Disparities by Race and Urbanicity in Online Health Care Facility Reviews

Abstract

Importance: Online review platforms offer valuable insights into patient satisfaction and the quality of health care services, capturing content and trends that traditional metrics might miss. The COVID-19 pandemic has disrupted health care services, influencing patient experiences. Objective: To examine health care facility numerical ratings and patient experience reported on an online platform by facility type and area demographic characteristics after the COVID-19 pandemic (ie, post-COVID). Design, Setting, and Participants: All reviews of US health care facilities posted on one online platform from January 1, 2014, to December 31, 2023, were obtained for this cross-sectional study. Analyses focused on facilities providing essential health benefits, which are service categories that health insurance plans must cover under the Affordable Care Act. Facility zip code tabulation area level demographic data were obtained from US census and rural-urban commuting area codes. Main Outcomes and Measures: The primary outcome was the change in the percentage of positive reviews (defined as reviews with ≥4 of 5 stars) before and post-COVID. Secondary outcomes included the association between positive ratings and facility demographic characteristics (race and ethnicity and urbanicity), and thematic analysis of review content using latent Dirichlet allocation. Results: A total of 1445706 reviews across 151307 facilities were included. The percent of positive reviews decreased from 54.3% to 47.9% (P