.8 (Range, 32–77). A total of 372 (56.8%) completed an orthopedic surgery fellowship. Mean adjusted 30-day complication rate was 2.24% (Range, 1.2–4.5%). After adjustment, factors associated with increased complication rates were surgeon age ≤ 42 (OR 3.15; P = 0.007) and lower case volume (≤ 100 cases) (OR 2.52; P < 0.0001). Gender, hospital geographic region, completion of a fellowship, medical degree type, and residency reputation were not significant factors.

Discussion

Complication rates of total knee arthroplasty surgeons may be utilized by patients and hospitals to gauge quality of care. Certain surgeon factors may influence complication rates of surgeons performing TKA at USNWR Top Ranked Orthopedic Hospitals.

Study Type

Level III, retrospective observational study.

Identifying Influences in Patient Decision-making Processes in Online Health Communities: Data Science Approach

Background

In recent years, an increasing number of users have joined online health communities (OHCs) to obtain information and seek support. Patients often look for information and suggestions to support their health care decision-making. It is important to understand patient decision-making processes and identify the influences that patients receive from OHCs.

Objective

We aimed to identify the posts in discussion threads that have influence on users who seek help in their decision-making.

Methods

We proposed a definition of influence relationship of posts in discussion threads. We then developed a framework and a deep learning model for identifying influence relationships. We leveraged the state-of-the-art text relevance measurement methods to generate sparse feature vectors to present text relevance. We modeled the probability of question and action presence in a post as dense features. We then used deep learning techniques to combine the sparse and dense features to learn the influence relationships.

Results

We evaluated the proposed techniques on discussion threads from a popular cancer survivor OHC. The empirical evaluation demonstrated the effectiveness of our approach.

Conclusions

It is feasible to identify influence relationships in OHCs. Using the proposed techniques, a significant number of discussions on an OHC were identified to have had influence. Such discussions are more likely to affect user decision-making processes and engage users’ participation in OHCs. Studies on those discussions can help improve information quality, user engagement, and user experience.

Psoriasis care in Germany: do patients who receive better care travel longer?

BACKGROUND

Large variations in the quality of psoriasis care lead to patients being willing to bypass the nearest physician to receive higher quality of care. However, it remains unknown whether actual travel time is associated with quality of care. This study aimed to identify perceived quality of care determinants for travel time to the physician among patients with psoriasis in Germany. Furthermore, differences in access and perceived quality of care between urban and rural areas in Germany were analyzed.

METHODS

This cross-sectional observational study based on patient-level healthcare data. Perceived quality of care and treatment satisfaction were assessed from the patients' perspective. Travel time was estimated by the patients. Multiple regression analysis with the predictors patient characteristics, system-related variables, urbanity, and patient satisfaction with treatment, was applied to identify determinants of travel time with subgroup analyses for rural and urban areas.

RESULTS

We included 497 patients from 29 dermatological practices in Germany. There were significant differences in psoriasis care between urban and rural areas. Longer travel time was associated with lower age, higher income, higher number of consulted dermatologists since diagnosis, rural residence, more waiting time for the first appointment, lower dermatologist density, and higher patient reported treatment satisfaction.

DISCUSSION

The results indicate an association between actual travel time and treatment satisfaction. Patients with higher perceived quality of care travel longer for their dermatological treatment. The results are also relevant to needs related planning.

Patient Experience Scores for Radiologists: Comparison With Nonradiologist Physicians and Changes After Public Posting in an Institutional Online Provider Directory

BACKGROUND. Patients are increasingly using online information regarding patient experiences to guide care decisions. OBJECTIVE. The purpose of our study was to compare patient experience scores between radiologists and nonradiologist physicians and to assess changes in scores after their public posting in an online physician directory. METHODS. This retrospective study included data collected from May 1, 2017, to November 30, 2018, at a single large academic medical center. After all institutional outpatient visits, patients were e-mailed the Press Ganey Medical Practice Survey, which included 10 questions (answered using a Likert scale and converted to 100-point range) relating to the patient's experience with the specific provider for the encounter. Surveys were distributed to patients after radiology encounters if involving an image-guided invasive procedure. Mean scores for each question and the mean weighted overall score were displayed on each physician's publicly available profile on the hospital's online physician directory and were updated monthly. Scores were compared between radiologists and nonradiologist physicians; temporal changes were assessed. RESULTS. The response rate was 18.0% (96,057/533,983). After exclusions (23,989 surveys completed without provider ratings; 183 surveys evaluating physician assistants), 71,885 physician surveys were evaluated: 2703 surveys for 65 radiologists, 49,403 surveys for 916 physicians in 17 nonsurgical specialties, and 19,779 surveys for 262 physicians in 13 surgical specialties. Over the study period, the mean overall score was 95.6 for radiologists and 95.9 for nonradiologists (94.6 for surgical specialties, 96.4 for nonsurgical specialties). For the 10 individual questions, scores ranged for radiologists from 94.6 (time spent with patient) to 96.8 (friendliness/courtesy) and for nonradiologists from 94.6 (time spent with patient) to 97.0 (friendliness/courtesy). The mean overall score increased from the first month to the final month for radiologists from 94.2 to 97.1 and for nonradiologists from 95.7 to 96.3. For radiologists, the largest improvement was for instructions regarding postprocedure follow-up care (increased from 91.4 to 97.4). CONCLUSION. Radiologists received high scores on patient experience surveys when evaluated on encounters involving invasive procedures, achieving scores similar to those for other physicians. Scores improved over time, possibly related to online posting of survey results. CLINICAL IMPACT. The findings support the utility of implementing patient experience surveys in radiology.

Negative reviews online: an exploratory analysis of patient complaints about dental services in Western Australia

OBJECTIVE

Rates of online reviews are continually increasing. Coinciding with this, is the beneficial abundance of subjective information that is now available to patients. Such information can be persuasive in selecting a healthcare provider. This analysis of one-and-two-star Google reviews received by dental practices within the Perth metropolitan region aims to identify common themes within dental practice complaints.

METHODS

This mixed-methods study was conducted by gathering reviews from the 'Google review' feature, which have been published by users between 2013 and 2020. These data were then coded into recognised themes, and crucial quotes were selected and de-identified creating a narrative about the themes present which formed the qualitative component of this research.

RESULTS

A total of 413 negative reviews were included in this study. From these, 1071 specific complaints were identified. Major themes identified included treatment issues, staffing, communication and professionalism, finance, and premise. Spread across these five themes were an additional thirty-eight subthemes. Overall, treatment was a primary concern for patients, making up 37.1% of the results. Within the subthemes 'treatment dissatisfaction (unspecified)' was also high, at 23.1%.

CONCLUSION

This study identified the most common complaints received by dental clinics on Google review within the Perth metropolitan area. Further investigation is required to provide supplementary data regarding factors that may influence complaint rates and types, such as the socio-economic status of areas and geographical factors such as distance from the Perth metropolitan.

Questioning the Yelp Effect: Mixed Methods Analysis of Web-Based Reviews of Urgent Cares

Background

Providers of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance.

Objective

In this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not.

Methods

We obtained a list of 8662 urgent care facilities from the Yelp application programming interface. By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. We used machine learning algorithms to summarize the contents of these reviews. Additionally, 200 randomly sampled reviews were analyzed by 4 annotators to verify the types of messages present and whether they were consistent with the Yelp effect.

Results

We collected 481,825 reviews, of which 1696 (95% CI 1240-2152) exhibited the Yelp effect. Negative reviews primarily identified operations issues regarding wait times, rude staff, billing, and communication.

Conclusions

Urgent care patients rarely express expectations for antibiotics in negative web-based reviews. Thus, our findings do not support an association between a lack of antibiotic prescriptions and negative web-based reviews. Rather, patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan.

Caring for care: Online feedback in the context of public healthcare services

People increasingly provide feedback about healthcare services online. These practices have been lauded for enhancing patient power, choice and control, encouraging greater transparency and accountability, and contributing to healthcare service improvement. Online feedback has also been critiqued for being unrepresentative, spreading inaccurate information, undermining care relations, and jeopardising professional autonomy. Through a thematic analysis of 37 qualitative interviews, this paper explores the relationship between online feedback and care improvement as articulated by healthcare service users (patients and family members) who provided feedback across different online platforms and social media in the UK. Online feedback was framed by interviewees as, ideally, a public and, in many cases, anonymous 'conversation' between service users and healthcare providers. These 'conversations' were thought of not merely as having the potential to bring about tangible improvements to healthcare, but as in themselves constituting an improvement in care. Vital to this was the premise that providing feedback was an enactment of care - care for other patients, certainly, but also care for healthcare as such and even for healthcare professionals. Ultimately, feedback was understood as an enactment of care for the National Health Service (NHS), as symbolically encompassing all of the above. Putting these findings in dialogue with STS scholarship on care, we argue that, in this context, the provision of online feedback can be understood as a form of care that is, simultaneously, both directed at healthcare (in the round, including patients, professionals, services, organisations, and, of course, health itself) and part of healthcare. We conceptualise this as 'caring for care'. This conceptualization moves beyond dominant framings of online feedback in terms of 'choice' and 'voice'. It embeds online feedback within pre-existing healthcare systems, relations and moral commitments, foregrounds the mutuality of care relations, and draws attention to the affective labour of feedback practices.

Facebook Reviews as a Supplemental Tool for Hospital Patient Satisfaction and Its Relationship with Hospital Accreditation in Malaysia

Patient satisfaction is one indicator used to assess the impact of accreditation on patient care. However, traditional patient satisfaction surveys have a few disadvantages, and some researchers have suggested that social media be used in their place. Social media usage is gaining popularity in healthcare organizations, but there is still a paucity of data to support it. The purpose of this study was to determine the association between online reviews and hospital patient satisfaction and the relationship between online reviews and hospital accreditation. We used a cross-sectional design with data acquired from the official Facebook pages of 48 Malaysian public hospitals, 25 of which are accredited. We collected all patient comments from Facebook reviews of those hospitals between 2018 and 2019. Spearman’s correlation and logistic regression were used to evaluate the data. There was a significant and moderate correlation between hospital patient satisfaction and online reviews. Patient satisfaction was closely connected to urban location, tertiary hospital, and previous Facebook ratings. However, hospital accreditation was not found to be significantly associated with online reports of patient satisfaction. This groundbreaking study demonstrates how Facebook reviews can assist hospital administrators in monitoring their institutions’ quality of care in real time.

Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety

BACKGROUND

Hospital reviews posted online by patients are unsolicited and less structured than Hospital Consumer Assessment of Healthcare Providers and Systems surveys. The differences between online review platforms and their degrees of correlation with validated satisfaction and safety measures are unknown.

METHODS

We identified 515 large acute care teaching hospitals in the United States. We collected patient satisfaction results and postsurgical patient safety indicators from Hospital Compare. We also collected hospital star ratings (1-5) from Facebook, Google, and Yelp. Mean ratings were compared with paired t tests. Concordance between ratings websites, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and surgical safety indicators were assessed with Pearson's correlation coefficient.

RESULTS

Mean Facebook ratings (3.81, interquartile range 3.5-4.3) were more favorable than Google (3.26, interquartile range 2.8-3.6) or Yelp (2.59, interquartile range 2.3-2.9). Facebook ratings were least strongly correlated with the Hospital Consumer Assessment of Healthcare Providers and Systems recommended hospital score (ρ = 0.356). Google was modestly correlated (ρ = 0.479), and Yelp was most strongly correlated (ρ = 0.500). The negative correlation between crowdsourced rating and composite safety indicator was too small to be meaningful on any platform.

CONCLUSION

There is variation between platforms in consumer ratings of hospitals. Ratings on Facebook are more favorable than Google or Yelp. These are independently correlated with Hospital Consumer Assessment of Healthcare Providers and Systems scores. These findings suggest that unstructured consumer reviews generally reflect similar directionality as Hospital Consumer Assessment of Healthcare Providers and Systems satisfaction scores. Users should be aware of the significant difference between platforms. Consumer ratings platforms are not consistently correlated with postsurgical patient safety indicators, so online ratings may not reflect the safety of surgical care received.

Predicting Hospital Overall Quality Star Ratings in the USA

The U.S. Centers for Medicare and Medicaid Services (CMS) assigns quality star ratings to hospitals upon assessing their performance across 57 measures. Ratings can be used by healthcare consumers for hospital selection and hospitals for quality improvement. We provide a simpler, more intuitive modeling approach, aligned with recent criticism by stakeholders. An ordered logistic regression approach is proposed to assess associations between performance measures and ratings across eligible (n = 4519) U.S. hospitals. Covariate selection reduces the double counting of information from highly correlated measures. Multiple imputation allows for inference of star ratings when information on all measures is not available. Twenty performance measures were found to contain all the relevant information to formulate star rating predictions upon accounting for performance measure correlation. Hospitals can focus their efforts on a subset of model-identified measures, while healthcare consumers can predict quality star ratings for hospitals ineligible under CMS criteria.

Online Reputations: Comparing Hospital- and Patient-Generated Ratings in Academic Otolaryngology

OBJECTIVES

This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results.

METHODS

Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.com were identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019.

RESULTS

742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P < .001). In patient-generated rating, an increased number of rating scores (>20) was associated with male gender, professor ranking, and >30 years in practice (P < .005). Physician demographics did not impact number of ratings in hospital-generated setting. With patient-generated, lower aggregate score was associated with professor ranking (P = .001). In hospital-generated, lower score was associated with >30+ years in practice (P = .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS:P < .001,Vitals:P = .027,Healthgrades:P = .016).

CONCLUSION

Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.com scores were lower than those of Vitals.com. Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.

The Association of "U.S. News & World Report" Hospital Rankings and Outcomes Following Anterior Cervical Fusions: Do Rankings Even Matter?

STUDY DESIGN

Retrospective observational study.

OBJECTIVE

The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals.

SUMMARY OF BACKGROUND DATA

Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited.

METHODS

The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in "Neurosurgery" and "Orthopedics." The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals.

RESULTS

A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001).

CONCLUSION

Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.Level of Evidence: 3.

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

OBJECTIVE

Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.

DESIGN

Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.

SETTING

This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.

PARTICIPANTS

Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.

RESULTS

Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.

CONCLUSION

This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.

Cross-sectional analysis of online patient reviews of infertility care providers

Objective

To observe the effects of practice type, location, and mandated insurance coverage on infertility physician online reviews by patients.

Design

Retrospective cohort study.

Setting

Not applicable.

Patient(s)

Patient online reviews of fertility specialists from 2016 to 2019.

Interventions(s)

None.

Main Outcome Measure(s)

The analysis consisted of the average rating out of 5 for each physician published on Vitals, RateMD, and Healthgrades.

Result(s)

Data were collected on 1,097 specialists. Physicians practicing in states with versus without mandated insurance coverage received an average rating of 4.093 versus 4.076, respectively. The average rating was 3.964 for physicians affiliated with a university or hospital versus 4.128 for those working in a private practice. Significant differences were found in physician ratings from the four regions. It was revealed that physicians who practiced in the South (n = 354) received significantly higher mean average ratings than those in the Northeast (n = 327) and Midwest (n = 175). Physicians practicing in the West (n = 241) received significantly higher ratings than those in the Midwest (n = 175).

Conclusion(s)

The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice compared with those affiliated with a university or hospital system. No significant difference was found between the average rating in states with versus without mandated insurance coverage for infertility treatment. We propose that qualities other than patient financial responsibility are implicated in the factors used to rate physicians.

1.

The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice than for those affiliated with a university or hospital system.

2.

No significant difference was found between the average rating in states with mandated insurance coverage for fertility treatment and that in states without mandated insurance coverage.

3.

The average online patient ratings of infertility specialists were found to be significantly higher for physicians working in the South and West.

Correlation of Online Physician Rating Subscores and Association With Overall Satisfaction: Observational Study of 212,933 Providers

BACKGROUND

Online physician rating websites commonly ask consumers to rate providers across multiple physician-based (eg, spending sufficient time, listening) and office-based (eg, appointment scheduling, friendliness) subdimensions of care in addition to overall satisfaction. However, it is unclear if consumers can differentiate between the various rated subdimensions of physicians. It is also unclear how each subdimension is related to overall satisfaction.

OBJECTIVE

The objectives of our study were to determine the correlation of physician-based and office-based subdimensions of care and the association of each with overall satisfaction.

METHODS

We sampled 212,933 providers from the Healthgrades website and calculated average provider metrics for overall satisfaction (likelihood to recommend doctor), physician-based subdimensions (trust in physician, ability to explain, ability to listen and answer questions, and spending adequate time), and office-based subdimensions (ease of scheduling, office environment, staff friendliness, and wait time). We used Spearman rank correlation to assess correlation between subdimension ratings. Factor analysis was used to identify potential latent factors predicting overall satisfaction. Univariate and multivariable linear regression were performed to assess the effect of physician and office-based factors on overall satisfaction.

RESULTS

Physician-based metrics were highly correlated with each other (r=.95 to .98, P<.001), as were office-based metrics (r=.84 to .88, P<.001). Correlations between physician-based and office-based ratings were less robust (r=.79 to .81, P<.001). Factor analysis identified two factors, clearly distinguishing between physician-based metrics (factor loading = 0.84 to 0.88) and office-based metrics (factor loading = 0.76 to 0.84). In multivariable linear regression analysis, the composite factor representing physician-based metrics (0.65, 95% CI 0.65 to 0.65) was more strongly associated with overall satisfaction than the factor representing office-based metrics (0.42, 95% CI 0.42 to 0.42). These factors eclipsed other demographic variables in predicting overall satisfaction.

CONCLUSIONS

Consumers do not differentiate between commonly assessed subdimensions of physician-based care or subdimensions of office-based care, but composite factors representing these broader categories are associated with overall satisfaction. These findings argue for a simpler ratings system based on two metrics: one addressing physician-based aspects of care and another addressing office-based aspects of care.

Do Hospital Rankings Mislead Patients? Variability Among National Rating Systems for Orthopaedic Surgery

INTRODUCTION

A growing number of online hospital rating systems for orthopaedic surgery are found. Although the accuracy and consistency of these systems have been questioned in other fields of medicine, no formal analysis of these systems in orthopaedics has been found.

METHODS

Five hospital rating systems (US News, HealthGrades, CareChex, Women's Choice, and Hospital Compare) were examined which designate "high-performing" and "low-performing" hospitals for orthopaedic surgery. Descriptive analysis was conducted for all hospitals defined as high- or low-performing in any of the five rating systems, and assessment for agreement/disagreement between ratings was done. A subsample of hospitals ranked by all systems was then created, and agreement between rating systems was investigated using a Cohen's kappa. Each hospital was included in a multinomial logistic regression model investigating which hospital characteristics increased the odds of being favorably/unfavorably rated by each system.

RESULTS

One thousand six hundred forty hospitals were evaluated by every rating system. Six hundred thirty-eight unique hospitals were identified as high-performing by at least 1 rating system; however, no hospital was ranked as high-performing by all five rating systems. Four hundred fifty-two unique hospitals were identified as low-performing; however, no hospital was ranked as low-performing by all the three rating systems which define low-performing hospitals. Within the study subsample of hospitals evaluated by each system, little agreement between any combination of rating systems (κ < 0.10) regarding top-tier or bottom-tier performance was found. It was more likely for a hospital to be considered high-performing by one system and low-performing by another (10.66%) than for the majority of the five rating systems to consider a hospital high-performing (3.76%).

CONCLUSION

Little agreement between hospital quality rating systems for orthopaedic surgery is found. Publicly available hospital ratings for performance in orthopaedic surgery offer conflicting results and provide little guidance to patients, providers, or payers when selecting a hospital for orthopaedic surgery.

LEVEL OF EVIDENCE

Level 1 economic study.

The Association Between Physician Race/Ethnicity and Patient Satisfaction: an Exploration in Direct to Consumer Telemedicine

BACKGROUND

Patient satisfaction measures have important implications for physicians. Patient bias against non-White physicians may impact physician satisfaction ratings, but this has not been widely studied.

OBJECTIVE

To assess differences in patient satisfaction by physician race/ethnicity.

DESIGN

A cross-sectional observational study.

PARTICIPANTS

Patients seeking care on a large nationwide direct to consumer telemedicine platform between July 2016 and July 2018 and their physicians.

MAIN MEASURES

Patient satisfaction was ascertained immediately following the encounter on scales of 1 to 5 stars and scored two ways: (1) top-box satisfaction (5 stars versus fewer) and (2) dissatisfaction (2 or fewer stars versus 3 or more). To approximate the information patients would use to make assumptions about physician race/ethnicity, four reviewers classified physicians into categories based on physician name and photo. These included White American, Black American, South Asian, Middle Eastern, Hispanic, and East Asian. Mixed effects logistic regression was used to assess differences in patient top-box satisfaction and patient dissatisfaction by physician race/ethnicity, controlling for patient characteristics, prescription receipt, physician specialty, and whether the physician trained in the USA versus internationally.

KEY RESULTS

The sample included 119,016 encounters with 390 physicians. Sixty percent were White American, 14% South Asian, 7% Black American, 7% Hispanic, 6% Middle Eastern, and 6% East Asian. Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54-0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53-0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction. Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12-2.64), South Asian physicians (aOR 1.77; 95% CI 1.23-2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38-3.20) were more likely to result in patient dissatisfaction.

CONCLUSIONS

In our study, patients reported lower satisfaction with some groups of non-White American physicians, which may have implications for their compensation, professional reputation, and job satisfaction.

[Patient orientation of websites of otorhinolaryngologists in private practice in Bavaria]

OBJECTIVE

The internet plays an important role in the search for health-specific information. So far, only a few studies exist on the user-friendliness of medical websites. This study thus examines the web presence of otorhinolaryngologists in private practice in Bavaria.

METHODS

All otorhinolaryngologists registered with statutory health insurance in Bavaria were evaluated using a standardized checklist. IBM SPSS version 25 (IBM Corp., Armonk, NY, USA) statistical software was used for the analysis.

RESULTS

Among all otorhinolaryngologists (n = 448), 73.0% (n = 327) had their own functioning website. Only a minority of websites (1.5%) had options to adjust the font size. Regarding functional possibilities of the websites, 18.3% of the physicians offered an online appointment calendar and 3.7% the possibility of feedback. A liability disclaimer was missing on 21.6% of all websites.

CONCLUSION

The results exhibit an inadequate use of criteria catalogues for web presence. A patient-oriented website configuration could help to improve customer acquisition and satisfaction, which is particularly relevant for cities with a high density of physicians.

Using online patient feedback to improve NHS services: the INQUIRE multimethod study

Background

Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care.

Objectives

To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts.

Design

A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations.

Setting

The UK.

Methods

We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site.

Results

Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible).

Limitations

This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites.

Conclusions

Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients.

Future work

Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.

Study registration

The ethnographic case study work was registered as Current Controlled Trials ISRCTN33095169.

Funding

This project was funded by the National institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 38. See the NIHR Journals Library website for further project information.

The Impact of Monetary Incentives on Physician Prosocial Behavior in Online Medical Consulting Platforms: Evidence From China

Background

In online medical consulting platforms, physicians can get both economic and social returns by offering online medical services, such as answering questions or sharing health care knowledge with patients. Physicians’ online prosocial behavior could bring many benefits to the health care industry. Monetary incentives could encourage physicians to engage more in online medical communities. However, little research has studied the impact of monetary incentives on physician prosocial behavior and the heterogeneity of this effect.

Objective

This study aims to explore the effects of monetary incentives on physician prosocial behavior and investigate the moderation effects of self-recognition and recognition from others of physician competence.

Methods

This study was a fixed-effect specification-regression model based on a difference-in-differences design with robust standard errors clustered at the physician level using monthly panel data. It included 26,543 physicians in 3851 hospitals over 133 months (November 2006-December 2017) from a leading online health care platform in China. We used the pricing strategy of physicians and satisfaction levels to measure their own and patients’ degree of recognition, respectively. Physicians’ prosocial behavior was measured by free services offered.

Results

The introduction of monetary incentives had a positive effect on physician prosocial behavior (β=1.057, P<.01). Higher self-recognition and others’ recognition level of physician competence increased this promotion effect (γ=0.275, P<.01 and γ=0.325, P<.01).

Conclusions

This study explored the positive effect of the introduction of monetary incentives on physician prosocial behavior. We found this effect was enhanced for physicians with a high level of self-recognition and others’ recognition of their competence. We provide evidence of the effect of monetary incentives on physicians’ prosocial behaviors in the telemedicine markets and insight for relevant stakeholders into how to design an effective incentive mechanism to improve physicians’ prosocial engagements.

What Do Patients Say About Doctors Online? A Systematic Review of Studies on Patient Online Reviews

Background

The number of patient online reviews (PORs) has grown significantly, and PORs have played an increasingly important role in patients’ choice of health care providers.

Objective

The objective of our study was to systematically review studies on PORs, summarize the major findings and study characteristics, identify literature gaps, and make recommendations for future research.

Methods

A major database search was completed in January 2019. Studies were included if they (1) focused on PORs of physicians and hospitals, (2) reported qualitative or quantitative results from analysis of PORs, and (3) peer-reviewed empirical studies. Study characteristics and major findings were synthesized using predesigned tables.

Results

A total of 63 studies (69 articles) that met the above criteria were included in the review. Most studies (n=48) were conducted in the United States, including Puerto Rico, and the remaining were from Europe, Australia, and China. Earlier studies (published before 2010) used content analysis with small sample sizes; more recent studies retrieved and analyzed larger datasets using machine learning technologies. The number of PORs ranged from fewer than 200 to over 700,000. About 90% of the studies were focused on clinicians, typically specialists such as surgeons; 27% covered health care organizations, typically hospitals; and some studied both. A majority of PORs were positive and patients’ comments on their providers were favorable. Although most studies were descriptive, some compared PORs with traditional surveys of patient experience and found a high degree of correlation and some compared PORs with clinical outcomes but found a low level of correlation.

Conclusions

PORs contain valuable information that can generate insights into quality of care and patient-provider relationship, but it has not been systematically used for studies of health care quality. With the advancement of machine learning and data analysis tools, we anticipate more research on PORs based on testable hypotheses and rigorous analytic methods.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42018085057; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=85057 (Archived by WebCite at http://www.webcitation.org/76ddvTZ1C)

Reporting of Patient Experience Data on Health Systems' Websites and Commercial Physician-Rating Websites: Mixed-Methods Analysis

BACKGROUND

Some hospitals' and health systems' websites report physician-level ratings and comments drawn from the Consumer Assessment of Healthcare Providers and Systems surveys.

OBJECTIVE

The aim was to examine the prevalence and content of health system websites reporting these data and compare narratives from these sites to narratives from commercial physician-rating sites.

METHODS

We identified health system websites active between June 1 and 30, 2016, that posted clinician reviews. For 140 randomly selected clinicians, we extracted the number of star ratings and narrative comments. We conducted a qualitative analysis of a random sample of these physicians' narrative reviews and compared these to a random sample of reviews from commercial physician-rating websites. We described composite quantitative scores for sampled physicians and compared the frequency of themes between reviews drawn from health systems' and commercial physician-rating websites.

RESULTS

We identified 42 health systems that published composite star ratings (42/42, 100%) or narratives (33/42, 79%). Most (27/42, 64%) stated that they excluded narratives deemed offensive. Of 140 clinicians, the majority had composite scores listed (star ratings: 122/140, 87.1%; narrative reviews: 114/140, 81.4%), with medians of 110 star ratings (IQR 42-175) and 25.5 (IQR 13-48) narratives. The rating median was 4.8 (IQR 4.7-4.9) out of five stars, and no clinician had a score less than 4.2. Compared to commercial physician-rating websites, we found significantly fewer negative comments on health system websites (35.5%, 76/214 vs 12.8%, 72/561, respectively; P<.001).

CONCLUSIONS

The lack of variation in star ratings on health system sites may make it difficult to differentiate between clinicians. Most health systems report that they remove offensive comments, and we notably found fewer negative comments on health system websites compared to commercial physician-rating sites.

Investigating the Effect of Paid and Free Feedback About Physicians' Telemedicine Services on Patients' and Physicians' Behaviors: Panel Data Analysis

Background

In recent years, paid online patient-physician interaction has been incorporated into the telemedicine markets. With the development of telemedicine and telemedicine services, online feedback has been widely applied, helping other patients to identify quality services. Recently, in China, a new type of service feedback has been applied to the telemedicine markets, namely, paid feedback. Patients who are satisfied with a physician’s online service can buy a virtual gift or give a tip to the physicians. This paid feedback can improve the reliability of service feedback and reduce the proportion of false information because it increases the cost for feedback providers. Paid online feedback can benefit the physicians, such as by providing them with monetary incentives; however, research on the impacts and value of such paid feedback from the physician perspective in the telemedicine markets is scant. To fill this research gap, this study was designed to understand the role of paid feedback by developing a research model based on the theories of signaling and self-determination.

Objective

This study aimed to explore the effects of free and paid feedback on patients’ choice and physicians’ behaviors as well as to investigate the substitute relationship between these 2 types of feedback in the telemedicine markets.

Methods

A JAVA software program was used to collect online patient-doctor interaction data over a 6-month period from a popular telemedicine market in China (Good Physician Online). This study drew on a 2-equation panel model to test the hypotheses. Both fixed and random effect models were used to estimate the combined effects of paid feedback and free feedback on patients’ choice and physicians’ contribution. Finally, the Hausman test was adopted to investigate which model is better to explain our empirical results.

Results

The results of this study show that paid feedback has a stronger effect on patients’ choice (a₅=0.566; t₂₁₉₂=9.160; P<.001) and physicians’ contribution (β₄=1.332; t₂₁₉₃=11.067; P<.001) in telemedicine markets than free feedback. Moreover, our research also proves that paid feedback and free feedback have a substitute relationship in determining patients’ and physicians’ behaviors (a₆=−0.304; t₂₁₉₁=−5.805; P<.001 and β₅=−0.823; t₂₁₉₂=−8.136; P<.001).

Conclusions

Our findings contribute to the extant literature on service feedback in the telemedicine markets and provide insight for relevant stakeholders into how to design an effective feedback mechanism to improve patients’ service experience and physicians’ engagement.