title: Tweets about hospital quality: a mixed methods study.
abstract: BACKGROUND
  Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services.
  
  
  OBJECTIVE
  To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates.
  
  
  METHODS
  A mixed methods study including a quantitative analysis of all 198,499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman's rank correlation coefficient.
  
  
  RESULTS
  11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics.
  
  
  CONCLUSIONS
  Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation.
authors.affiliation: Centre for Health Policy, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Felix
authors.initials: F
authors.lastname: Greaves
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Antony A
authors.initials: AA
authors.lastname: Laverty
authors.affiliation: Centre for Health Policy, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Daniel Ramirez
authors.initials: DR
authors.lastname: Cano
authors.affiliation: Department of Computer Science, Oxford University, Oxford, UK.
authors.forename: Karo
authors.initials: K
authors.lastname: Moilanen
authors.affiliation: Department of Computer Science, Oxford University, Oxford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pulman
authors.affiliation: Centre for Health Policy, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D004739:England; D005260:Female; D006302:Health Services Research; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D011787:Quality of Health Care; D061108:Social Media
keywords: Health Services Research; Patient Satisfaction; Quality Measurement
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