Can online physician reviews really measure quality of care?

Online reviews can be used to identify high-volume versus low-volume surgeons, but determining true quality of care is difficult due to inconsistencies among review site metrics and “soft measures” often communicated by patients who use such sites, according to recently published research.

Jeffrey Segal, MD, JD, wanted to determine whether doctors with positive online reputations actually deliver higher quality of care typically associated with better clinical outcomes and better safety records.

The study, published in the Journal of Medical Internet Research, focused on online reviews from nine Web sites for high- and low-volume surgeons who performed lumbar surgery, total knee replacement, and bariatric surgery. The scope of the study did not address whether patient volume and online reviews are similarly correlated for primary care physicians in the office setting.

Segal concludes that physician review sites online may not be the best indicators of true quality of care because typically they measure whether patients “like” their doctor and other subjective responses. Online review sites would benefit from using more objective communication measures, such as asking about a doctor’s ability to communicate risks of a procedure or treatment options, rather than simply asking whether the physician listened to the patient or whether the patient enjoyed his or her experience with the doctor, he says.

But the medical literature also supports the idea that for some surgical procedures, volume correlates with clinical outcomes, and volume is one area that online review sites could identify accurately at least 61% of the time, based on analytics such as the total number of ratings per Web site. Evidence exists that online review sites can identify high-volume surgeons-which correlates with higher quality of care-but the effect on patients is minimal, Segal writes.

“From a patient’s perspective, a far better way to determine whether a surgeon performs a high volume of procedures is to ask the doctor,” Segal writes. “Or the doctor could preemptively provide such information on the various review Web sites.”

Surprisingly, Segal adds, although the total number of reviews correlates with procedure volume, the actual ratings values do not. And it’s unclear why the total number of reviews and comments are associated with surgeon volume, the study notes. It could be that high-volume surgeons are more comfortable with their skills and are therefore more likely to ask patients for feedback, but that point requires further study, Segal says.

Segal recommends additional study to determine what other data from online review sites might be useful in differentiating doctors who provide better clinical outcomes.

The full study can be found at www.jmir.org/2012/2/e50/.

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