title: Influence of Intensified Supervision by Health Care Inspectorates on Online Patient Ratings of Hospitals: A Multilevel Study of More Than 43,000 Online Ratings.
abstract: In the Netherlands, hospitals with quality or safety issues are put under intensified supervision by the Dutch Health Care Inspectorate, which involves frequent announced and unannounced site visits and other measures. Patient rating sites are an upcoming phenomenon in health care. Patient reviews might be influenced by perceived quality including the media coverage of health care providers when the health care inspectorate imposes intensified supervision, but no data are available to show how these are related.
  
  
  
  The aim of this study was to investigate whether and how being under intensified supervision of the health care inspectorate influences online patient ratings of hospitals.
  
  
  
  We performed a longitudinal study using data from the patient rating site Zorgkaart Nederland, from January 1, 2010 to December 31, 2015. We compared data of 7 hospitals under intensified supervision with a control group of 28 hospitals. The dataset contained 43,856 ratings. We performed a multilevel logistic regression analysis to account for clustering of ratings within hospitals. Fixed effects in our analysis were hospital type, time, and the period of intensified supervision. Random effect was the hospital. The outcome variable was the dichotomized rating score.
  
  
  
  The period of intensified supervision was associated with a low rating score for the hospitals compared with control group hospitals; both 1 year before intensified supervision (odds ratio, OR, 1.67, 95% CI 1.06-2.63) and 1 year after (OR 1.79, 95% CI 1.14-2.81) the differences are significant. For all periods, the odds on a low rating score for hospitals under intensified supervision are higher than for the control group hospitals, corrected for time. Time is also associated with low rating scores, with decreasing ORs over time since 2010.
  
  
  
  Hospitals that are confronted with intensified supervision by the health care inspectorate have lower ratings on patient rating sites. The scores are independent of the period: before, during, or just after the intervention by the health care inspectorate. Health care inspectorates might learn from these results because they indicate that the inspectorate identifies the same hospitals as "at risk" as the patients rate as underperformers.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands. tijn.kool@radboudumc.nl.
authors.forename: Rudolf Bertijn
authors.identifier: 0000-0003-3134-487X
authors.initials: RB
authors.lastname: Kool
authors.forename: Sophia Martine
authors.identifier: 0000-0003-1291-075X
authors.initials: SM
authors.lastname: Kleefstra
authors.forename: Ine
authors.identifier: 0000-0002-7023-0261
authors.initials: I
authors.lastname: Borghans
authors.forename: Femke
authors.identifier: 0000-0002-5944-2431
authors.initials: F
authors.lastname: Atsma
authors.forename: Tom H
authors.identifier: 0000-0002-5401-8973
authors.initials: TH
authors.lastname: van de Belt
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D006761:Hospitals / Q000592:standards; D006801:Humans; D020407:Internet; D017060:Patient Satisfaction; D061108:Social Media
keywords: hospitals; online reviews; rating sites; social media; supervision