Abstract To increase transparency of healthcare quality, the Centers for Medicare and Medicaid Services (CMS) initiated the Physician Quality Reporting System (PQRS). However, the impact of PQRS on physicians is unclear, particularly as related to their online reputation. Is there an association between a physician’s online reputation and her adherence to clinical guidelines stipulated in the PQRS? Is online reputation associated with use of electronic health records (EHR)? To investigate these questions, we combine data on online physician reviews with the PQRS data on clinical guideline adherence and EHR use. Unlike prior research, which primarily uses clinical outcomes as proxies for care quality, our study uses adherence to clinical guidelines, a process measure that reflects physician conformance with evidence-based clinical practices. In addition, we focus on EHR use at the physician level, in contrast to the usual approach of examining it at the aggregate institutional level. Consistent with the economic theory of credence goods, we observe no significant relationship between physicians’ adherence to clinical guidelines and their online reviews. Although there is some evidence of association between EHR use and their overall rating, similar relationships are not consistently observed for individual dimensional ratings. Overall, the online reputation of a physician exhibits minimal association with her actual clinical activities — and is mostly driven by latent topics in the textual reviews — implying that the ability of online reviews to inform prospective patients of care quality might be quite limited. Therefore, patients should be cautious when using online physician reviews, and policymakers should increase the accessibility of PQRS and other similar data to help patients make informed physician choices.

中文翻译：

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遵守临床指南、电子病历使用和在线评论

摘要 为了提高医疗质量的透明度，医疗保险和医疗补助服务中心 (CMS) 启动了医师质量报告系统 (PQRS)。然而，PQRS 对医生的影响尚不清楚，特别是与他们的在线声誉有关。医生的在线声誉与其遵守 PQRS 中规定的临床指南之间是否存在关联？在线声誉是否与电子健康记录 (EHR) 的使用相关？为了调查这些问题，我们将在线医师评论数据与临床指南依从性和 EHR 使用的 PQRS 数据相结合。与之前的研究主要使用临床结果作为护理质量的代理不同，我们的研究使用对临床指南的遵守情况，这是一种反映医生对循证临床实践的遵守情况的过程指标。此外，我们专注于医生级别的 EHR 使用，这与在总体机构级别对其进行检查的通常方法相反。与信用商品的经济理论一致，我们观察到医生遵守临床指南与其在线评论之间没有显着关系。尽管有一些证据表明 EHR 的使用与其总体评分之间存在关联，但对于单个维度评分并没有一致地观察到类似的关系。总体而言，医生的在线声誉与她的实际临床活动的关联很小——并且主要由文本评论中的潜在主题驱动——这意味着在线评论向潜在患者告知护理质量的能力可能非常有限。所以，