Understanding online review behaviors of patients in online health communities: an expectation-disconfirmation perspective

PurposeAlthough online health communities (OHCs) and online patient reviews can help to eliminate health information asymmetry and improve patients' health management, how patients write online reviews within OHCs is poorly understood. Thus, it is very necessary to determine the factors influencing patients' online review behavior in OHCs, including the emotional response and reviewing effort.Design/methodology/approachBased on expectation-disconfirmation theory, this study proposes a theoretical model to analyze the effects of service quality perception (i.e. outcome quality and process quality perceptions) and disconfirmation (i.e. outcome quality and process quality disconfirmations) on patients' emotional response and reviewing effort. The authors test the research model by using empirical data collected from a popular Chinese OHC and applying ordinary least squares (OLS) regression and zero-truncated negative binomial (ZTNB) regression models.FindingsBoth service quality perception and disconfirmation have a positive effect on patients' positive emotional intensity in textual reviews, and disease severity enhances these relationships of process quality. Moreover, there is an asymmetric U-shaped relationship among service quality perception, disconfirmation and reviewing effort. Patients who perceive low service quality have higher reviewing effort, while service quality disconfirmation has the opposite relationship. Specifically, patients' effort in writing textual reviews is lowest when perceived outcome quality is 3.5 (on a five-point scale), perceived process quality is 4 or outcome quality and process quality disconfirmations are −1.Originality/valueThis study is the first to examine patients' online review behavior and its motivations and contributes to the literature on online reviews and service quality. In addition, the findings of this study have important management implications for service providers and OHC managers.

Health care quality in nonparametric efficiency studies: a review

Scientists are increasingly considering quality in nonparametric frontier efficiency studies in health care. There are many ways to include quality in efficiency analyses. These approaches differ, among other things, in the underlying assumptions about the influence of quality on the attainable efficiency frontier and the distribution of inefficiency scores. The aim is to provide an overview of how scholars have taken quality into account in nonparametric frontier efficiency studies and, at the same time, to address the underlying assumptions on the relationship between efficiency and quality. To this end, we categorized empirical efficiency studies according to the methodological approaches and quality dimensions and collected the quality indicators used. We performed a Web of Science search for studies published in journals covered by the Science Citation Index Expanded, the Social Sciences Citation Index, and the Emerging Sources Citation Index between 1980 and 2020. Of the 126 studies covered in this review, 78 are one-stage studies that incorporate quality directly into the efficiency model and thus assume that quality impacts the attainable efficiency frontier. Forty-four articles are two-stage studies that consider quality in the first and the second stage or the second stage only. Four studies do not assume a priori a specific association between efficiency and quality. Instead, they test for this relationship empirically. Outcome quality is by far the most frequently incorporated quality dimension. While most studies consider structural quality as an environmental variable in the second stage, they include outcome quality predominantly directly in the efficiency model. Process quality is less common.

Controlling fibroblast fibrinolytic activity allows for the bio-engineering of stable connective tissue equivalents

In tissue engineering, cell origin is important to ensure outcome quality. However, the impact of the cell type chosen for seeding in a biocompatible matrix has been less investigated. Here, we investigated the capacity of primary and immortalized fibroblasts of distinct origins to degrade a gelatin/alginate/fibrin (GAF)-based biomaterial. We further established that fibrin was targeted by degradative fibroblasts through the secretion of fibrinolytic matrix-metalloproteinases (MMPs) and urokinase, two types of serine protease. Finally, we demonstrated that besides aprotinin, specific targeting of fibrinolytic MMPs and urokinase led to cell-laden GAF stability for at least several days. These results support the use of specific strategies to tune fibrin-based biomaterials degradation over time. It emphasizes the need to choose the right cell type and further bring targeted solutions to avoid the degradation of fibrin-containing hydrogels or bioinks.

Determinants of Quality of Health Insurance Services in Brazil

This research proposes the application of a hierarchical and multidimensional model for quality measurement in health insurance services. The modelling assumes that perceived health insurance quality is composed of a three-stage hierarchical structure, which includes primary quality dimensions, interaction, environment conditions and outcome and each primary dimension is supported from the following sub-dimensions: Interaction quality (attitude), behaviour and expertise; environment conditions quality (environment conditions), design and social factors; and outcome quality (waiting time, tangibles and valence). For model validation, structural equation system is used. The application through structural equation modelling showed that only the outcome quality is significant to the overall perceived quality with the health insurance, and significant sub-dimensions for the study were social conditions, waiting time and tangible. The application of the modelling provided the estimation of the determinants of quality in the service. The determinants of perceived quality can help managers in the direction of improvement actions in order to increase the quality perceived by the users of health insurance services.

DOP81 Quality improvement by semi-automated benchmarking of a core outcome quality indicator set in Inflammatory Bowel Disease: A multicentric feasibility study

Background Quality of care in inflammatory bowel disease (IBD) depends on multiple factors and is assessed through structure, process and outcome indicators. Structure and process indicators are more static and can easily be measured by an audit. Patient-oriented outcome indicators that impact on the quality of life are more difficult to assess. The aim of the project was to build a platform that automatically captures key outcome quality indicators and provide benchmarking output to improve quality of care in IBD centres. Methods Literature was reviewed for relevant quality indicators in IBD. After two non-anonymized Delphi like review and consensus meetings, twelve quality indicators were selected for implementation. The definitions of the outcomes were aligned in consensus with the available International Consortium for Health Outcomes Measurement (ICHOM). A web-based interface was built in three large volume IBD centres in Belgium to collect data on multiple ways: (i) Patients complete patient-reported outcome questionnaires and disease specific questions when attending the outpatient clinic and/or day clinic; (ii) The software automatically extracts data from the electronic medical files including biochemical and endoscopic reports; (iii) The medical baseline characteristics and outcome indicators for each patient are completed by the healthcare professional at inclusion and after this on a yearly basis. Results In total 265 patients were included in the participating IBD centres. Three indicators could be directly extracted from the patient-reported outcome questionnaires (clinical remission, fatigue, work productivity). Two items could be retrieved by use of the bot that automatically extracts biochemical and endoscopic reports from the medical files (anaemia, deep remission). The other items were collected throughout yearly confirmation by a health care professional (colorectal cancer, steroid use [systemic/topical], severe infections, hospital admission, IBD surgery [perianal/abdominal]). All items are benchmarked in an anonymous way on a benchmarking dashboard. Each centre can only see his own position in the benchmarking diagram. Additionally, the case mix per centre (type IBD, severity, demographic data) was added to the benchmarking output to provide a balanced evaluation of the outcome indicators. Conclusion This is the first partially automated benchmarking initiative for quality of care in IBD. The data collection is feasible and provides an objective assessment and comparison of the IBD related quality of care in different centres. Further prospective evaluation needs to confirm that implementation of benchmarking improves the performance and quality of IBD management.

The Impact of Service Quality on Business Commitment in Contract Manufacturing Services: An Exploratory Study of F&B Industry in Malaysia

Business environment is highly competitive for food & beverage(F&B)industry due to the low entry barrier. In order to improve their financial performances, F&B manufacturers opt to offer contract manufacturing services (CMS).There is a formal relationship established between the service provider and the buyer. However, the impact of service quality on retaining the business relationship particularly has not been empirically investigated. To fill this gap, this study explores the determinants of contract manufacturing service quality (CMSQ) and the interrelationship between CMSQ, customer satisfaction and loyalty of the F&B CMSs’ customers in Malaysia. Four focus group interviews (28 participants) were held in this study and they comprised 12 contract manufacturers and 16 business customers. Three new dimensions were discovered from the focus group interviews; product development capability, Halal certification and outcome quality in addition to the SERVQUAL dimensions. Relevantinformation via structured questionnaires were collected via online survey and drop-off method. 146 usable questionnaires were analysed using partial least squares. The results indicate that CMSQ consists of eight dimensions namely empathy, assurance, reliability, responsiveness, tangibles, outcome quality, Halal certification and product development capability. The Empathy dimension is the most important dimension influencing customers’ decision to stay with the contract manufacturers.CMSQ was found to have a small effect size on loyalty while customer satisfaction largely influenced loyalty. The result implies that CMSQ is a complement in the formation of customer loyalty while customer satisfaction is a significant predictor of behavioural intention.The findings also provide empirical evidence that the contextual specific service quality is essential particularly for contract manufacturing in F&B.

The effect of body mass index on one-year functional outcome, quality of life and postoperative complications in total shoulder arthroplasty

The aim of this retrospective cohort study was to investigate the effect of BMI on 1-year functional outcome, quality of life (QoL) and rate of postoperative complications after shoulder arthroplasty. We included 121 patients (59 men and 62 women) with primary osteoarthritis (OA) who underwent anatomical or reverse total shoulder arthroplasty (TSA or rTSA) between 2011 and 2016. Age, sex, preoperative BMI, preoperative medical status using American score of anesthesiologists (ASA) class, type of prosthesis, preoperative and 1-year postoperative functional outcome using the Constant score and quality of life (QoL) using the EQ-5D as well as postoperative complication rate were documented. Patients were divided into three groups based on their BMI, group 1 (normal weight, BMI <25), group 2 (overweight, BMI 25-30) and group 3 (obese, >BMI 30). All three groups were comparable regarding age, sex and ASA class, preoperative Constant score EQ-5D. We found significant improvement of the Constant score and EQ- 5D at 1-year postoperative follow-up, regardless of BMI (p<0.05). Comparing the three groups, we found no significant differences among them in 1-year Constant score, EQ-5D or postoperative rate of complications. This study showed that BMI did not affect functional outcome, QoL and postoperative complication rate in TSA. These results can help physicians and patients to make reasonable perioperative expectations and planning.

When Reinforcing Processes Generate an Outcome-Quality Dip

When does market success indicate superior merit? We show that when consumer choices between products with equal prices depend on quality but also on past popularity, more popular products are not necessarily of higher quality. Rather, a medium level of popularity may be associated with lower quality than lower levels of popularity. Using a formal model, we show that this kind of nonmonotonic association occurs when reinforcing processes are strong. More generally, a dip can occur when outcomes depend on both quality and resources and the latter are allocated bimodally, with some being given a lot of resources and most receiving little. Empirically, we illustrate that such a dip occurs in the association between movie theater sales and ratings. The presence of a dip in the outcome-quality association complicates learning from market outcomes and evaluation of individuals and new ventures, challenges the legitimacy of stratification systems, and creates opportunities for sophisticated evaluators who understand the dip.