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Abstract
Background Hospital care costs are high while quality varies across hospitals. Patient satisfaction may be associated with better clinical quality, and social media ratings may offer another opportunity to measure patient satisfaction with care.
Objectives To test if Facebook user ratings of hospitals are associated with existing measures of patient satisfaction, cost and quality.
Research design Data were obtained from Centers for Medicare and Medicaid Services Hospital Compare, the Hospital Inpatient Prospective Payment System impact files and the Area Health Resource File for 2015. Information from hospitals’ Facebook pages was collected in July 2016. Multivariate linear regression was used to test if there is an association between Facebook user ratings (star rating and adjusted number of ‘likes’) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures, the 30-day all-cause readmission rate, and the Medicare spending per beneficiary (MSPB) ratio.
Subjects One hundred and thirty-six acute care hospitals in New York State in 2015.
Results An increase in the Facebook star rating is associated with significant increases in 21/23 HCAHPS measures (p≤0.003). An increase in the adjusted number of ‘likes’ is associated with very small increases in 3/23 HCAHPS measures (p<0.05). Facebook user ratings are not associated with the 30-day all-cause readmission rate or the Medicare spending per beneficiary ratio.
Conclusions Results demonstrate an association between HCAHPS patient satisfaction measures and Facebook star ratings. Adjusted number of ‘likes’ may not be a useful measure of patient satisfaction.
- social media
- hospital quality
- patient satisfaction
- cost of care
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Introduction
In recent years, studies have demonstrated large variability in quality of care across hospitals, which suggests important opportunities for quality improvement.1–3 In response, programmes such as public reporting and pay-for-performance demonstrations have been implemented to motivate improvements in hospital quality. At the same time, the costs of hospital care comprise the largest share of healthcare spending in the USA. These costs have continued to rise,4 5 leading to payment reform strategies, including bundled payments and value-based purchasing, which may help to improve quality while reducing costs.6 7
However, these initiatives may not sufficiently address patient satisfaction with care, as clinical outcomes may be less useful to consumers and may not provide a comprehensive view of the patient experience.8 Measures related to patient satisfaction may be more meaningful to patients, and existing research shows that patient satisfaction measures are associated with hospital quality.9 For example, a study by Isaac and colleagues found that higher performance on measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey was associated with higher quality for medical and surgical processes of care and fewer rates of complication for some medical and surgical procedures.10 Therefore, publicly reported measures of patient satisfaction may help potential patients to identify hospitals that also perform better on clinical measures of quality.
In addition to existing patient satisfaction measures, social media ratings may provide another means for consumers to obtain information on hospital quality. Social media adoption has grown substantially in recent years and, in the USA alone, there are 156.5 million unique Facebook users.11 At the same time, internet and social media use for health and healthcare information have become more ubiquitous: for example, a majority of Americans have used the internet12 13 or a smartphone14 to obtain information on health or medical care. Expansion of internet and social media use has provided a unique forum for healthcare consumers and their families to share their perspectives on healthcare that is simple to access and, in the face of conflicting quality information from different sources,15 may be used to assist consumers in deciding where to seek care.16 17
Although several studies have examined user-generated social media ratings and their relationship to clinical outcomes and/or patient satisfaction,18–20 none have examined the relationship between Facebook user ratings of hospitals and patient satisfaction or costs of hospital care. Therefore, this study attempts to fill this knowledge gap by testing if Facebook user ratings are associated with different publicly reported measures of hospital quality and costs: (1) HCAHPS patient satisfaction scores; (2) the 30-day all-cause readmission rate; and (3) the Medicare spending per beneficiary (MSPB) ratio.
Methods
Data
Data were obtained from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare files for December 2015. Hospital Compare is a website for public reporting maintained by CMS (http://www.medicare.gov/hospitalcompare/search.html) with the goal of promoting enhanced decision-making among healthcare consumers. Hospital-level results of the HCAHPS Survey are publicly available on Hospital Compare and are updated quarterly.21 The HCAHPS Survey, developed by CMS and the Agency for Healthcare Research and Quality, assesses patient views on hospital care and surveys a random sample of adult hospital patients after discharge. The survey is administered between 48 hours and 6 weeks following discharge, and results are adjusted for case mix.21 The HCAHPS Survey contains 21 measures in nine domains, which are communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment and transition of care, and two overall ratings.22
We also used Hospital Compare to obtain the 30-day all-cause readmission rate, an indicator of hospital quality of care,23 and the MSPB ratio, which compares the average cost per Medicare beneficiary for a specific hospital to the average cost per Medicare beneficiary nationally;24 these measures have been reported on Hospital Compare since 2015.23 25 Hospital-level characteristics on hospital location, organisational structure and financial performance were obtained from the CMS Hospital Inpatient Prospective Payment System (IPPS) impact files for 2015, and market covariates were obtained from the 2015 Area Health Resource File (AHRF).
The study sample included all acute care hospitals in New York State that were available in both hospital-level data sets from CMS and could be matched to the AHRF by their county code. Some specialty hospitals and cancer treatment centres were excluded from analyses, as were those that did not have enough cases to calculate the quality measures. Using this list of hospitals, we used Google Search to search for individual hospital web pages, and then searched within each individual page for a link to the hospital’s Facebook page. For hospital websites that did not include a link to their Facebook page, we searched Facebook for the hospital’s official page, and confirmed this information using the hospital’s address as listed in Hospital Compare. Hospitals with either an individual, official Facebook page or that were members of a hospital system with an official Facebook page were treated in analyses as hospitals with a Facebook presence. The analytical sample contained 136 hospitals; of these hospitals, 133 hospitals had a Facebook presence (95 hospitals had an individual Facebook page, 38 hospitals had a Facebook presence through a page for a hospital system) and 3 hospitals had no Facebook presence.
Dependent variables
In separate hospital-level analyses, dependent variables were each of the 21 HCAHPS measures, the 30-day all-cause readmission rate and the MSPB ratio. HCAHPS measures fall into two categories: star ratings on a scale from 1 to 5, where more stars indicates higher quality, and per cent of top-box respondents (those who definitely, always or strongly agree with a measure), where higher per cent indicates higher quality. HCAHPS measures include ratings of patient satisfaction, such as overall hospital rating, communication with doctors and nurses, and the cleanliness of the hospital environment.22 For a complete list of HCAHPS measures included in analyses, please see table 2.
Characteristics of hospitals in New York State, 2015 (n=132–136)
The 30-day all-cause readmission rate is a hospital-wide readmission measure based on Medicare claims data. The 30-day all-cause readmission rate is risk-adjusted for the hospital’s case mix and service mix, and includes only unplanned readmissions.23 In the Hospital Compare data, the 30-day all-cause readmission rate is given as the per cent of patients at the hospital who are readmitted for any cause within 30 days following discharge (lower rates are better).
The MSPB ratio is a measure of how much is spent, on average, on a Medicare beneficiary treated in a specific hospital, compared with the average amount spent on a Medicare beneficiary per episode of care across all hospitals nationally. Payments are price-standardised and risk-adjusted. A lower ratio indicates that Medicare spending per patient at this hospital is less than the national average.25
Independent variables
The predictors used in analyses were Facebook star ratings and adjusted number of Facebook ‘likes’. On each hospital’s Facebook page, the hospital can allow users to leave a rating on a scale of 1–5 stars, with more stars indicating higher quality. Out of 141 hospitals with a Facebook presence, 102 had publicly available star ratings. Hospitals may also publicly report the number of Facebook ‘likes’, a way to acknowledge enjoyment of a post without leaving a comment.26 In order to account for more visitor traffic to Facebook pages that have been available for longer, the number of ‘likes’ was adjusted by dividing it by the age of the Facebook page in years.
Analyses controlled for hospital covariates from Hospital Compare and the IPPS impact file, including number of beds, disproportionate share hospital status (labelled as 1 if a disproportionate share hospital and 0 if otherwise), academic medical centre (labelled as 1 if an academic medical centre and 0 if otherwise), ownership (labelled as 0 if non-profit, 1 if government-owned and 2 if for-profit) and urban location (labelled as 1 if the hospital is in an urban setting and 0 if otherwise). Prior literature suggests that these variables are associated with measures of hospital quality, including the HCAHPS ratings,27 and with consumer reports of hospital quality.20 Analyses also controlled for the age of the Facebook page (labelled as 1 if created on or after 1 July 2010 and 0 if otherwise). In addition, we included market characteristics in analyses, including median household income in 2013, the per cent of persons in the county ≥25 years of age with four or more years of college, and market competition, measured as 1−Hirschman-Herfindahl Index (HHI). HHI is the sum of squared shares of beds of all hospitals in the county, ranging from 0, reflecting a monopoly, to 1, indicating perfect competition.
Analysis
Descriptive characteristics of Facebook characteristics were conducted for hospitals with a Facebook presence (table 1); descriptive statistics of hospital characteristics were conducted in the entire sample (table 2) and for hospitals by type of Facebook presence (individual page, system presence, no page/presence; table 3). Pairwise correlation was used to determine the correlation between measures of satisfaction from Facebook and from HCAHPS, with p≤0.05 accepted as statistically significant. Generally, we viewed correlations less than 0.2 as weak, between 0.2 and 0.5 as moderate, and greater than 0.5 as strong. Separate multivariate linear regression analyses were used to determine the association between Facebook measures of satisfaction (star rating and adjusted number of ‘likes’) and HCAHPS measures of patient satisfaction with hospitals, between Facebook measures and 30-day all-cause readmission rate, and between Facebook measures and MSPB ratio. Discussion of findings is based on results that were significant at p≤0.05. Sensitivity analyses were conducted categorising hospitals into those with an individual Facebook page and those without an individual Facebook page, the latter including hospitals represented by a hospital system page. For results of sensitivity analyses, please see online supplementary appendix.
Facebook characteristics of hospitals in New York State with Facebook presence, 2015 (n=102–141)
Characteristics of hospitals in New York State by Facebook page, 2015
Results
Descriptive statistics of Facebook characteristics for hospitals with a Facebook presence are provided in table 1, and descriptive statistics of hospitals in the full sample are provided in table 2. For descriptive statistics and analytical results conducted in the sample of hospitals with individual Facebook pages only, please see online supplementary appendix. Almost 97% of hospitals have a Facebook presence, and the average Facebook star rating is 3.95. The adjusted number of ‘likes’ is approximately 2500, and the average age of the Facebook page is 5 years. The average 30-day all-cause readmission rate is 16%, and the average MSPB ratio is 0.98. With respect to the HCAHPS star ratings on a 1-–5 scale, average ratings range from a low of 1.72 stars for the quietness of the hospital environment, to a high of 2.76 for pain management. Regarding the HCAHPS measures for per cent of top-box respondents, ratings range from 47%, for patients who strongly agree they understood care, to 84%, for staff gave patients discharge information.
Descriptive statistics of hospitals by whether they had an individual page, a system page or no page are shown in table 3. In general, hospitals with individual Facebook pages have higher average performance on HCAHPS star ratings than hospitals with a system page or no page, and hospitals with any Facebook presence usually perform better on HCAHPS star ratings than hospitals with no Facebook presence. Analysis of variance (ANOVA) was used to compare the differences between hospitals with and without a Facebook page and with and without a Facebook presence using the Bonferroni, Scheffe and Sidak methods, and results were insignificant. Performance on per cent of top-box respondents measures are similar between hospitals with individual and system pages, and both groups of hospitals perform better on these measures than hospitals with no Facebook page. However, hospitals with an individual or system page also have slightly higher 30-day all-cause readmission rates and MSPB ratios than hospitals with no Facebook page.
Correlations between Facebook satisfaction ratings and HCAHPS measures are presented in table 4. All HCAHPS measures are positively correlated with Facebook star ratings, and correlations are generally moderate. Most (19 out of 23) correlations are significant (p≤0.05); among significant correlations, the Pearson correlation coefficients range from 0.27, for the responsiveness of hospital staff star rating, to 0.61, for the recommend the hospital star rating. Adjusted number of ‘likes’ is positively correlated with most of the HCAHPS measures, and most correlations are weak. Only 2 out of 23 correlations are statistically significant (p≤0.05); these Pearson correlation coefficients range from 0.20, for the per cent of respondents who would definitely recommend the hospital, to 0.23, for the recommend the hospital star rating.
Correlations between Facebook user ratings and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of patient satisfaction, 2015–2016
Results of the multivariate regression models are provided in table 5. For models examining the association between Facebook star rating and HCAHPS measures, R2 values range from 0.16, for the per cent of top-box respondents reporting that their room was always quiet, to 0.50, for the star rating for recommendation. An increase in the Facebook star rating is associated with a significant increase in 21 out of 23 HCAHPS measures, controlling for hospital and market characteristics, and the age of the Facebook page. For example, an increase in Facebook star rating is associated with a 1.33 point increase in overall hospital rating, a 1.53 point increase in recommendation and a 1.25 point increase in communication with nurses (p<0.001). Higher Facebook star rating is also associated with a 14.75% increase in the per cent of respondents who would definitely recommend the hospital, an 11.34% increase in the per cent of respondents who would give the hospital a rating of 9 or 10, and a 7.73% increase in the per cent of respondents who strongly agree that they understood their care (p<0.001). The associations between Facebook star rating and 30-day all-cause readmission rate and between Facebook star rating and MSPB ratio are not statistically significant (p>0.05).
Association between Facebook user ratings and Hospital Consumer Assessment of Healthcare Providers and Systems(HCAHPS) patient satisfaction scores in New York State hospitals, 2015–2016
For models examining the association between Facebook adjusted number of ‘likes’ and HCAHPS measures, R2 values range from 0.16, for the per cent of top-box respondents reporting that their room was always quiet, to 0.40, for the star rating for communication about medicines. An increase in the adjusted number of ‘likes’ is associated with slight increases in 3 out of 23 HCAHPS measures. For example, an increase in the adjusted number of ‘likes’ by 100 is associated with a 0.003 point increase in the HCAHPS star rating for pain management, a 0.004 point increase in the star rating for cleanliness of hospital environment and a 0.02 point increase in the per cent of top-box respondents reporting that the area around their room was always clean (p<0.05). Adjusted number of ‘likes’ is not significantly associated with the 30-day all-cause readmission rate or the MSPB ratio (p>0.05).
Correlations between Facebook satisfaction ratings for hospitals with an individual Facebook page and HCAHPS measures are presented in the online supplementary appendix. Similar to the results in table 4, most (21 out of 23) HCAHPS measures are positively and significantly (p≤0.05) correlated with Facebook star ratings; adjusted number of ‘likes’ is positively correlated with all HCAHPS measures, and 2 out of 23 correlations are statistically significant (p≤0.05). Associations between Facebook user ratings for hospitals with an individual page and HCAHPS measures are also provided in the online supplementary appendix. Consistent with the results in table 5, an increase in the Facebook star rating is associated with significant increases in 21 out of 23 HCAHPS measures (p≤0.015), and is also associated with a 1.19% decrease in the 30-day all-cause readmission rate (p=0.003). An increase in the adjusted number of ‘likes’ is associated with small increases in 5 out of 23 HCAHPS measures (p<0.04), and is not significantly associated with the 30-day all-cause readmission rate or the MSPB ratio.
Discussion
Consistent with previous studies,20 28 we found in unadjusted analyses that Facebook star ratings for hospitals in New York State were positively correlated with HCAHPS measures. In adjusted analyses, Facebook star ratings were associated with statistically significant increases in the majority of HCAHPS measures of patient satisfaction with hospital care. Adjusted number of ‘likes’ does not appear to be a useful measure of patient satisfaction; this measure may be related to community support (ie, non-patients ‘liking’ a post about community outreach or a charitable event), as opposed to consumer ratings.
We also found that hospitals without any Facebook presence performed worse on HCAHPS measures than hospitals with a Facebook presence, although this difference in performance may not be tangible, as there were only three hospitals in the sample without any Facebook presence. However, in sensitivity analyses, we also found that hospitals without a Facebook page generally had lower scores on the HCAHPS measures than hospitals with a Facebook page, lending credence to our main results; future research at the multistate or national levels may be warranted. Given a larger sample, it is possible that hospitals with a Facebook presence or page may perform better on HCAHPS measures because they may take advantage of this additional opportunity for feedback from consumers. Social media offers hospitals a new way to engage with patients and connect with the community they serve in a potentially powerful and cost-effective way.29 30 Social media may offer hospitals the opportunity to reach more consumers than through traditional commercial or federal reporting websites.18 Hospitals may also use social media to promote public health and increase patient knowledge of health and healthcare: for example, some hospitals maintain specific disease management or patient education programmes, offer information on primary care or provide public service announcements through their Facebook pages.29 31 32 In addition, hospitals may also use their Facebook pages for non-healthcare related advertising of charitable and community events, or to solicit donations.30 It is likely that the hospital’s motivation to maintain a Facebook page is related to how the hospital uses the information it receives from users.
Social media ratings offer a new opportunity for consumers to provide additional feedback to hospitals and voice their opinions, and evidence suggests that these ratings may have some influence over consumer choice.33 For patients seeking care for elective or non-emergent conditions, Facebook provides readily available information that can be accessed on multiple devices (eg, computer, smartphone). In some respects, social media ratings may be more useful to consumers than existing quality reporting tools because the information they provide is non-technical and easy to understand, limiting usual barriers to access to ratings, such as awareness of ratings and time to access and use them.34
However, social media ratings are largely untested and unregulated, whereas traditional ratings have been validated and tested, as well as risk-adjusted, when appropriate. Social media users can post content about a hospital or provide a review without having been a patient at that hospital. At best, this could mean that social media users are posting reviews/comments based on their perception of care that a friend or family member received while in the hospital, which is likely correlated with patient satisfaction with care.35 36 What is more concerning is that social media users could rate a hospital without having any knowledge of the care that hospital provides, and that consumers could base their decisions in part on false information.27 37 38 Hospitals could help to prevent this by publishing additional quality metrics on their Facebook pages: for example, hospitals could post their performance on clinical or patient satisfaction measures available from Hospital Compare, which may aid consumer decision-making and promote the use of validated quality measures.
Overall, we found that Facebook star ratings and adjusted number of ‘likes’ were positively correlated with most of the HCAHPS measures; however, most of the correlations between Facebook star ratings and the HCAHPS measures were statistically significant (p≤0.05), while the correlations between adjusted number of ‘likes’ and the HCAHPS measures were insignificant, suggesting that this measure may not reflect hospital quality, which will be discussed in more detail below.
Although most of the correlations between Facebook star rating and the HCAHPS measures are significant, there is a wide range in the correlation across HCAHPS measures. For example, the correlation between Facebook star rating and HCAHPS star rating for the quietness of the hospital environment is very weak, at 0.08 (p>0.05), while the correlation between Facebook star rating and the HCAHPS star rating for overall hospital rating is strong, at 0.54 (p≤0.001). One reason for this may be that Facebook only allows reviewers to provide an overall rating, which may reflect many aspects or a single aspect of their experiences with care. Thus, Facebook star ratings may capture some of the HCAHPS items, but may also capture other items not represented on the HCAHPS Survey. For example, in a study of Yelp reviews, Ranard and colleagues found additional domains beyond those included on the HCAHPS Survey, such as cost of hospital visit, insurance and billing, scheduling, and compassion of staff.20 Thus, Facebook star ratings may capture some of this additional information.
Moreover, the differences in these relationships may have face validity: when a hospital performs well on the HCAHPS star rating for overall hospital rating, it may make sense that this hospital also performs well on the Facebook star rating (ie, on average, the hospital receives positive feedback from consumers). In contrast, when a hospital receives a high score on the HCAHPS star rating for quietness of hospital environment, this may or may not be reflected in the Facebook star rating; some Facebook reviewers may think this was an important element of a hospital stay, and may base a substantial portion of their rating on factors related to this item. Other reviewers may value different items, as seen in the range of HCAHPS scores. More research is needed to determine if the narrative reviews provided in Facebook comments reflect the HCAHPS items.
With respect to this study, Facebook star ratings were associated with significant increases in most of the HCAHPS patient satisfaction measures, demonstrating the face validity of the Facebook star ratings. Although these ratings are largely unregulated, and there is the potential for selection bias, given this association, it appears that the consumer feedback provided in Facebook star ratings in the study sample is sound. Whereas the HCAHPS ratings measure patient satisfaction in multiple domains, Facebook star ratings may provide a snapshot of consumer satisfaction with hospital care, which may be useful to consumers seeking information on hospital quality: the Facebook star ratings are straightforward and easily accessible, reducing barriers to access to information on hospital quality. Thus, Facebook star ratings may enhance consumers’ healthcare decision-making. In addition, the HCAHPS measures are expensive to collect, and Facebook star ratings may be able to supplement or reinforce existing satisfaction measures at a lower cost. Furthermore, by giving feedback, consumers can provide potentially valuable or actionable information on their personal experiences.
Although evidence suggests that consumers are influenced by ratings provided by other users,33 little is known about how providers may use consumer feedback, including both numerical ratings and anecdotal comments.37 For example, in a study of England’s National Health Service Choices website, which allows users to provide a narrative on experience with care, Greaves and colleagues note that most feedback on hospitals focused on ‘medication error, discharge irregularities, and quality of care’.17 This information suggests specific areas on which providers could focus, and providers could possibly use this feedback to improve patient experience and quality of care.17 Numerical ratings and narrative reviews may both present an opportunity to providers to improve patient care, and supplement existing satisfaction measures.20 If hospitals are monitoring consumer reviews on their Facebook pages, they may be able to respond to some consumer-reported issues, either directly via their Facebook pages or through internal policy changes; at this point, the extent to which hospitals are able to incorporate user ratings is unclear, and more research in this area may be warranted.
However, the adjusted number of ‘likes’ was generally not associated with the HCAHPS satisfaction measures. Hospitals may post information on their Facebook pages that is unrelated to hospital care: hospitals may provide public health information, but may also provide information on fundraising events or charitable programmes. Facebook users may subsequently ‘like’ a post on a hospital’s page that is unrelated to care provided at that hospital. In addition, Facebook users may ‘like’ a post without having received care at that hospital. Thus, the number of ‘likes’ may not be related to consumer satisfaction with hospital care and could, potentially, be misleading to consumers. Furthermore, the number of ‘likes’ provided on a Facebook page has not been adjusted for factors that may influence this number. For example, pages that have been active for more years (ie, the age of the Facebook page) or that have extensive social media outreach may have more ‘likes.’ Additionally, larger hospitals may potentially have a higher number of ‘likes’ because they receive a higher volume of visitor traffic. Therefore, the unadjusted number of ‘likes’ that is posted on the Facebook page may not be useful to consumers’ healthcare decision-making, and consumers may not be able to use this information to directly compare hospitals. In our study, we found that 141 hospitals provided the number of ‘likes’ on their Facebook page, whereas only 102 hospitals had publicly available star ratings. Hospitals may want to make their Facebook star ratings publicly available to provide what may be a more useful measure of patient satisfaction.
Furthermore, we found that the Facebook star rating and the adjusted number of ‘likes’ were not correlated with the 30-day all-cause readmission rate or the MSPB ratio. Although Facebook star ratings may reasonably provide an overview of consumer satisfaction with hospital care, neither of these social media ratings appear to be associated with cost or clinical quality. Therefore, these ratings could be used to supplement existing publicly reported measures, such as the clinical quality or cost measures published on CMS’ Hospital Compare, but should not replace these measures.
In addition, social media ratings may have the potential to reach a larger proportion of the population, but they may also leave out key groups of people. Research demonstrates that social media users tend to be younger;28 with respect to social media and healthcare, studies find that users tend to be younger and female.38 Although evidence suggests that there are no differences in social media use by education or by race/ethnicity,39 more research is needed to determine whether hospital ratings on social media reach the appropriate patient populations.
Limitations
Omitted variable bias may be a problem in analyses, as other hospital characteristics may influence patient satisfaction, such as nurse staffing or hospital-level quality improvement programmes. Although these variables were not available in the data, we did control for covariates related to hospital quality. Also, because our study only considers numerical ratings, we do not know the factors on which consumers are basing their ratings. Additional research examining the contents of Facebook users’ narrative reviews may be beneficial to further supplement existing, validated ratings or to help providers address issues with patient care. In addition, our study sample is small and only includes hospitals in New York State; future studies are needed to determine whether there is an association between HCAHPS patient satisfaction scores and Facebook user ratings for hospitals in other States or nationally.
Conclusions
Study results suggest that there is an association between HCAHPS patient satisfaction measures and Facebook star ratings. These results suggest that Facebook star ratings may successfully capture the interpersonal aspects of hospital care, and provide consumers with an overall measure of patient satisfaction at a lower cost than the HCAHPS. Number of ‘likes’ may better represent community support for a hospital than consumer ratings, and consumers should exercise caution when using this untested measure. In addition, as neither Facebook star ratings nor adjusted number of ‘likes’ are correlated with readmissions or costs (measured by the hospital-wide 30-day all cause readmission rate and the MSPB ratio, respectively), social media ratings may supplement, but should not replace, existing publicly reported quality measures.
References
Footnotes
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.