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Yelp Star Ratings on Health Care Facilities May Reveal County-Level Death Rate Disparities

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A one-star disparity on health care facility Yelp reviews could indicate a 60-death-peryear difference between some United States counties where those facilities are located, according to researchers at the Penn Medicine Center for Digital Health. Their study, published in JAMA Network Open, 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.

More than 95,000 different facilities that provided some form of care recognized by the Affordable Care Act were included in the study. 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 United States county it was located in, resulting in more than 1,300 counties (roughly a third of the country) being represented in the work.

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 percent of their total, while one-star reviews were at just 29.1 percent. In the group of counties with the highest death rates, five-star reviews made up only 42.9 percent of the total, compared to 38.8 percent one-stars.

The researchers then found that if a county’s health facilities’ reviews were a star higher than their average – one point on the scale – models indicated that it translated to 18 fewer deaths per 100,000 residents. But when the study was refined to include counties with three or more health care facilities, the impact was greater, indicating a reduction in roughly 53 deaths per 100,000. Refined even further to counties with five health care facilities or more, the impact grew to approximately 60 preventable deaths.

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