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From the closest observers of patient care: a thematic analysis of online narrative reviews of hospitals
  1. Naomi S Bardach1,2,
  2. Audrey Lyndon3,
  3. Renée Asteria-Peñaloza2,
  4. L Elizabeth Goldman4,
  5. Grace A Lin2,4,
  6. R Adams Dudley2,4
  1. 1Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
  2. 2Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, USA
  3. 3Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA
  4. 4Department of Medicine, University of California San Francisco, San Francisco, USA
  1. Correspondence to Dr Naomi Bardach, Department of Pediatrics, University of California San Francisco, 3333 California St. Suite 265, San Francisco, CA 94118, USA; naomi.bardach{at}


Objective Patient-centred care has become a priority in many countries. It is unknown whether current tools capture aspects of care patients and their surrogates consider important. We investigated whether online narrative reviews from patients and surrogates reflect domains in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and we described additional potential domains.

Design We used thematic analysis to assess online narrative reviews for reference to HCAHPS domains and salient non-HCAHPS domains and compared results by reviewer type (patient vs surrogate).

Setting We identified hospitals for review from the American Hospital Association database using a stratified random sampling approach. This approach ensured inclusion of reviews of a diverse set of hospitals. We searched online in February 2013 for narrative reviews from any source for each hospital.

Participants We included up to two narrative reviews for each hospital. Exclusions: Outpatient or emergency department reviews, reviews from self-identified hospital employees, or reviews of <10 words.

Results 50.0% (n=122) of reviews (N=244) were from patients and 38.1% (n=93) from friends or family members. Only 57.0% (n=139) of reviews mentioned any HCAHPS domain. Additional salient domains were: Financing, including unexpected out-of-pocket costs and difficult interactions with billing departments; system-centred care; and perceptions of safety. These domains were mentioned in 51.2% (n=125) of reviews. Friends and family members commented on perceptions of safety more frequently than patients.

Conclusions A substantial proportion of consumer reviews do not mention HCAHPS domains. Surrogates appear to observe care differently than patients, particularly around safety.

  • Patient-centred care
  • Qualitative research
  • Hospital medicine
  • Quality improvement
  • Patient safety

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  • Twitter Follow Naomi Bardach at @naomibardach

  • Contributors NSB conceived of and designed the work, supervised collecting the data, analysed the data, drafted and revised the manuscript. She is the guarantor. AL contributed to design, analysis, and gave critical revisions. RAP collected and analysed the data, and contributed to drafting and critically revising the manuscript. LEG contributed to analysis and gave critical revision. GAL contributed to analysis and gave critical revision. RAD contributed to conception and design, analysis, and critically revised the manuscript. All authors give final approval of the manuscript to be published and agree to be accountable for all aspects of the work. All authors had full access to the data and take responsibility for data integrity and accuracy of the analysis.

  • Funding California HealthCare Foundation, California HealthCare Foundation (KL2 RR024130), National Institute of Child Health and Human Development (K23HD065836).

  • Competing interests None declared.

  • Ethics approval The University of California San Francisco Institutional Review Board deemed this study exempt from review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing: A full data set and code book are available from the corresponding author.