Health Policy Journal Club

Health Policy Journal Club: How Did Your Last Patient Rate You on Yelp?

Researchers recently leveraged Yelp ratings to provide a general “gist” of how satisfied patients are with the care they receive in emergency departments (EDs) and urgent care centers (UCCs). There were 3 key takeaways. First, people are using Yelp as a way to comment on their experiences in these settings; there were over 100,000 ratings across both sites between 2005 and 2017. Second, similar to all Yelp business reviews, ratings for both EDs and UCCs follow a bimodal pattern (ie, spikes in both 1-star (worst) and 5-star (best) ratings). UCCs had overall higher ratings than EDs (47% of users gave EDs 1-star ratings vs. 30% for UCCs) and only 27% of users gave 5-star ratings to EDs (vs. 51% to UCCs). Third, the themes that emerged from the comments can inform what aspects of care correlate with high versus low ratings (e.g., good bedside manner was associated with 5-star ratings). 

To make sense of all the comments, they employed natural language processing tools to focus on the comments in the extreme ratings (1-star and 5-star) and then used differential language analysis to match up the topics that were correlated with low- and high- ratings. For the ED, topics of quality of care were more likely correlated with high ratings whereas service was more likely correlated with a low rating. The opposite was true for UCCs. 

The authors rightfully acknowledge that Yelp can be easily dismissed as a data source as it unverifiable, unstructured, and cannot be considered to be truly representative of all patients. However, Yelp offers rich, narrative data and serves as a platform that allows people to share reflections in real time, unlike publicly inaccessible, proprietary data sources such as Press Ganey.

In spite of these limitations, tens of thousands of people feel compelled to share their thoughts through online platforms and, as researchers and clinicians, we should figure out how to best listen and learn from these raw reflections. Further, in an era where patient satisfaction is increasingly considered an important quality, it will become important to more effectively analyze all data points – regardless of the source – to inform how we can better care for patients.

PMID: 30392737 

Agarwal AK, Mahoney K, Lanza AL, et al. Online Ratings of the Patient Experience: Emergency Departments Versus Urgent Care Centers. Ann Emerg Med. 2019;73(6):631-638.


STUDY OBJECTIVE:  Individuals increasingly use online rating platforms to rate and review hospitals. We seek to describe and compare publicly available online review content
and ratings of emergency departments (EDs) and urgent care centers.
METHODS:  We analyzed Yelp reviews of EDs and urgent care centers to identify topics most correlated with 1- and 5-star ratings. Latent Dirichlet Allocation, a method of identifying groups of co-occurring words in narrative text, was used to identify and label 25 topics across 1- and 5-star reviews of urgent care centers and EDs. Differential Language Analysis was then used to measure the correlation of these topics with 1- and 5-star reviews for urgent care centers and EDs.
RESULTS: We analyzed 100,949 Yelp reviews, 16,447 from 1,566 EDs and 84,502 from 5,601 urgent care centers. There were significantly more 5-star urgent care center reviews (n=43,487; 51%) than 5-star ED reviews (n=4,437; 27%). Themes associated with 5-star reviews among EDs and urgent care centers were similar for comfort, professionalism, facilities, pediatric care, and staff interactions. Themes associated with 1-star reviews among EDs and urgent care centers were similar for communication, telephone experience, waiting, billing, pain management, and diagnostic testing. Themes unique to 5-star ED reviews included bedside manner, care for family members, and access. Themes unique to 5-star urgent care center reviews were based on recommendation and prescription refills. Themes unique to 1-star ED reviews were service and speed of care. Themes unique to 1-star urgent care center reviews were lack of confidence and reception experience.
CONCLUSION:  Understanding drivers for high and low online ratings and what patients value in their ED and urgent care center experiences offers insights for health systems and providers to improve acute care delivery. Patients' perspectives may become increasingly important as they seek care in the expanding urgent care markets.


EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems.

As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula.

This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.


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