title: Social media and rating sites as tools to understanding quality of care: a scoping review.
abstract: BACKGROUND
  Insight into the quality of health care is important for any stakeholder including patients, professionals, and governments. In light of a patient-centered approach, it is essential to assess the quality of health care from a patient's perspective, which is commonly done with surveys or focus groups. Unfortunately, these "traditional" methods have significant limitations that include social desirability bias, a time lag between experience and measurement, and difficulty reaching large groups of people. Information on social media could be of value to overcoming these limitations, since these new media are easy to use and are used by the majority of the population. Furthermore, an increasing number of people share health care experiences online or rate the quality of their health care provider on physician rating sites. The question is whether this information is relevant to determining or predicting the quality of health care.
  
  
  OBJECTIVE
  The goal of our research was to systematically analyze the relation between information shared on social media and quality of care.
  
  
  METHODS
  We performed a scoping review with the following goals: (1) to map the literature on the association between social media and quality of care, (2) to identify different mechanisms of this relationship, and (3) to determine a more detailed agenda for this relatively new research area. A recognized scoping review methodology was used. We developed a search strategy based on four themes: social media, patient experience, quality, and health care. Four online scientific databases were searched, articles were screened, and data extracted. Results related to the research question were described and categorized according to type of social media. Furthermore, national and international stakeholders were consulted throughout the study, to discuss and interpret results.
  
  
  RESULTS
  Twenty-nine articles were included, of which 21 were concerned with health care rating sites. Several studies indicate a relationship between information on social media and quality of health care. However, some drawbacks exist, especially regarding the use of rating sites. For example, since rating is anonymous, rating values are not risk adjusted and therefore vulnerable to fraud. Also, ratings are often based on only a few reviews and are predominantly positive. Furthermore, people providing feedback on health care via social media are presumably not always representative for the patient population.
  
  
  CONCLUSIONS
  Social media and particularly rating sites are an interesting new source of information about quality of care from the patient's perspective. This new source should be used to complement traditional methods, since measuring quality of care via social media has other, but not less serious, limitations. Future research should explore whether social media are suitable in practice for patients, health insurers, and governments to help them judge the quality performance of professionals and organizations.
authors.affiliation: IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands. Lise.Verhoef@radboudumc.nl.
authors.forename: Lise M
authors.initials: LM
authors.lastname: Verhoef
authors.forename: Tom H
authors.initials: TH
authors.lastname: Van de Belt
authors.forename: Lucien J L P G
authors.initials: LJ
authors.lastname: Engelen
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Rudolf B
authors.initials: RB
authors.lastname: Kool
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D006282:Health Personnel / Q000592:standards; D006801:Humans; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D061108:Social Media
keywords: patient experiences; patient satisfaction; quality of health care; rating sites; social media