Are online reviews of assisted living communities associated with patient‐centered outcomes?

Abstract

Background: Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient-centered outcome.Methods: Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score (ranging 1-5) and rating status (no-rating, low-rating, and high-rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs.Results: Residents were predominately older (average 81.2 years), non-Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' riskadjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high-rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time.Conclusions: Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time.

Home time and state regulations among Medicare beneficiaries in assisted living communities

“…17 Home time has been shown to be a meaningful and a robust patient-centered outcome on its own but is also associated with other outcome measures (e.g., self-rated health, mobility impairment, and depression), 15 and with consumers' online satisfaction reports. 18 Although this measure is not without controversy, 19 it is one of the few available aggregate metrics reflecting what is important to AL residents, that is, ability to age in place while remaining in a relatively stable health. 20 To date, there has been only one study of home time in ALs, focusing largely on its association with residents' online reviews.…”

“…First studied among patients with acute events such as stroke and heart failure, 12–14 home time has also been examined among Medicare beneficiaries living in the community, 15 discharged from skilled nursing facilities, 16 and in the last 6 months of life 17 . Home time has been shown to be a meaningful and a robust patient‐centered outcome on its own but is also associated with other outcome measures (e.g., self‐rated health, mobility impairment, and depression), 15 and with consumers' online satisfaction reports 18 . Although this measure is not without controversy, 19 it is one of the few available aggregate metrics reflecting what is important to AL residents, that is, ability to age in place while remaining in a relatively stable health 20 .…”

“…20 To date, there has been only one study of home time in ALs, focusing largely on its association with residents' online reviews. 18 Unlike nursing homes, uniform measures allowing comparisons between lower and higher quality ALs are largely absent. This is further confounded by the fact that, unlike nursing homes, ALs are loosely regulated by states and are typically owned by mixed senior housing and service corporations.…”

“…Although this measure is not without controversy, 19 it is one of the few available aggregate metrics reflecting what is important to AL residents, that is, ability to age in place while remaining in a relatively stable health 20 . To date, there has been only one study of home time in ALs, focusing largely on its association with residents' online reviews 18 …”

One accurate measurement is worth 1000 expert opinions—Assessing quality care in assisted living

“…To this end, the authors of “Are online reviews of assisted living communities associated with patient‐centered outcomes?” approach the thorny problem of measuring quality in AL with great pragmatism (JAGS REFERENCE TBA). Mao et al 7 use the measure “home‐time,” the percentage of time a resident spends within their home as opposed to a clinical environment, such as a hospital, rehab facility, or long‐term nursing home. The measure is not without controversy, as it does not integrate concepts of symptom or caregiver burden 8 .…”