Essays on Health Information Technology, Social Media, and Care Quality
Saifee, Danish Hasnain
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This dissertation consists of five chapters. Chapter 1 provides introduction to the research framework and questions examined in Chapters 2, 3 and 4. In Chapter 5, I conclude by summarizing the key findings and implications. The main focus of this dissertation is technology, such as health information technology (IT) and social media, and their relationship with care quality and provider performance. In Chapter 2, I examine the association between care quality (outcomes), health IT usage, and Medicare reimbursements for congestive heart failure cases. This examination was done using a three-year hospital-level panel dataset. The main finding is that hospitals with a higher level of technology usage tend to experience higher reimbursements. Although this finding supports the idea that technology improves efficiency, I do not observe any effectiveness gains, that is, there is no reason to believe that improvements are happening because of improvements in clinical outcomes. This is one of the first studies to look at reimbursements and how technology impacts them in comprehensive way. In Chapter 3, I study whether online reviews of physicians can provide reliable signals for the actual clinical outcomes experienced by their patients. To study this question, I leveraged a granular patient-admission-discharge dataset alongside physician reviews scraped from a public website, Vitals.com. Contrary to findings in recent research, my study finds that there is no clear relationship between online reviews of physicians and their patients’ clinical outcomes, such as the readmission or the ER visit rate. Hence, online reviews may not be as helpful in the context of healthcare services ridden with credence qualities as they usually are for experience goods such as books, movies, or hotels. So, patients, providers, and policy makers should be careful when inferring physician performance from online physician reviews. In Chapter 4, I empirically investigate whether online reviews truly capture a physician’s adherence to clinical guidelines. In addition, I examine whether the reviews indeed reflect the benefits expected from using an electronic health records (EHR) system. The findings from this investigation suggest that there is no significant relationship between adherence to clinical guidelines by physicians and their online reviews, but there exists a positive relationship between EHR usage and some dimensions of online reviews. The implication of these findings is that, although the credence nature of healthcare services might obscure the quality of care delivery and make online reviews somewhat unreliable, efficiency improvements from increased use of health IT translates into positive patient perceptions, providing a natural motivation for a greater adoption. The above-mentioned findings have important implications for several stakeholders including healthcare providers, patients, and policymakers. In Chapter 5, I summarize them alongside conclusions that can be drawn from Chapters 2, 3 and 4.