title: Measuring patient-perceived quality of care in US hospitals using Twitter.
abstract: Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches.
  
  
  
  To assess the use of Twitter as a supplemental data stream for measuring patient-perceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures.
  
  
  
  404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients.
  
  
  
  Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients (p<0.001) and above the national median for nurse/patient ratio (p=0.006), and to be a non-profit hospital (p<0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates (p=0.003).
  
  
  
  Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represent a potentially untapped indicator of quality and may be valuable to patients, researchers, policy makers and hospital administrators.
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, USA Informatics Program, Boston Children's Hospital, Boston, USA.
authors.forename: Jared B
authors.initials: JB
authors.lastname: Hawkins
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, USA Informatics Program, Boston Children's Hospital, Boston, USA Department of Pediatrics, Harvard Medical School, Boston, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Brownstein
authors.affiliation: Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, USA Computer Science, Virginia Tech, Blacksburg, Virginia, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Tuli
authors.affiliation: Informatics Program, Boston Children's Hospital, Boston, USA.
authors.forename: Tessa
authors.identifier: 0000-0003-1942-966X
authors.initials: T
authors.lastname: Runels
authors.affiliation: Informatics Program, Boston Children's Hospital, Boston, USA.
authors.forename: Katherine
authors.identifier: 0000-0001-9872-9833
authors.initials: K
authors.lastname: Broecker
authors.affiliation: Informatics Program, Boston Children's Hospital, Boston, USA Department of Pediatrics, Harvard Medical School, Boston, USA Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Elaine O
authors.initials: EO
authors.lastname: Nsoesie
authors.affiliation: Informatics Program, Boston Children's Hospital, Boston, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: McIver
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rozenblum
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.affiliation: Informatics Program, Boston Children's Hospital, Boston, USA Department of Pediatrics, Harvard Medical School, Boston, USA.
authors.forename: Florence T
authors.initials: FT
authors.lastname: Bourgeois
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Felix
authors.initials: F
authors.lastname: Greaves
mesh_terms: D000328:Adult; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D061108:Social Media; D014481:United States
keywords: Healthcare quality improvement; Patient satisfaction; Performance measures; Quality improvement methodologies; Quality measurement