Online Patient Reviews for Continuous Quality Improvement: Topic Modeling of Hospital Service Quality in Taiwan and the United States

Background/Objectives: Continuous quality improvement (CQI) requires timely, patient-centered evidence on how people experience healthcare delivery. Structured surveys provide important benchmarks, but their predetermined items may miss emerging or system-specific concerns. This study assesses whether unsolicited online patient reviews can serve as a scalable patient-experience data source for identifying hospital service quality priorities across contrasting healthcare systems. Methods: We analyzed 8247 Google Maps hospital reviews posted in 2024, including 5007 Chinese-language reviews from 24 Taiwanese medical centers and 3240 English-language reviews from 21 large U.S. referral hospitals. Separate language-specific preprocessing pipelines and Latent Dirichlet Allocation (LDA) topic models identified patient-salient service quality dimensions in each country. Cross-lingual semantic mapping then distinguished universal dimensions from system-specific concerns, and star-rating differences across semantically equivalent dimensions were compared. Results: Seven service quality dimensions emerged in each country: five were cross-nationally shared (emergency care, positive care experience, professional medical team, administrative process, and inpatient/treatment care), and each system had two system-specific dimensions. Taiwanese reviews foregrounded service attitude and facility/environment quality, while U.S. reviews foregrounded billing/insurance and clinic systems/access. Ratings for emergency care and administrative process were consistently low across both systems, whereas ratings for the professional medical team were substantially higher in U.S. reviews. Conclusions: Online patient reviews can complement formal patient-experience instruments by revealing actionable CQI priorities that are both universal and context dependent. Emergency care and administrative efficiency represent shared improvement needs across both systems. System-specific interventions include interpersonal training and infrastructure investment in high-utilization single-payer settings, and billing transparency and care coordination in fragmented multi-payer systems. Institutional structures appear to play a more prominent role than cultural factors in shaping which service quality dimensions emerge, though both forces contribute. Established frameworks may inadequately capture system-specific patient concerns.

• ✓Emergency care and administrative efficiency represent shared improvement needs across both systems.
• ✓System-specific interventions include interpersonal training and infrastructure investment in high-utilization single-payer settings, and billing transparency and care coordination in fragmented multi-payer systems.
• ✓Institutional structures appear to play a more prominent role than cultural factors in shaping which service quality dimensions emerge, though both forces contribute.
• ✓Established frameworks may inadequately capture system-specific patient concerns.