Background: Google searches for hospitals typically yield a Google star rating (GSR). These ratings are an important source of information for consumers. The degree to which GSRs are associated with traditional quality measures has not been evaluated recently. We sought to characterize the relationship between a hospital’s GSR, its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and Centers for Medicare and Medicaid Services (CMS) quality measures.
Methods: We used Selenium WebDriver to scrape data on mean GSR and number of reviews in August 2020. We excluded pediatric, rehabilitation, long-term care, and specialty hospitals. Hospitals with ten or fewer reviews were excluded. Data on readmissions (2015-2018), safety and mortality (2016-2019), and HCAHPS scores (2019) were obtained from the CMS Physician Compare website. We generated quality composite scores using the weighted mean of observed/expected medical readmissions (acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure, and pneumonia), surgical readmissions (coronary artery bypass graft (CABG) and total hip or knee replacement), medical quality (mean of quintiles of adjusted 30-day mortality rates for AMI, COPD, stroke, heart failure, and pneumonia), and surgical quality (mean of quintiles of adjusted 30-day CABG mortality, PSI-04 score (CMS post-surgical mortality measure), and PSI-90 (CMS perioperative adverse event measure)), and then divided hospitals into quintiles for each of these four metrics (with a higher quintile representing higher quality). We dichotomized hospitals at 3.5 stars and compared hospital characteristics, HCAHPS scores (overall stars and likelihood to recommend score), and quality outcomes by quintile. Univariate regressions of dichotomous GSR category on each quality metric (as a quintile) were performed.
Results: There were 4,437 acute care hospitals in our sample, of which 985 had ten or fewer GSR and 270 had none. For a given review, Google stars ranged from 1 to 5 (discrete values), and the overall mean hospital GSR was 3.14 (standard deviation (SD) 0.66). High GSR hospitals had statistically significant though minimally superior surgical readmissions, medical quality, and surgical quality (Table 1). Specifically, the average hospital in the ≥3.5 Google star group relative to the < 3.5 Google star group was in a 0.16 higher surgical readmissions quintile (p< 0.05), a 0.26 higher medical quality quintile (p< 0.001), and 0.35 higher surgical quality quintile (p< 0.001). Scatterplots of mean GSRs and observed/expected readmissions and quality composite scores (high score=low quality) were constructed, and correlation coefficients ranged from -0.065 for medical readmissions to -0.13 for surgical quality (Figure 1).
Conclusions: The correlation between a hospital’s GSR and its HCAHPS scores was positive, though weaker than we had anticipated. Our analysis suggests that GSRs are a poor predictor of CMS-defined quality. New and innovative ways for consumers to determine the quality of care at a hospital, especially ones that are updated in real time, might be beneficial. Future studies could evaluate the relationship between GSRs and other measures of quality (like rates of medication errors and misdiagnoses) and other non-quality measures like healthcare costs.