Investigating the Association between Drug-induced Mortality and Online Review Content: Applying Natural Language Processing and Multi-level Modeling to Online Reviews of SAMHSA-designated Substance Use Disorder Treatment Facilities and Drug-Induced Mortality Rates in the United States
ABSTRACT
Background:
Drug-induced mortality across the United States has continued to rise. To date there are limited measures to evaluate patient preferences and priorities regarding SUD treatment and many patients do not have access to evidence-based treatment options. Patients and their families seeking SUD treatment may begin their search for a SUD treatment facility online, where they can find information about individual facilities, as well as a summary of patient-generated online reviews via popular platforms such as Google or Yelp. Online reviews of healthcare facilities may reflect information about factors associated with positive or negative patient satisfaction. The association between patient satisfaction with substance use disorder (SUD) treatment and drug-induced mortality is not well understood.
Objective:
The objective of this study was to examine the association between online review content of SUD treatment facilities and drug-induced state mortality.
Methods:
A cross-sectional analysis of online reviews and ratings of SAMHSA-designated SUD treatment facilities listed between September 2005 and October 2021 was conducted. The primary outcomes were 1) mean online rating of SUD treatment facilities from 1 star (worst) to 5 stars (best), and 2) average drug-induced mortality rates from the CDC WONDER Database (2006-2019). Clusters of words with differential frequencies within reviews were identified. A three-level model was used to estimate the association between online review ratings and drug-induced mortality.
Results:
589 SAMHSA-designated facilities (n=9597 reviews). Drug-induced mortality was compared to the average. Approximately half of states (51%) had below average (“low”) mortality rates (mean: 13.40 deaths/100,000 people; SD: 2.45) and half (49%) had above average (“high”) drug-induced mortality rates (mean: 21.92 deaths/100,000 people; SD:3.69). The top five themes associated with low drug-induced mortality included detoxification/addiction rehabilitation services (r=0.26), gratitude for recovery (r=-0.25), thankful for treatment (r=-0.32), caring staff and amazing experience (r=-0.23), and individualized recovery programs (r=-0.20). The top five themes associated with high mortality were care from doctors/providers (r=0.24), rude and insensitive care (r=0.23), medication/prescriptions (r=0.22), front desk and reception experience (r=0.22), and dissatisfaction with communication (r=0.21). In the multilevel model, a state with a 10 deaths/100,000 people increase in mortality was associated with a 0.30 lower average Yelp rating (P=.005).
Conclusions:
Lower online ratings of SUD treatment facilities were associated with higher drug-induced mortality at the state level. Elements of patient experience may be associated with state-level mortality. Identified themes from online, organically-derived patient content can inform efforts to improve high-quality and patient-centered SUD care. Clinical Trial: N/A
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.