We conducted a cross-sectional analysis of data from the 2017-2018 US News and World Report publicly available annual rankings for adult and children’s hospitals. US News hospital rankings are composed of both objective and subjective data that determine the total US News score; this score then determines the overall rank of the hospital within each subspecialty. The objective data are primarily based on survival outcomes, patient safety indices, and other care-related indicators, including nursing ratios, patient volume, and other subspecialty-specific quality of care data [1,2]. The subjective component consists of an annual survey of board-certified physicians who list up to 5 adult hospitals (up to 10 for children’s hospitals) that have the highest expertise in that subspecialty or where they would send their sickest patients, ignoring cost or location. This survey determines a hospital’s reputation score for that subspecialty [1,2]. Although the significance of the reputation component has been decreasing over time, it still composes 27.5% of the score for adult hospitals and 15% (8.5% in cardiology and heart surgery) for children’s hospitals.

Using these data, we determined a hospital’s total reputation score, as previously described in the literature, as the sum of each subspecialty reputation score for an individual hospital [6]. Although the total raw US News score is not reported for every hospital, the formula is reported to the public and was used to calculate each hospital’s total US News score [1,2]. These publicly available data were manually extracted from the 2017-2018 US News Adult and Children’s hospital reports. The descriptive statistics for these data can be viewed in those publicly available reports [1,2] with a summary of the statistics available in Multimedia Appendix 1. We used Microsoft Excel software (Microsoft Corporation) to store the data for this study.

The primary objective of this study was to analyze the association between social media metrics and US News rankings. Twitter, Facebook, and Instagram metrics for all hospitals that received a ranking in at least one subspecialty in US News were obtained on August 30, 2017, for children’s hospitals and October 12, 2017, for adult hospitals (Multimedia Appendix 1). For Twitter metrics, we obtained the number of followers, number of tweets, and Klout score (max=100), a metric that quantifies the Web-based social influence over the past 90 days, for each adult and children’s hospital with active accounts. All hospitals had active social media accounts for >90 days, ensuring that the Klout score represents an accurate estimation of the influence for all hospitals. Furthermore, the number of Facebook and Instagram followers were obtained for each adult and children’s hospital with an active account.

In this study, multiple regression analyses were used with social media metrics as the dependent variable. In one set of analyses, the independent variables were the total reputation score and the number of hospital beds at each institution. For the other set of analyses, the independent variables were the total points and the number of hospital beds at each institution. For analyses of tweets and Twitter followers, the number of months on Twitter was also included as one of the independent variables. Of note, we did not include a control for the active months of activity on Facebook and Instagram because they are not easily identifiable or reported. From these analyses, partial correlation coefficients were calculated between each social media metric and both the reputation score and total points. We defined statistical significance as P<.05. Analyses were performed using Stata v.15.0 (StataCorp).

Table 1 summarizes the social media and correlation statistics for children’s hospitals when controlling for time on Twitter for Twitter metrics and bed size. Of the 79 children’s hospitals with at least one subspecialty ranked, 69, 68, and 46 hospitals had active Twitter, Facebook, or Instagram accounts, respectively. Children’s hospitals without an independent account were removed from the analysis. Twitter and Facebook followers correlated significantly with the total points (ie, higher rank) as well as with the reputation for children’s hospitals (P<.001).

Table 2 summarizes the social media and correlation statistics for adult hospitals when controlling for the bed size and time on Twitter for Twitter metrics. Of the 128 adult hospitals with, at least, one subspecialty ranked, 106, 105, and 62 had active Twitter, Facebook, or Instagram accounts, respectively. For adult hospitals, Twitter followers, the number of tweets, Klout score, Facebook followers, and Instagram followers correlated significantly with the total points (Table 2). Except for Instagram followers, these metrics also correlated significantly with the total reputation (Table 2). Hospitals with scores of 0 in the number of tweets and Klout score had active accounts with followers but no posts.

In this first study comparing social media metrics for adult and pediatric hospitals with US News rankings and reputation score, we found that both adult and children’s hospitals with more Twitter and Facebook followers had a higher 2017-2018 US News reputation score and total points (ie, overall rank). Although this correlation suggests that social media presence may influence the reputation of a hospital, it is also possible that the reputation and rank of a hospital drive social media followers. We also found that adult hospitals with more tweets and higher Klout scores, a measure of active social media participation, were associated with a higher reputation score and overall rank. Although it is possible that more prestigious hospitals have more followers because of prestige, it is also possible that this correlation may reflect that active engagement with social media may affect a hospital’s US News reputation score. Therefore, we have found marked correlations between a hospital’s social media metrics and its hospital rankings; however, further longitudinal studies will need to be conducted to determine causality.

There are a few limitations to our initial study. First, because social media metrics are cumulative, it is possible that hospitals which adopted social media earlier have larger followings and therefore, more posts. Furthermore, larger hospitals may have superior social media metrics because of increased resources for marketing and social media engagement. When controlling for time on Twitter and bed size of hospitals, these correlations remained significant, although other external factors, such as the size of the marketing department and total revenue of a hospital, may contribute as well. Second, owing to the cross-sectional analysis used in our study, we were unable to assess whether the increased social media presence over time correlates directly with an increase in reputation; this type of analysis could be conducted as a future study to confirm this finding. Third, because the subjective component of the rankings is based on physician voting, it would be helpful to know how many followers of a hospital are physicians; however, these data are not readily available, and usernames do not always identify the profession of their owner. Finally, Instagram correlated with both scores for adult and children’s hospitals, but it was only significant for the adult total score; this is likely because of Instagram being a newer platform with fewer hospitals active on Instagram.

We believe that this study is the first to report the association between social media metrics and US News and World Report annual hospital rankings for both adult and children’s hospitals. This study establishes a correlation between increased social media engagement and US News rankings and reputation score for hospitals. Therefore, because previous studies have shown that physicians are increasingly engaged in large networks on social media [8] and US News rankings are disproportionately influenced by reputation scores [7], increasing a hospital’s social media presence could be a potential method of improving the reputation of hospitals and their rank in US News annual Best Hospital Rankings. Future studies should include a content analysis of Twitter, Facebook, and Instagram posts to determine the type of content being posted by hospitals and an assessment of the relationship between the use of social media and changes in hospital rankings over time to confirm whether increasing social media presence correlates with an increase in the hospital rank.