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      Developments in the Frequency of Ratings and Evaluation Tendencies: A Review of German Physician Rating Websites

      , MBHL, PhD 1 , 2 , , Dr med, Dr Phil , 1 , , Dr Phil 1

      (Reviewer), (Reviewer), (Reviewer), (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications

      physician rating websites, patient satisfaction

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          Abstract

          Background

          Physician rating websites (PRWs) have been developed to allow all patients to rate, comment, and discuss physicians’ quality online as a source of information for others searching for a physician. At the beginning of 2010, a sample of 298 randomly selected physicians from the physician associations in Hamburg and Thuringia were searched for on 6 German PRWs to examine the frequency of ratings and evaluation tendencies.

          Objective

          The objective of this study was to examine (1) the number of identifiable physicians on German PRWs; (2) the number of rated physicians on German PRWs; (3) the average and maximum number of ratings per physician on German PRWs; (4) the average rating on German PRWs; (5) the website visitor ranking positions of German PRWs; and (6) how these data compare with 2010 results.

          Methods

          A random stratified sample of 298 selected physicians from the physician associations in Hamburg and Thuringia was generated. Every selected physician was searched for on the 6 PRWs (Jameda, Imedo, Docinsider, Esando, Topmedic, and Medführer) used in the 2010 study and a PRW, Arztnavigator, launched by Allgemeine Ortskrankenkasse (AOK).

          Results

          The results were as follows: (1) Between 65.1% (194/298) on Imedo to 94.6% (282/298) on AOK-Arztnavigator of the physicians were identified on the selected PRWs. (2) Between 16.4% (49/298) on Esando to 83.2% (248/298) on Jameda of the sample had been rated at least once. (3) The average number of ratings per physician ranged from 1.2 (Esando) to 7.5 (AOK-Arztnavigator). The maximum number of ratings per physician ranged from 3 (Esando) to 115 (Docinsider), indicating an increase compared with the ratings of 2 to 27 in the 2010 study sample. (4) The average converted standardized rating (1=positive, 2=neutral, and 3=negative) ranged from 1.0 (Medführer) to 1.2 (Jameda and Topmedic). (5) Only Jameda (position 317) and Medführer (position 9796) were placed among the top 10,000 visited websites in Germany.

          Conclusions

          Whereas there has been an overall increase in the number of ratings when summing up ratings from all 7 analyzed German PRWs, this represents an average addition of only 4 new ratings per physician in a year. The increase has also not been even across the PRWs, and it would be advisable for the users of PRWs to utilize a number of PRWs to ascertain the rating of any given physician. Further research is needed to identify barriers for patients to rate their physicians and to assist efforts to increase the number of ratings on PRWs to consequently improve the fairness and practical importance of PRWs.

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          Most cited references 43

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          Systematic review: the evidence that publishing patient care performance data improves quality of care.

          Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review. To synthesize the evidence for using publicly reported performance data to improve quality. Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999-2006) and independent review of articles (1986-1999) identified in a previous systematic review. Only sources published in English were included. Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences. Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted. Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan-level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider-level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant. Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included. Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.
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            A Changing Landscape of Physician Quality Reporting: Analysis of Patients’ Online Ratings of Their Physicians Over a 5-Year Period

            Background Americans increasingly post and consult online physician rankings, yet we know little about this new phenomenon of public physician quality reporting. Physicians worry these rankings will become an outlet for disgruntled patients. Objective To describe trends in patients’ online ratings over time, across specialties, to identify what physician characteristics influence online ratings, and to examine how the value of ratings reflects physician quality. Methods We used data from RateMDs.com, which included over 386,000 national ratings from 2005 to 2010 and provided insight into the evolution of patients’ online ratings. We obtained physician demographic data from the US Department of Health and Human Services’ Area Resource File. Finally, we matched patients’ ratings with physician-level data from the Virginia Medical Board and examined the probability of being rated and resultant rating levels. Results We estimate that 1 in 6 practicing US physicians received an online review by January 2010. Obstetrician/gynecologists were twice as likely to be rated (P < .001) as other physicians. Online reviews were generally quite positive (mean 3.93 on a scale of 1 to 5). Based on the Virginia physician population, long-time graduates were more likely to be rated, while physicians who graduated in recent years received higher average ratings (P < .001). Patients gave slightly higher ratings to board-certified physicians (P = .04), those who graduated from highly rated medical schools (P = .002), and those without malpractice claims (P = .1). Conclusion Online physician rating is rapidly growing in popularity and becoming commonplace with no evidence that they are dominated by disgruntled patients. There exist statistically significant correlations between the value of ratings and physician experience, board certification, education, and malpractice claims, suggesting a positive correlation between online ratings and physician quality. However, the magnitude is small. The average number of ratings per physician is still low, and most rating variation reflects evaluations of punctuality and staff. Understanding whether they truly reflect better care and how they are used will be critically important.
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              Patients' evaluations of health care providers in the era of social networking: an analysis of physician-rating websites.

              Internet-based social networking tools that allow users to share content have enabled a new form of public reporting of physician performance: the physician-rating website. To describe the structure and content of physician-rating websites and to assess the extent to which a patient might find them valuable. We searched Google for websites that allowed patients to review physicians in the US. We included websites that met predetermined criteria, identified common elements of these websites, and recorded website characteristics. We then searched the websites for reviews of a random sample of 300 Boston physicians. Finally, we separately analyzed quantitative and narrative reviews. We identified 33 physician-rating websites, which contained 190 reviews for 81 physicians. Most reviews were positive (88%). Six percent were negative, and six percent were neutral. Generalists and subspecialists did not significantly differ in number or nature of reviews. We identified several narrative reviews that appeared to be written by the physicians themselves. Physician-rating websites offer patients a novel way to provide feedback and obtain information about physician performance. Despite controversy surrounding these sites, their use by patients has been limited to date, and a majority of reviews appear to be positive.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                August 2017
                25 August 2017
                : 19
                : 8
                Affiliations
                1 Institute for History, Ethics and Philosophy of Medicine Hannover Medical School Hannover Germany
                2 Institute for Biomedical Ethics Universität Basel Basel Switzerland
                Author notes
                Corresponding Author: Daniel Strech strech.daniel@ 123456mh-hannover.de
                Article
                v19i8e299
                10.2196/jmir.6599
                5591403
                28842391
                ©Stuart McLennan, Daniel Strech, Swantje Reimann. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.08.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                Categories
                Original Paper
                Original Paper

                Medicine

                patient satisfaction, physician rating websites

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