Wisdom of the Experts Versus Opinions of the Crowd in Hospital Quality Ratings: Analysis of Hospital Compare Star Ratings and Google Star Ratings.

BACKGROUND: Popular web-based portals provide free and convenient access to user-generated hospital quality reviews. The Centers for Medicare & Medicaid Services (CMS) also publishes Hospital Compare Star Ratings (HCSR), a comprehensive expert rating of US hospital quality that aggregates multiple measures of quality. CMS revised the HCSR methods in 2021. It is important to analyze the degree to which web-based ratings reflect expert measures of hospital quality because easily accessible, crowdsourced hospital ratings influence consumers' hospital choices. OBJECTIVE: This study aims to assess the association between web-based, Google hospital quality ratings that reflect the opinions of the crowd and HCSR representing the wisdom of the experts, as well as the changes in these associations following the 2021 revision of the CMS rating system. METHODS: We extracted Google star ratings using the Application Programming Interface in June 2020. The HCSR data of April 2020 (before the revision of HCSR methodology) and April 2021 (after the revision of HCSR methodology) were obtained from the CMS Hospital Compare website. We also extracted scores for the individual components of hospital quality for each of the hospitals in our sample using the code provided by Hospital Compare. Fractional response models were used to estimate the association between Google star ratings and HCSR as well as individual components of quality (n=2619). RESULTS: The Google star ratings are statistically associated with HCSR (P<.001) after controlling for hospital-level effects; however, they are not associated with clinical components of HCSR that require medical expertise for evaluation such as safety of care (P=.30) or readmission (P=.52). The revised CMS rating system ameliorates previous partial inconsistencies in the association between Google star ratings and quality component scores of HCSR. CONCLUSIONS: Crowdsourced Google star hospital ratings are informative regarding expert CMS overall hospital quality ratings and individual quality components that are easier for patients to evaluate. Improvements in hospital quality metrics that require expertise to assess, such as safety of care and readmission, may not lead to improved Google star ratings. Hospitals can benefit from using crowdsourced ratings as timely and easily available indicators of their quality performance while recognizing their limitations and biases.

Value of new performance information in healthcare: evidence from Japan.

Mandatory measurement and disclosure of outcome measures are commonly used policy tools in healthcare. The effectiveness of such disclosures relies on the extent to which the new information produced by the mandatory system is internalized by the healthcare organization and influences its operations and decision-making processes. We use panel data from the Japanese National Hospital Organization to analyze performance improvements following regulation mandating standardized measurement and peer disclosure of patient satisfaction performance. Drawing on value of information theory, we document the absolute value and the benchmarking value of new information for future performance. Controlling for ceiling effects in the opportunities for improvement, we find that the new patient satisfaction measurement system introduced positive, significant, and persistent mean shifts in performance (absolute value of information) with larger improvements for poorly performing hospitals (benchmarking value of information). Our setting allows us to explore these effects in the absence of confounding factors such as incentive compensation or demand pressures. The largest positive effects occur in the initial period, and improvements diminish over time, especially for hospitals with poorer baseline performance. Our study provides empirical evidence that disclosure of patient satisfaction performance information has value to hospital decision makers.

Do hospitals without physicians on the board deliver lower quality of care?

This study examines whether hospitals without physician participation on their boards of directors deliver lower quality of care. Using data from California nonprofit hospitals from 2004 to 2008, the authors document that the absence of physicians on the board is associated with a decrease of 3 to 5 percentage points in 3 of 4 measures of care quality. This result was obtained using regression analysis, which controls for various hospital characteristics. The authors also identify factors that influence quality of care in hospitals. Specifically, hospital size, church affiliation, urban location, and system affiliation are positively associated with quality of care; proportion of Medicaid patient revenue and poverty level of the county in which the hospital is located are negatively associated with quality of care. These results highlight the importance of physician participation in hospital governance and indicate areas for hospitals and policy makers to focus on to enhance medical quality management.

Characterizing rare-event property distributions via replicate molecular dynamics simulations of proteins.

As computational resources increase, molecular dynamics simulations of biomolecules are becoming an increasingly informative complement to experimental studies. In particular, it has now become feasible to use multiple initial molecular configurations to generate an ensemble of replicate production-run simulations that allows for more complete characterization of rare events such as ligand-receptor unbinding. However, there are currently no explicit guidelines for selecting an ensemble of initial configurations for replicate simulations. Here, we use clustering analysis and steered molecular dynamics simulations to demonstrate that the configurational changes accessible in molecular dynamics simulations of biomolecules do not necessarily correlate with observed rare-event properties. This informs selection of a representative set of initial configurations. We also employ statistical analysis to identify the minimum number of replicate simulations required to sufficiently sample a given biomolecular property distribution. Together, these results suggest a general procedure for generating an ensemble of replicate simulations that will maximize accurate characterization of rare-event property distributions in biomolecules.

Modeling and simulation of chemomechanics at the cell-matrix interface.

Chemomechanical characteristics of the extracellular materials with which cells interact can have a profound impact on cell adhesion and migration. To understand and modulate such complex multiscale processes, a detailed understanding of the feedback between a cell and the adjacent microenvironment is crucial. Here, we use computational modeling and simulation to examine the cell-matrix interaction at both the molecular and continuum lengthscales. Using steered molecular dynamics, we consider how extracellular matrix (ECM) stiffness and extracellular pH influence the interaction between cell surface adhesion receptors and extracellular matrix ligands, and we predict potential consequences for focal adhesion formation and dissolution. Using continuum level finite element simulations and analytical methods to model cell-induced ECM deformation as a function of ECM stiffness and thickness, we consider the implications toward design of synthetic substrata for cell biology experiments that intend to decouple chemical and mechanical cues.

Folding and unfolding of helix-turn-helix motifs in the gas phase.

Ion mobility measurements and molecular dynamic simulations have been performed for a series of peptides designed to have helix-turn-helix motifs. For peptides with two helical sections linked by a short loop region: AcA(14)KG(3)A(14)K+2H(+), AcA(14)KG(5)A(14)K+2H(+), AcA(14)KG(7)A(14)K+2H(+), and AcA(14)KSar(3)A(14)K+2H(+) (Ac = acetyl, A = alanine, G = glycine, Sar = sarcosine and K = lysine); a coiled-coil geometry with two anti-parallel helices is the lowest energy conformation. The helices uncouple and the coiled-coil unfolds as the temperature is raised. Equilibrium constants determined as a function of temperature yield enthalpy and entropy changes for the unfolding of the coiled-coil. The enthalpy and entropy changes depend on the length and nature of the loop region. For a peptide with three helical sections: protonated AcA(14)KG(3)A(14)KG(3)A(14)K; a coiled-coil bundle with three helices side-by-side is substantially less stable than a geometry with two helices in an antiparallel coiled-coil and the third helix collinear with one of the other two.