Identifying Patient-Recognised Care Practices and Variation in Positive Feedback Content: A Nationwide...

Background/Objectives: Large-scale evidence linking positive feedback content to patient and care characteristics remains limited. We identified patient-recognised care practices and examined associations with patient, care-setting and hospital characteristics. Methods: We conducted a cross-sectional text analysis of 215,690 unique comments from China's 2024-2025 national patient satisfaction survey across 31 provincial-level regions. Model-assisted screening for positive content covered all output categories. General praise was distinguished from specific positive experiences, with rules and model-assisted judgements supporting multi-label coding into 13 categories across three domains. Two rounds of human coding refined and independently validated the scheme. Multilevel logistic models with hospital random intercepts examined domain mentions with Benjamini-Hochberg false discovery rate (FDR) adjustment. Results: Of 115,466 screened comments, 75.35% expressed general praise and 23.99% mentioned care practices (27,698). Independent validation in 600 screened comments yielded a weighted micro-averaged F1 of 95.82% (95% CI 92.63-97.66%) for 13-category coding. Among care-practice comments, interpersonal interaction and relational care was most frequently mentioned (89.84%); service attitude (64.93%) and responsibility (23.49%) were the most frequent categories. Regression included 27,098 comments from 6580 hospitals. Inpatient versus outpatient comments had higher adjusted odds of mentioning interpersonal interaction and relational care (OR 1.23, 95% CI 1.12-1.34) and lower odds of mentioning care processes and service support (OR 0.55, 95% CI 0.49-0.61). Clinical and professional care mentions were positively associated with each age group ≥ 40 versus 20-29 years and each higher education group versus junior secondary or below. These associations remained significant after FDR adjustment in primary and sensitivity analyses. Conclusions: Positive feedback should be interpreted in relation to patient composition and care setting. Future studies could incorporate information such as patient comorbidities to explain feedback differences and evaluate the effects of categorised feedback on team learning and service improvement.