White Coat Black Art

Yelp rates your hospital like the pros

How useful is a Yelp review of your local hospital? Surprisingly more than you think, says White Coat, Black Art host Dr Brian Goldman.
(Kathy Willens/AP Photo)

When people want a good sushi restaurant, they head to Yelp. Now Yelp's online reviewers are expanding their attention beyond restaurants, to hospitals in the US and Canada.

It turns out Yelp's crowd-sourced reviews and comments are surprisingly informative, and health care providers are paying attention.

In fact, Yelp was born because of a search for a good doctor. Ex-PayPal employees Jeremy Stoppelman and Russel Simmons started up Yelp back in 2004.  Stoppelman was on the road when he caught the flu and had a tough time getting a recommendation for a local physician. That was the inspiration for Yelp, which was originally supposed to be an email based referral network in which you could solicit recommendations. The email referral system wasn't a hit. But the "Real Reviews" feature that allows consumers to post unsolicited reviews did catch on.

As of the end of June, Yelp.com had 108 million reviews.  Yelp.ca  the Canadian version  was launched in 2008. Shopping is the #1 category of reviews with 22% of the posted reviews; health is #7 on the list at 6%.

I looked at Yelp pages devoted to a selection of hospitals across Canada. In general, patients write about the quality of doctors, nurses, x-ray and lab facilities, how long you have to wait, as well as amenities.  

Not surprisingly, a hospital with a busy obstetrics department has a lot of comments about care around the birth. Here's what a patient wrote about a hospital in downtown Toronto: "This hospital also has one of the best neurologists."  This comment was posted about a hospital on the west coast: "At any given moment the ER is full of people and looks like a Red Cross camp. Staff are completely incompetent and have the most demeaning attitudes you can imagine."  Not surprisingly, reviews of U.S. hospitals talk a lot about billing and insurance issues.

Those random, unsolicited comments on Yelp are almost as accurate as patient satisfaction surveys gathered in a U.S. government patient survey called HCAHPs or Hospital Consumer Assessment of Healthcare Providers and Systems Survey.  The more than 3.1 million surveys collected so far are used to create the scores that allow health consumers to compare nearly 4,200 U.S. hospitals on the Hospital Compare web site.

Earlier this year, researchers from the University of Pennsylvania looked at 17,000 Yelp reviews of 1,352 hospitals across the U.S and compared them to HCAHPs. The  researchers used software to extract specific comments contained in the Yelp reviews and put them into 11 categories used by HCAHPs - how well doctors and nurses communicate with patients, cleanliness and pain management - to name three.  Yelp comments covered most of the 11 categories on HCAHPs.  The researchers also found that for hospitals with at least three Yelp reviews, the Yelp rating closely matched the rating from HCAHPs.  Bottom line: Yelp comments are useful. Other studies have come to the same conclusion.

And it gets even better. That study by University of Pennsylvania researchers identified 12 additional quality indicators covered by Yelp but not by the government survey - including the quality and compassion of nurses and other staff, the technical aspects of health care, specific types of medical care such as heart surgery and joint replacements, scheduling, and hospital amenities.  

The availability of this data in real time makes it easier for patients to decide at which hospital to receive treatment - something a growing number of patients in the U.S. are beginning to do.  It's forcing hospitals to address problems quickly; for instance, a review that says a hospital isn't kept clean enough. There is also evidence that American hospitals with higher scores attract more patients, and that more patients in turn leads to higher quality. 

As usual, Canada is somewhat behind the U.S. in harnessing the comments of health consumers, but we're getting there.  The Canadian Institute of Health Information or CIHI developed the Canadian Patient Experiences Survey In patient Care (CPES-IC) and the Canadian Patient Experiences Reporting System (CPERS). The survey has been endorsed by Accreditation Canada, and includes 22 items from the HCAHPS survey plus 19 questions that address key areas relevant to the Canadian health care system like discharge and transitions from say, admission to hospital to home care.

There are plenty of Yelp reviews about Canadian hospitals. I suspect hospitals could put them to very good use making health care better by responding to the needs of patients and their families.


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