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Single word most associated with negative hospital reviews on yelp is 'told'

February 14, 2019

PHILADELPHIA-- When analyzing reviews of hospitals on Yelp, Penn Medicine researchers found that the word most associated with negative reviews, including those rated at one-star, was "told," which appeared almost 20 percent of the posts. Published today in the Journal of General Internal Medicine, the study points to the value patients and their loved ones' place on communication in health care settings.

Among the one-star reviews the researchers saw that featured "told" were frustrations about information that was ostensibly shared ("They never told me the cost of any of the procedures"), anger at a lack of listening ("I told her I did not want to discuss it any more but she persisted to badger me.") and feelings of futility ("Some idiot doctor examined me and told me there was nothing they could do for me.").

"Oftentimes, words such as 'told' hint at a breakdown in communication," said Anish Agarwal, MD, a National Clinician Scholars fellow and Emergency Medicine physician at Penn Medicine. "I suspect that patients are not feeling listened to or heard and this could be driving poor experiences and low reviews."

A previous study comparing Yelp reviews of hospital emergency departments to those of urgent care centers by Agarwal and his study co-author, Raina Merchant, MD, the director of the Penn Medicine Center for Digital Health and an associate professor in Emergency Medicine, showed that the majority of reviews were of the one-star variety: 47 percent for emergency departments and 30 percent in urgent care centers. Delving deeper, the pair then used a machine learning tool to pick out words that appeared most often in reviews, and correlated them to star levels.

After analyzing 51,376 reviews for 1,566 United States hospitals, researchers found that the word "told" appeared in 9,578 reviews, which, taken together, averaged 1.78 stars.

When it came to positive reviews, the word "friendly" was found in nearly 11 percent of them, 5,594 total. Along with the word "great," it correlated the most with five-star reviews. In these, reviews often focused on the clinical staff's demeanor and attentiveness ("The entire staff was very friendly and made sure we were taken care of.").

"Patients value communication highly in their overall experience when they're in the hospital," Agarwal said. "As health care transitions to being more patient-centered, I think hospitals and providers need to continue to work on how we improve communication, how we listen, and how we approach all patient interactions."

While official surveys about hospital experiences are available, the study authors feel that Yelp reviews are a valuable tool to view unfiltered thoughts and feelings.

"Friends, family members and patients all can post a review from their unique perspectives on their hospital experience," Agarwal explained. "Even more, these online review sites usually do not have prompts or a list of questions to guide people, which means the individual posting the review can comment on what comes to mind and, perhaps, what means most to them."

By keeping an eye on these reviews, hospitals might be able to pinpoint areas currently causing problems in the patient experience. And as online reviews and social media continue to grow--and become intertwined--Agarwal expects to continue exploring this data to point out potential approaches for improvement.
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Arthur Pelullo, MS, an application developer at the Center for Digital Health, also served as a co-author on this study. Lyle Ungar, PhD, a professor of Computer and Information Science, was also involved in the research.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.

The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $405 million awarded in the 2017 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2017, Penn Medicine provided more than $500 million to benefit our community.

University of Pennsylvania School of Medicine

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