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Do ratings of internists gathered through internet searches predict the quality of care they deliver to patients with diabetes or hypertension?


Gray B, Vandergrift J, Lipner R. — American Board of Internal Medicine

Guodong G. — University of Maryland

McCoullough J. — University of Minnesota

Presented: AcademyHealth Annual Research Meeting, June 2013

Background: Considering the growth in the use of the Internet to obtain information about physicians, consumers should understand whether Internet ratings of physicians by patients relate to physician quality.

Study Design: Physician quality measures (QMs) were drawn primarily from patient charts for 1,042 internists who completed an American Board of Internal Medicine (ABIM) Diabetes or Hypertension Practice Improvement Module (PIM). Completing a PIM is part of the ABIM Maintenance of Certification process. PIM-QMs mirror measures applied by CMS and NCQA. PIM completion included abstracting 25 charts and collecting 25 patient survey responses for patients with the applicable chronic condition. A composite measure was constructed, heavily weighted by chart-based QMs, based on an expert panel's assessment of the relative value of PIM-QMs. Individual PIM-QMs applicable to both patient cohorts from charts included: share of patients with blood pressure/LDL controlled and providing smoking cessation advice. Patient survey PIM-QMs included patient assessment of care quality/physician self-care support as very good or excellent. To mimic typical consumer searches, each internist's name and location were entered into a Google search and extracted ratings from the first two websites on the search list. Searches captured 1,007 ratings for 599 internists (57% of the sample). The analysis was limited to the following health websites: Healthgrades (n=465), Ucomparehealthcare (n=192), Vitals (n=243), Avvo (n=56), and Wellness (n=51). Websites had about six patient reviews per physician. Website ratings were normalized by dividing each website rating by that website's maximum possible score. A mean Web rating of two out of five stars yields a normalized rating of 40%. A website rating was categorized as top score if the normalized website rating was >=80% (59% of website ratings) and bottom score <=40% (12% of website ratings).

Population Studied: Internists who completed an ABIM Diabetes or Hypertension PIM between 2011 and 2012.

Methodology: Relationships were estimated between internists' PIM-QMs and having any website rating using Probit regression. PIM-based physician QMs were evaluated as dependent variables in binomial-regression (with a Logit link) where a website mean rating was the explanatory variable controlling for subspecialization, PIM type, website and accounting for physicians being rated on multiple websites.

Principal Findings: Physicians with a greater share of patients who rated them highly on either patient satisfaction PIM-QM were more likely to be rated on the Internet (p<.01). No chart-based QM predicted having a rating (p>.24). Among physicians rated on the Internet, a bottom score predicted a statistically significant 5.3% decrease in share of patients with LDL controlled (p<.05). No other association between website rating measures and PIM-QMs was statistically significant (p>.05).

Conclusions: Patients with diabetes or hypertension would obtain limited information from Internet searches regarding which physicians to avoid (only bottom website rating predicted patient share with LDL control) but not whom to choose (normalized website rating or having a top website rating was not associated with any PIM-QM and only six raters per website).

Implications for Policy, Delivery or Practice: Information currently available from the Internet has limited effectiveness in informing consumers of physician quality. Considering the use of the Internet by consumers, more rigorously drawn patient surveys need to be made accessible to the public.

For more information about this presentation, please contact Research@abim.org