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      Do Health Care Providers Use Online Patient Ratings to Improve the Quality of Care? Results From an Online-Based Cross-Sectional Study

      , MHMM, PhD , 1 , , MSc 2 , , MD 3

      (Reviewer), (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications

      public reporting, physician-rating website, quality measures, patient care, quality of health care

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          Physician-rating websites have become a popular tool to create more transparency about the quality of health care providers. So far, it remains unknown whether online-based rating websites have the potential to contribute to a better standard of care.


          Our goal was to examine which health care providers use online rating websites and for what purposes, and whether health care providers use online patient ratings to improve patient care.


          We conducted an online-based cross-sectional study by surveying 2360 physicians and other health care providers (September 2015). In addition to descriptive statistics, we performed multilevel logistic regression models to ascertain the effects of providers’ demographics as well as report card-related variables on the likelihood that providers implement measures to improve patient care.


          Overall, more than half of the responding providers surveyed (54.66%, 1290/2360) used online ratings to derive measures to improve patient care (implemented measures: mean 3.06, SD 2.29). Ophthalmologists (68%, 40/59) and gynecologists (65.4%, 123/188) were most likely to implement any measures. The most widely implemented quality measures were related to communication with patients (28.77%, 679/2360), the appointment scheduling process (23.60%, 557/2360), and office workflow (21.23%, 501/2360). Scaled-survey results had a greater impact on deriving measures than narrative comments. Multilevel logistic regression models revealed medical specialty, the frequency of report card use, and the appraisal of the trustworthiness of scaled-survey ratings to be significantly associated predictors for implementing measures to improve patient care because of online ratings.


          Our results suggest that online ratings displayed on physician-rating websites have an impact on patient care. Despite the limitations of our study and unintended consequences of physician-rating websites, they still may have the potential to improve patient care.

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          Most cited references 35

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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, 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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              Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice.

              To make informed choices and navigate within a complex health care system, consumers must have easily available, accurate, and timely information, and they must use it. Contrary to the consumer-driven approach, however, the evidence demonstrates that having an abundance of information does not always translate into its being used to inform choices. The challenge is not merely to communicate accurate information to consumers, but to understand how to present and target that information so that it is actually used in decision-making. This paper reviews what is known from studies of human judgment and decision-making and discusses their implications for supporting informed consumer choice. We delineate the types of decisions that consumers and patients are making, the barriers to using information effectively in choice, and draw upon the evidence for the efficacy of different presentation strategies to propose an initial framework for evaluating and choosing comparative information presentation approaches.

                Author and article information

                J Med Internet Res
                J. Med. Internet Res
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                September 2016
                19 September 2016
                : 18
                : 9
                1Health Services Management, Institute of Management School of Business and Economics Friedrich-Alexander-University Erlangen-Nuremberg NurembergGermany
                2Health Care Management, Institute of Management School of Business and Economics Friedrich-Alexander-University Erlangen-Nuremberg NurembergGermany
                3Media, Information and Design Department of Information and Communication University of Applied Sciences and Arts, Hannover HannoverGermany
                Author notes
                Corresponding Author: Martin Emmert Martin.Emmert@
                ©Martin Emmert, Nina Meszmer, Uwe Sander. Originally published in the Journal of Medical Internet Research (, 19.09.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (, 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, as well as this copyright and license information must be included.

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