Yelp star ratings may reveal county-level death rate disparities

A one-star disparity on health care facility Yelp reviews could indicate a 60-death-per-year difference between some United States counties where those facilities are located, according to researchers at the Penn Medicine Center for Digital Health. Their study shows that counties holding health care facilities with the greatest share of 1-star Yelp reviews had the highest death rates, and a difference of just one point—roughly one star—between counties’ average scores could indicate a mortality rate that is better or worse by dozens of lives. This work is published in the JAMA Network Open.

Empty hospital bed and wheelchair in a health care facility with curtains drawn.

“Many of the facilities that provide essential care may not otherwise have standardized measures or approaches to collect data about patients’ experience of care. This is a missed opportunity,” says the study’s senior author, Raina Merchant, the director of the Center for Digital Health and a professor of emergency medicine in the Perelman School of Medicine. “Much of the focus in health care is on quality and outcomes—patient experience is also critically important and should be factored into how to improve care across the board. This appears to be one novel data source for doing that.”

More than 95,000 different facilities that provided some form of care recognized by the Affordable Care Act were included in the study led by Merchant and its lead author, Daniel Stokes, a researcher with the Center for Digital Health and an internal medicine resident at UCLA Health.. Each entity included in the study had at least three reviews between 2015 and 2019 on Yelp, a review website which uses a five-star rating system. Each health care facility’s ratings were also coded to the specific U.S. county it was located in, resulting in more than 1,300 counties (roughly a third of the country) being represented in the work.

Overall, health care facilities achieved an average 2.9 score (out of 5 stars), but reviews were weighted very heavily to either side of the scale: five-star reviews account for 52.9% of all reviews, while one-stars made up 33.3%.

When the researchers looked at the county-level data of reviews, though, they found that five-star reviews within the group with the lowest death rates made up 55.6% of their total, while one-star reviews were at just 29.1%. In the group of counties with the highest death rates, five-star reviews made up only 42.9% of the total, compared to 38.8% one-stars.

This story is by Frank Otto. Read more at Penn Medicine News.