title: From the closest observers of patient care: a thematic analysis of online narrative reviews of hospitals.
abstract: Patient-centred care has become a priority in many countries. It is unknown whether current tools capture aspects of care patients and their surrogates consider important. We investigated whether online narrative reviews from patients and surrogates reflect domains in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and we described additional potential domains.
  
  
  
  We used thematic analysis to assess online narrative reviews for reference to HCAHPS domains and salient non-HCAHPS domains and compared results by reviewer type (patient vs surrogate).
  
  
  
  We identified hospitals for review from the American Hospital Association database using a stratified random sampling approach. This approach ensured inclusion of reviews of a diverse set of hospitals. We searched online in February 2013 for narrative reviews from any source for each hospital.
  
  
  
  We included up to two narrative reviews for each hospital.
  
  
  
  Outpatient or emergency department reviews, reviews from self-identified hospital employees, or reviews of <10 words.
  
  
  
  50.0% (n=122) of reviews (N=244) were from patients and 38.1% (n=93) from friends or family members. Only 57.0% (n=139) of reviews mentioned any HCAHPS domain. Additional salient domains were: Financing, including unexpected out-of-pocket costs and difficult interactions with billing departments; system-centred care; and perceptions of safety. These domains were mentioned in 51.2% (n=125) of reviews. Friends and family members commented on perceptions of safety more frequently than patients.
  
  
  
  A substantial proportion of consumer reviews do not mention HCAHPS domains. Surrogates appear to observe care differently than patients, particularly around safety.
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.|Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, USA.
authors.forename: Naomi S
authors.identifier: 0000-0002-5178-0719
authors.initials: NS
authors.lastname: Bardach
authors.affiliation: Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
authors.affiliation: Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, USA.
authors.forename: Renée
authors.initials: R
authors.lastname: Asteria-Peñaloza
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, USA.
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.affiliation: Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, USA.|Department of Medicine, University of California San Francisco, San Francisco, USA.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Lin
authors.affiliation: Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, USA.|Department of Medicine, University of California San Francisco, San Francisco, USA.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
mesh_terms: D005190:Family / Q000523:psychology; D033062:Friends / Q000523:psychology; D006739:Hospital Administration / Q000592:standards*; D017722:Hospital Charges; D006801:Humans; D020407:Internet; D061214:Patient Safety; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D010465:Perception; D019984:Quality Indicators, Health Care
keywords: Hospital medicine; Patient safety; Patient-centred care; Qualitative research; Quality improvement