Improving the patient experience through patient portals: Insights from experienced portal users

Background: Patient portals have become part of the ecosystem of care as both patients and providers use them for a range of activities both individually and collaboratively. As patients and providers gain greater experience using portals, their use and needs related to portals may evolve. Objective: This study aimed to learn from experienced patient portal users to improve our understanding of their perspectives on portal use for collaboration and engagement as well as explore how using a portal influenced their experiences with primary care providers. Methods: Qualitative study involving 29 semi-structured interviews with family medicine patients from a large Academic Medical Center (AMC). Interviewees were patients with chronic conditions who had been identified by their providers as experienced portal users. Interview transcripts were analyzed using rigorous qualitative methods. Results: Common themes emerged around both logistical and psychological benefits of portal use. Logistical benefits included increased efficiency, improved ability to track their health information, and better documentation of communications and information during and between office visits. Psychological benefits were a greater sense of collaboration in care, increased trust in providers, and enhanced engagement in health care activities. Conclusion: Experienced portal users discussed ways in which patient portals improved both their ability to manage their care and their relationships with providers. Frequent users described a sense of collaboration with their providers and greater trust in the relationship. These findings suggest that portal use may be a mechanism through which patients can increase patient engagement and improve the patient experience

Why do they do that?: Looking beyond typical reasons for non-urgent ED use among Medicaid patients

Barriers to accessing primary care, including lack of transportation and inadequate appointment times, are common reasons for non-urgent emergency department (ED) use yet even when these barriers are addressed, the problem persists. This study explored non-urgent ED use by Medicaid enrollees through interviews with patients and providers and sought to identify themes beyond the commonly mentioned logistical and access issues. Qualitative interviews with 23 Medicaid enrollees and 31 PCP and ED providers utilizing a semi-structured interview guide focused on reasons for seeking care in the ED and issues associated with PCP appointments. We identified overlap as well as surprising differences in themes identified by providers and by patients. Providers identified cultural and educational issues including that many Medicaid patients had grown up using the ED as their main source of care and lacked awareness of other sources healthcare. Patients did not mention educational and cultural factors directly, but discussed a concern that their condition was too serious for the PCP, or that the ED provided more comprehensive services. Both patients and providers raised neglected concepts, particularly those related to understanding primary care compared to emergency care. These results highlight the importance of addressing multiple paths toward more appropriate ED use, including barriers beyond logistical and access-related concerns. Considering the patient’s perception of the situation, as well as identifying opportunities to improve patients’ understanding of where to seek care may help to create interventions with broader impact than those that address access and logistical barriers alone

Why providers participate in clinical trials: Considering the National Cancer Institute's Community Clinical Oncology Program

The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute’s Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials

Increasing Capacity for Evaluation of Community-Based Organizations: Lessons from the Ohio Equity Institute

Background: Community-based organizations (CBOs) play an important role delivering disease prevention and health promotion activities to address community health needs and improve the health of individuals living in their communities. While CBOs play this important role, evaluation of the services they deliver is hampered by limited infrastructure to systematically collect data from these organizations. To address this gap, we report on a case study of the development of the Ohio Equity Institute (OEI) Data Portal. The OEI is a statewide initiative that supports 65 CBOs across Ohio to deliver 3 evidence-based interventions (ie, CenteringPregnancy, Community Health Workers, and Home Visiting) to address infant mortality in underserved populations. Methods: Employing principles of community-engaged stakeholder research and user-centered design, we conducted Plan-Do-Study-Act cycles, including semistructured interviews with 43 key informants, to improve the development, implementation, and use of the OEI Data Portal. Results: This process identified both technical and implementation challenges, and offered opportunities to make improvements to the data collection system itself as well as to the integration of this system with CBO workflows. These improvements yielded significant gains in terms of the quantity and quality of data submission, ultimately contributing to ongoing outcome evaluation efforts. Conclusion: Our findings provide important insight into the challenges experienced by CBOs when participating in a statewide CBO data evaluation infrastructure development and implementation. As Ohio and other states push to expand collaborations between CBOs and health care organizations, leaders should leverage existing data collection to facilitate a more comprehensive and effective process

The business case for provider participation in clinical trials research: An application to the National Cancer Institute’s community clinical oncology program

Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions

Challenges and Facilitators of Community Clinical Oncology Program Participation: A Qualitative Study:

Successful participation in the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) can expand access to clinical trials and promote cancer treatment innovations for patients and communities otherwise removed from major cancer centers. Yet CCOP participation involves administrative, financial, and organizational challenges that can impact hospital and provider participants. This study was designed to improve our understanding of challenges associated with CCOP participation from the perspectives of involved providers, and to learn about opportunities to overcome these challenges

A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks: Analyzing the Business Case for Research

The Community Clinical Oncology Program (CCOP) plays an essential role in the National Cancer Institute’s (NCI) efforts to increase enrollment in clinical trials. There is currently little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. This paper presents a conceptual model of the business case for PBRN participation and provides a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization

Development of a Multilevel Intervention to Increase Colorectal Cancer Screening in Appalachia

Background Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of “Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,” a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. Methods Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. Conclusions Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. Trial registration Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020

Designing and Developing Effective Disease Management Programmes: Key Decisions for Programme Success

The effectiveness of disease management programmes hinges on a combination of factors, all of which are important to consider when selecting a programme for implementation. This article provides a brief overview of disease management programmes commonly found in healthcare organisations, highlighting the issue of programme effectiveness. Seven factors critical to the design and development of an effective disease management programme are outlined to guide practitioners and healthcare managers who are responsible for making decisions about such programmes. These decision factors are: 1. defining and establishing programme goals; 2. defining a target population; 3. selecting measures of programme success; 4. determining data availability and information systems capability; 5. deciding to build or buy all or parts of a programme; 6. determining and enhancing the level of physician involvement; and 7. selecting strategies to enhance organisational support. Careful consideration of these factors in the decision stage for a disease management programme will help ensure effective and appropriate programme development and implementation. Healthcare managers applying these considerations will be better able to develop disease management programmes that achieve their objectives and provide a foundation for organisational success.Disease management programmes, Health economics