Patients' online hospital reviews reflect data on hospital outcomes

Since 2008, patients have been able to post comments on and rate hospitals using the NHS Choices website, in the same way as they might rate a hotel on Tripadvisor. The system's proponents suggest that it helps patients to choose the best services, but no previous study has investigated whether these online ratings are related to clinical measures of healthcare quality, such as mortality rates and incidence of hospital-acquired infections.

Researchers at Imperial College London examined 10,274 ratings of all NHS acute hospital trusts in England submitted on NHS Choices in 2009 and 2010. They found that hospitals with better patient ratings tend to have lower death rates and lower readmission rates. Hospitals rated by patients as being cleaner have lower rates of MRSA infections.

"There are a lot of data available to the public on hospital performance, but people rarely use conventional measures and often find them difficult to understand," said Dr Felix Greaves, from the School of Public Health at Imperial College London, who led the study. "Our results suggest that NHS Choices ratings may provide useful and relevant information for patients making choices about their care."

When the 25 per cent of hospitals with the best ratings on NHS Choices are compared with the 25 per cent rated worst, mortality rates were 5 per cent lower and readmission rates were 11 per cent lower in the more highly-rated hospitals. The 25 per cent of hospitals with best cleanliness ratings had a 42 per cent lower rate of MRSA infections than the 25 per cent of hospitals with the worst cleanliness ratings.

"The match between online ratings and other measures is far from perfect - it's possible for an individual hospital to have good ratings on NHS Choices but a high mortality rate, or vice versa," Dr Greaves said. "However, the general trend is that where a hospital's overall performance on clinical measures is good, patients seem to rate it highly - and vice versa.

"In our article we compare these findings to James Surowiecki's book, The Wisdom of Crowds, about how collective judgements result in better decisions than individuals can make by themselves. We suggest that, at least to an extent, the crowd of patients appears to be wise."

The results also showed that the majority of ratings were positive, with 68 per cent of respondents saying they would recommend their hospital to friends.

"This means it's not just used by people wanting to complain about their care," Dr Greaves said.

More information: F Greaves et al. 'Associations between web-based patient ratings and objective measures of hospital quality.' Archives of Internal Medicine, 13 February 2012.

Journal reference: JAMA Internal Medicine

Provided by Imperial College London