Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort

(C) The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.Financial disclosure: This project was supported by the National Institute on Aging (R01 AG030611), the National Center for Research Resources (5UL1RR025741), and the National Center for Advancing Translational Sciences (Grant 8UL1TR000150). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Smith is currently supported by a Cancer Research UK Fellowship

Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations

Describes a system of hospitals and community- and school-based clinics tailored to low-income patients through systemwide strategies, high-quality specialty and hospital care, and integrated care delivery via care management and information technology

PATIENT PORTAL USE AND ITS ASSOCIATION WITH CLINICAL OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES

Background: The rapid growth of type 2 diabetes mellitus (T2DM) in the United States presents significant challenges. Patient portals are promising tools that address the increasing number of individuals with T2DM and engage these people in the process of managing their chronic condition. Objectives: The purposes of this study were: 1) to describe the portal usage pattern by individuals with T2DM over the two-year study period; 2) to identify whether sociodemographic, socioeconomic, and clinical characteristics differ between portal users and non-users; and 3) to longitudinally examine the effect of portal use on glycemic control in patients with T2DM. Methods: This two-year retrospective, observational cohort study utilized data from the ambulatory electronic health records (EHR) of the University of Pittsburgh Medical Center (UPMC) Physician Services and its ancillary patient portal. The study included adults seen in an outpatient setting of UPMC between January 2015 and December 2016. We applied descriptive statistics to describe sample characteristics and portal usage patterns. Logistic regression was used to examine factors associated with portal use. A propensity score matching (PSM) technique was conducted to equate the portal user and non-user groups, and mixed modeling was performed to examine the effect of portal use on hemoglobin A1c (HbA1c) over time. Results: Nearly one-third of the individuals (n=12,615, 32.9%, 95% CI: [32.3%,33.3%]) with T2DM used the portals. An increased portal usage was observed before and after a physician visit, and on weekdays compared to weekends (p<0.001). In general, we found associations of age, race, income, and the number of chronic conditions with portal usage, and several other predictors modified these effects (ps<0.05). After PSM, both groups showed a non-linear decline of HbA1c over time (p<.001), and the portal users (n=4,924) demonstrated a greater decrease and better maintenance than the non-users (n=4,924, p<.001). Conclusions: Our findings highlight the promising effect of a patient portal on clinical glycemic control in persons with T2DM. Disparities in patient portals need to be addressed to bridge the existing gaps in diabetes outcomes. Future study should explore mechanisms through which the portal contributes to better clinical outcomes to guide evidence-based portal design and implementation

Consumers\u27 Perceptions of Patient-Accessible Electronic Medical Records

Background: Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective: The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods: This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results: Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions: Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually engaging, and have user-friendly navigation

The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review

Background: Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective: The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods: We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results: Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions: Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency

Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives

The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety

Repairing the Digital Divide Can Increase the Service Divide: The Effects of Patient Portals on Kidney Allocation

The severe shortage of organs combined with increasing demand for them characterizes the outcomes for the kidney allocation process. Despite the efforts to improve the allocation of kidneys, notable inefficiencies and unequal access to available organs persist across patient populations. The goal of this study is to examine (i) whether the adoption of a patient-oriented information technology (IT), namely the patient portals, can mitigate inefficiencies in the allocation of these scarce resources (kidneys) in general; (ii) whether the adoption of patient portals magnify or alleviate the disparity issues around access to transplants. Using a rich dataset of all the kidney transplant records in the U.S. from 2011 to 2014, we show that the likelihood that the patient receives deceased donor transplant at a given point in time increases in the presence of patient portals. However, the varying impact of IT across sub-populations may indicate that the efforts to bridge the digital divide may benefit some groups of patients at the expense of other groups, leading to further disparities

The Barrier that Deters the Geriatric Population from Receiving Quality Healthcare

Purpose : This literature analysis aims to understand the tangible and intangible barriers that impact the growing geriatric population in preventing from receiving quality healthcare Methods: This literature review allowed for the investigation of the various types of barriers when the American geriatric population tries to access high-quality healthcare. Different types of settings were considered; however, there was a focus on Philadelphia. The analysis allowed for the creation of possible associations and solutions for this issue. Additional articles about the most significant barriers were searched based on an original article by Horton and Johnson (2010). Results: Cost seems to be one of the important, tangible aspects in regards to the lack of access and quality of care (Fitzpatrick et al. 2004). The highest percentage of all health spending consisted of the elderly population. As of 2016, there were 7,000 practicing geriatricians in the United States (Hafner 2016). There is a positive relationship between health literacy, of the geriatric population, and perception of social standing (Fernandez et al. 2016). Approximately 20% of elderly patients belonged to the dislike subgroup--making going to the doctor the most cited reason for delaying care (Sun and Smith 2017). Conclusion: Medical professionals, public health officials, and policymakers must address the negative aging stereotypes and delay of health care delay amongst the geriatric population. Once the negative stigma of aging is gone, then additional programs and resources can be developed to assist the elderly population. Recently there has been a shift towards patient/person-centered care--focusing on “personal choice and autonomy for people receiving health services” (Kogan, A. C., Wilber, K., & Mosqueda, L. 2016)

Med Care

BackgroundBy shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services.ObjectiveTo examine the impact of a HDHP on outpatient visits and associated laboratory and radiology tests.Research Design/SubjectsWe used a pre-post with comparison group study design to examine the differential change in outpatient service utilization among 7953 adults who were switched from a traditional HMO plan to a HDHP compared with 7953 adults remaining in traditional plans. HDHP members had full coverage of preventive laboratory tests and modest copayments for outpatient visits, similar to controls, but faced full cost sharing under the deductible for radiology tests and laboratory tests not classified as preventive.ResultsCompared to controls, the HDHP group experienced moderate relative decreases in overall office visits (ratio of IRRs=0.91, or a 9% relative reduction; 95% confidence interval 0.88, 0.94) and visits for higher (0.91; 0.85, 0.97) and lower-priority (0.89; 0.81, 0.99) chronic conditions. There were no significant differences in changes in visit rates for acute higher or lower-priority conditions (both 0.93; 0.86, 1.01) or preventive laboratory tests (0.97; 0.93, 1.02). HDHP members showed moderate relative reductions in the use of general laboratory tests (0.91; 0.86, 0.97) but not radiology tests (0.97, 0.91, 1.03).ConclusionsChronic outpatient visits declined among HDHP members, although preventive labs and acute visits remained unchanged. HDHP patients with chronic illnesses who have more contact with the health care system might be more likely to reduce utilization because of increased exposure to costs associated with ambulatory visits.P30 DK092924/DK/NIDDK NIH HHS/United StatesU58 DP002719/DP/NCCDPHP CDC HHS/United States1P30-DK092924/DK/NIDDK NIH HHS/United States5U58DP002719-03/DP/NCCDPHP CDC HHS/United States2016-12-09T00:00:00Z24322990PMC514702

Factors Associated With Patient Portal Utilization, Preventive Services Utilization, and Health Promoting Behaviors Among Adults in the United States

Background: Nearly 60% of adults in the United States are estimated to have one or more chronic conditions, necessitating strategies to improve the health status of persons with chronic disease. Given that health information technology (HIT) is considered highly valuable for superior disease management, it is imperative to examine how HIT use can improve health behaviors, which can in turn improve health status. This study aimed to examine if there was an association between patient portal utilization and the use of preventive services & health-promoting behaviors. Also, this study examined the influence of self-efficacy on preventive health behaviors among adults in the United States. Methods: This study analyzed secondary data from the nationally representative Health Information National Trends Survey 5 combined dataset from 2017 to 2020. Data analysis was restricted to respondents who had used their patient portals in the past year and the sample size was 14,103. Binomial & multinomial logistic regression models were conducted for this study. Results: Patient portal utilization was significantly associated with preventive health behaviors such as pap smear testing, mammogram screening, non-smoking, levels of participation in physical activities, and muscle-strengthening activities. Self-efficacy was significantly associated with mammogram screening and the levels of participation in physical and muscle-strengthening activities. Conclusion: The study provides information that suggests that stakeholders need to encourage the population to use their patient portals. Also, optimizing the patient portals for not just clinical care but preventive care may reduce the incidence and cost of chronic diseases