Using Sentiment Analysis to Understand What Patients Are Saying About Hand Surgeons Online

Background: Physician review websites have influence on a patient’s selection of a provider. Written reviews are subjective and difficult to quantitatively analyze. Sentiment analysis of writing can quantitatively assess surgeon reviews to provide actionable feedback for surgeons to improve practice. The objective of this study is to quantitatively analyze large subset of written reviews of hand surgeons using sentiment analysis and report unbiased trends in words used to describe the reviewed surgeons and biases associated with surgeon demographic factors. Methods: Online written and star-rating reviews of hand surgeons were obtained from healthgrades.com and webmd.com . A sentiment analysis package was used to calculate compound scores of all reviews. Mann-Whitney U tests were performed to determine the relationship between demographic variables and average sentiment score of written reviews. Positive and negative word and word-pair frequency analysis was also performed. Results: A total of 786 hand surgeons’ reviews were analyzed. Analysis showed a significant relationship between the sentiment scores and overall average star-rated reviews ( r2 = 0.604, P ≤ .01). There was no significant difference in review sentiment by provider sex; however, surgeons aged 50 years and younger had more positive reviews than older ( P < .01). The most frequently used bigrams used to describe top-rated surgeons were associated with good bedside manner and efficient pain management, whereas those with the worst reviews are often characterized as rude and unable to relieve pain. Conclusions: This study provides insight into both demographic and behavioral factors contributing to positive reviews and reinforces the importance of pain expectation management.

1033. Skin Surface Thermal Imaging to Differentiate Cellulitis and Pseudocellulitis in the Emergency Department

Background Cellulitis is misdiagnosed in up to 30% of cases, resulting in overuse of antibiotics. This represents a threat to patient safety and public health. Surface thermal imaging has been proposed as a tool to reduce errors in diagnosing cellulitis. The study objective was to compare skin surface temperature measurements between patients with cellulitis and pseudocellulitis. Methods We prospectively enrolled patients presenting to the emergency department (ED) with dermatologic lower extremity complaints that involved visible erythema. Using a thermal imaging camera, the maximum temperature value (Tmax) for the affected area of skin and corresponding area on an unaffected limb were captured. The Tmax gradient between the affected and unaffected limb was calculated. Gold standard diagnosis (cellulitis versus pseudocellulitis) was determined by consensus of a blinded, multidisciplinary physician review panel (two infectious disease, two dermatologists and two emergency medicine). Differences in temperature variables (Tmax and Tmax gradient) between cellulitis and pseudocellulitis were compared using t-tests. Results The sample included 204 participants, 59% male with an average age of 57 years. Based on expert panel consensus diagnosis, 92 (45%) of the participants had cellulitis. The cellulitis group had an average Tmax of 33.2°C and 30.2°C for affected and unaffected skin respectively, which was a significant difference of 2.9°C (CI: 2.5 to 3.6; p&lt; 0.001). The difference in the Tmax gradients between patients with cellulitis and pseudocellulitis was 2.08°C (CI: 1.46-2.70; p&lt; 0.001). Conclusion This represents the largest validation study of skin surface temperature differences between cellulitis and pseudocellulitis. Significant difference in temperature gradients between cases of cellulitis and pseudocellulitis suggests thermal imaging could be a useful diagnostic adjunct that can help differentiate these conditions. Such a modality could be particularly helpful in the ED setting where providers must balance diagnostic uncertainty with antimicrobial stewardship principles. Future work will identify the best performing temperature variables and determine optimal cutoff values for use in diagnostic algorithms. Disclosures All Authors: No reported disclosures

114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

Background Blood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We have assessed the effectiveness of one blood diversion device in a prospective trial performed at the two separate emergency departments (EDs) of a three-campus Academic Medical Center. Methods A multi-phase prospective crossover trial was performed with the blood diversion device initially in use at one ED (Memorial) and standard equipment at the other ED (University) for 10 weeks. After a washout phase, a second 10-week study phase used the blood diversion device in the other ED (University) and standard equipment at the first ED (Memorial). Contaminants were identified by the clinical microbiology lab using standard criteria, and further defined by independent retrospective review by 3 infectious disease physicians prior to statistical analysis. An intention-to-treat analysis was performed, and Chi-square tests were used to compare contaminant rates among samples obtained using the blood diversion device versus standard equipment. Results 5,675 blood samples were obtained with 5,661 samples analyzed after 14 were deemed inconclusive by the ID physician review. There were 1,719 samples obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected during diversion device periods and 2,825 during standard equipment periods. Based on the ID physician review, the contaminant rates were 1.9% in diversion device periods versus 2.9% in standard equipment periods (P = 0.018). There was a marked difference in blood culture contamination rates between the two EDs with contaminant rates at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively. Conclusion The blood diversion device was able to significantly lower blood culture contamination rates overall by 1% at the institution’s two EDs (34% relative reduction), with a stronger effect noted at the campus with both a level 1 trauma center and transplant programs. Disclosures All Authors: No reported disclosures

Trends and causes of adult mortality from 2007 to 2017 using verbal autopsy method, Addis Ababa, Ethiopia

ObjectivesWe aim to analyse the trends and causes of mortality among adults in Addis Ababa.SettingThis analysis was conducted using verbal autopsy data from the Addis Ababa Mortality Surveillance in Addis Ababa, Ethiopia.ParticipantsAll deceased adults aged 15 years and above between 2007–2012 and 2015–2017 were included in the analysis.Outcome measuresWe collected verbal autopsy and conducted physician review to ascertain cause of death.ResultA total of 7911 data were included in this analysis. Non-communicable disease (NCD) accounted for 62.8% of adult mortality. Mortality from communicable diseases, maternal conditions and nutritional deficiencies followed this by accounting for 30.3% of total mortality. Injury accounted for 6.8% of total mortality. We have observed a significant decline in mortality attributed to group one cause of death (43.25% in 2007 to 12.34% in 2017, p<0.001). However, we observed a significant increase in mortality attributed to group II cause of death (from 49.95% in 2007 to 81.17% in 2017, p<0.001). The top five leading cause of death in 2017 were cerebrovascular disease (12.8%), diabetes mellitus (8.1%), chronic liver disease (6.3%), hypertension (5.7%), ischaemic heart disease (5.7%) and other specified neoplasm (5.2%).ConclusionWe documented an epidemiological shift in cause of mortality from communicable diseases to NCD over 10 years. There is a great progress in reducing mortality due to communicable diseases over the past years. However, the burden of NCDs call for actions for improving access to quality health service, improved case detection and community education to increase awareness. Integrating NCD intervention in to a well-established and successful programme targeting communicable diseases in the country might be beneficial for improving provision of comprehensive healthcare.

Correlation between social media utilization by academic neurosurgery departments and higher online patient ratings

OBJECTIVE Patients increasingly utilize online physician review websites (PRWs) and social media to inform healthcare-related decisions. This provides neurosurgeons with opportunities for increased patient engagement. And despite the growing use of social media among neurosurgeons, the relationship between social media utilization and online reviews remains unknown. The goal of this study was to characterize the relationship between social media utilization and PRW ratings across academic neurosurgery departments. METHODS Social media accounts (Twitter, Facebook, YouTube, Instagram) of academic neurosurgery departments were identified. Online reviews for individual faculty were obtained from Healthgrades, Vitals, WebMD, and Google. Reviews were aggregated to identify the total number of reviews per department, to generate a composite departmental rating, and to calculate a summed departmental score. US News & World Report (USNWR) and Doximity rankings were recorded for each department. Social media utilization by individual neurosurgeons and associated ratings were investigated within the departments with the highest social media utilization. RESULTS Seventy-eight percent of academic neurosurgery departments utilized social media. The most prevalent platform was YouTube (49.1%), followed by Twitter (46.5%), Facebook (38.6%), and Instagram (16.7%). Higher patient ratings on PRWs were associated with the utilization of YouTube (p = 0.048) or Twitter (p = 0.02). The number of social media platforms utilized demonstrated a significant, positive correlation with patient ratings (p = 0.006) and summed patient ratings (p = 0.048). Although USNWR (p = 0.02) and Doximity (p = 0.0008) rankings correlated with patient ratings, only the number of social media platforms utilized remained a significant predictor of patient ratings on multivariate analysis (p = 0.0001). Thirty-one percent of academic neurosurgeons from departments with high social media utilization were active on social media. The most prevalent social media platform among individual neurosurgeons was Twitter (27.4%), followed by Instagram (8.4%), Facebook (4.9%), and YouTube (2.2%). Higher summed patient scores were associated with individual neurosurgeon utilization of YouTube (p = 0.04), Facebook (p < 0.0001), and Instagram (p = 0.01). Increased social media utilization among neurosurgeons was correlated with a greater number of patient reviews (p = 0.006) and higher summed patient scores (p = 0.003). On multivariate analysis, only Facebook use remained a significant predictor of the number of patient reviews received (p = 0.002) and summed patient satisfaction scores (p < 0.001). CONCLUSIONS An increased social media presence is associated with higher ratings on PRWs. As neurosurgeons continue to expand their online presence, they should be aware of the possible impact of social media on online patient reviews.

Survey of the Use of Physician Review Websites in Patients Under Orthopaedic Care (Preprint)

BACKGROUND Physician-rating websites (PRWs) are rising in popularity as the healthcare sector focuses more on patient-centered value-based care delivery. Recent studies have reported that the vast majority of orthopaedic surgeons across subspecialties already have at least one rating or review on at least one PRW. However, there are few studies identifying patient-facing factors related to the knowledge and use of PRWs and the level of influence PRWs may have on patient decision-making. OBJECTIVE The objectives of this study are: 1) to determine the prevalence of PRW use by patients seeking orthopaedic care, 2) to identify the influence PRWs have on patient decision-making, and 3) to identify factors associated with knowledge and use of PRWs. METHODS Survey administration was performed at three outpatient orthopaedic multi-specialty. Patients were asked about demographic characteristics including age, sex, occupation, and education, as well as their familiarity with PRWs, use of PRWs, and how PRWs have influenced their decision to see their surgeon. RESULTS A total of 350 patients completed the survey. The majority were women (59%) and Caucasian (77%), and the mean age of the population was 58 years old (range 15-91). 155 patients (44%) reported being somewhat (31%) or very (13%) familiar with PRWs, and 195 patients (56%) reported no familiarity with PRWs. Patients most familiar with PRWs were between 45-64 years old (p = 0.02), women (p < 0.01), had graduate/professional degrees (p < 0.01), and seen by adult reconstruction surgeons (p = 0.02). Seventy-two percent of patients utilizing PRWs reported that PRWs had an impact on their decision to see their chosen provider, with 93% noting ratings and reviews as the most valuable information. CONCLUSIONS Many patients in this study were not familiar with PRWs and did not utilize PRWs prior to their visit. However, most patients who did consult PRWs reported that the ratings and reviews did have an impact in their decision to choose their orthopaedic specialist. As PRW use increases, factors that influence patient decision-making are important to understand for surgeons and administrators.

A good dentist or not: understanding the role of storytelling in online dentist reviews

PurposeNarrative comments about dentists on physician review sites have been documented to increasingly influence people's selection of their dentists. From a communication standpoint, these comments are a type of narrative communication that people share their experiences with dentists by telling stories. Based on the frameworks of rhetoric structure theory and extended elaborated likelihood model, this study aimed to examine the effects of such storytelling from two perspectives including narrative structure and narrative focus.Design/methodology/approachA 4 (narrative structure) × 2 (narrative focus) between-subjects experiment was conducted to examine the proposed hypotheses and research questionsFindingsThe results showed that a one-sided comprehensive comment focusing on technical competence generated the strongest persuasion effects measured by attitude and behavioral intention. These effects were mediated by perceived narrative credibility and enjoyment.Originality/valueThis study contributes to the extant literature in two ways. First, it extends previous studies of online narrative comments by showing which narrative structure and focus are deemed to be more persuasive when selecting a dentist. Second, it offers a test of two routes of information processing (i.e. cognitive and experiential) to understand the mechanism underlying the effects of narrative comments.Peer reviewThe peer-review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0359

FACTORS THAT INFLUENCE PATIENTS’ RECOMMENDATION OF ORTHOPAEDIC SURGEONS: AN ANALYSIS OF A POPULAR ONLINE RATING WEBSITE

Background: In the modern digital age, patients are increasingly consulting online physician reviews prior to making healthcare decisions. Physician review websites are being used in many medical fields including orthopaedic surgery. The purpose of this study is to investigate trends in online physician reviews and determine which factors are most strongly correlated with the likelihood that an orthopaedic surgeon is to be recommended by patients. Methods: Healthgrades.com, the most comprehensive physician rating and comparison database, was queried for “orthopaedic surgery” in the state of New Jersey. Demographic information, fellowship training status, years of experience, malpractice/disciplinary actions, physician ratings and the likelihood to recommend score (LTRS) was collected for all physicians. Quantitative analysis was conducted using descriptive statistics, student t-test, and one-way ANOVA. Qualitative analysis of randomly selected positive comments and all negative comments was conducted. Common themes were identified using frequency-based word cloud generator. Results: 834 board certified orthopaedic surgeons (800 Males, 34 Females), with a mean age of 55.7±12.5 years and an average LTRS of 4.1±0.84 were included for analysis. Compared with non-fellowship trained orthopaedic surgeons, fellowship trained surgeons were more likely to be recommend by patients [3.8 vs. 4.3; P< 0.0001]. Physicians with waiting time <10min were more likely to be recommended compared with their counterparts with waiting time >10min (P< 0.0001). No differences were observed in LTRS between male and female orthopaedic surgeons (P= 0.79) or based on malpractice status (P= 0.61). Qualitative analysis of a randomly selected sample of 4,151 out of a total of 12,168 positive comments and 1,113 total negative comments revealed that positive comments centered on surgeon competence and professionalism, while negative comments centered on surgeon personality and waiting time. Conclusion: Orthopaedic surgeons have generally favorable ratings and mostly positive comments. Fellowship status and waiting time are important factors that impact LTRS. Patients were more likely to write positive comments about surgeon competence and professionalism, and negative comments pertaining to surgeon personality and waiting time. Knowledge of surgeon specific attributes that are important to patients may help educate orthopaedic surgeons to improve patient care, patient satisfaction and online ratings. Tables and Figures [Table: see text][Table: see text][Figure: see text]