Patterns and correlates of internet use, cellphone use, and attitudes towards patient portals among a predominantly Mexican-American clinic population

Objectives: To describe access, and health related use of the internet, and cell phones, attitudes towards medical record access and patient portals and willingness to use them in the future. Methods: A bilingual cross-sectional survey was conducted. Univariate and multivariable analyses were conducted to understand factors associated with past Web 2.0 use and willingness to use these technologies in the future. Results: 201 participants were recruited (response rate: 53.3%). Respondents had an average age of 61.5 years, were predominantly female (63.2%), Hispanic (71.6%), of low income (93.0% \u3c $25,000), and low educational attainment (49.8$25,000), and low educational attainment (49.8% \u3c High school). 44.8% reported internet access and 39.3% reported internet use. Barriers identified included access (80%) and not knowing how to use the internet (76.5%). 98.5% reported having a cellphone available in their house, and 76.5% had used a cell phone. 16.3% had heard of a patient portal; 94.5% agreed it was a good idea to review medical records, but only 49.2% thought it was a good idea to review medical records online. In multivariable analyses, younger age (p\u3c0.001) was associated with willingness to use patient portals and text messaging, and health literacy predicted willingness to use patient portals. Conclusion: Significant barriers to use of web 2.0 exist, willingness to use these technologies is higher among younger patients and those with higher health literacy, suggesting that incorporating Web 2.0 strategies into health care may still leave certain populations underserved

IPASS These Patients To You

Quality, standardized sign-out between medical providers is integral to patient safety on an inpatient service. It has become increasingly important with restrictions to resident work hours. The IPASS handoff structure (i.e., illness severity, patient summary, action items, situational awareness and contingency planning, synthesis by receiver) has previously been established to reduce verbal and written miscommunications and errors when used and implemented within an education bundle (Sectish et al, Pediatrics 2011). Our aim was to utilize the IPASS structure to standardize the written handoff process between day and night teams in the internal medicine residency. We performed seven PDSA cycles. The first PDSA cycle was sending an email to the interns on a single team explaining IPASS and how to use it. Uptake was the main barrier with the interns reporting it was burdensome. Handoffs were scored on a numerical scale correlated to incomplete, partially complete and complete. During the second cycle the resident on a single team interactively provided ongoing education on IPASS. The interns were more receptive to implementation in this cycle and furthermore the sign-outs were more complete (19% improvement). The next PDSA was to explore the impact of IPASS compared to the traditional handoff method on the night float interns, who completed a survey. The night float interns did not notice a large difference between traditional method and IPASS. Our next step was exploring resident uptake through asking two residents on different teams to implement IPASS. They received an email explaining IPASS and were asked to incorporate it into handoff of all new patients to the team. They successfully passed this message onto their interns. However, night float reported it was confusing to have mixed formats on the same team. We next attempted to implement it into the electronic system to reduce barriers to implementation but found this was not readily possible in discussion with IT. Next, in an effort to further justify IPASS, we completed another PDSA cycle of timing verbal handoff which averaged approximately 1 minute per patient. The last completed cycle was implementation of IPASS on an entire team with night float feedback which garnered good responses from the program. In conclusion, these results are promising for the uptake of the validated IPASS sign-out format however implementation into current workflow remains the greatest barrier. Future work is focused on IT incorporation for IPASS