Preliminary findings regarding the association between patient demographics and ED experience scores across a regional health system: A cross sectional study using natural language processing of patient comments

Abstract

Objective: Existing literature shows associations between patient demographics and reported experiences of care, but this relationship is poorly understood. Our objective was to use natural language processing of patient comments to gain insight into associations between patient demographics and experiences of care.

Methods: This is a cross-sectional study of 14,848 unique emergency department (ED) patient visits from 1/1/2020 to 12/31/2020. Patients discharged from one of 16 ED sites in a regional health system who filled out a patient experience survey with comments were included. This study had two outcome variables: (1) positive vs. non-positive (negative/neutral) comment sentiment, and (2) promoter vs. non-promoter status (based on NRCHealth's Net Promoter Score; likelihood to recommend of 9 or 10 are considered "promoters", while scores of 8 or below are "non-promoters"). We used natural language processing to sort patient comments into topics and sentiments. Logistic regression with mediation analysis was used to estimate the associations between patient demographics and the following: (1) comments about compassion vs. other topics, (2) positive comments, and (3) patient experience, defined as likelihood to recommend.

Results: Comments about care and compassion (51 % of total comments) had highly positive sentiment (97 %), compared to mixed sentiment for other topics. Older, male, and Asian patients were more likely to comment on compassion and most likely to make positive comments. Our mediation analysis suggests that the demographic association with positive patient comments and net promoter scores was mediated by their focus on care and compassion as a primary comment theme for their visit. Notably, the overall percentage of patients providing comments was only 1.8 %, raising concerns about whether data currently used for hospital and physician feedback has adequate validity to yield meaningful insights.

Conclusions: The increased likelihood of specific patient sub-groups to comment on compassionate care may explain previously reported differences in experience by patient demographics.

Keywords: Emergency department; Mediation analysis; Natural language processing; Patient experience; Patient-centeredness; Structured equation modeling.