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Hughes M, Doyle M, Moroney D, Fennelly O. Designing an interoperable patient portal to augment an Advanced Nurse Practitioner service for Children with hydrocephalus. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100223. [PMID: 39131241 PMCID: PMC11315161 DOI: 10.1016/j.ijnsa.2024.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 08/13/2024] Open
Abstract
Background Children's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services. Aim The aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus. Methods Interviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using Braun and Clarke's (2006) framework. Results Four key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus. Conclusions The availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from. Study Registration This study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland. Twitter Abstract A study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus.
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Affiliation(s)
- Mary Hughes
- Trinity School of Nursing and Midwifery, Dublin Ireland
| | - Michelle Doyle
- Neurosurgery Team, Children's Health Ireland at Temple Street, Dublin 1
| | | | - Orna Fennelly
- Trinity School of Nursing and Midwifery, Dublin Ireland
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Ong YN, Koh YLE, Tan NC. Usage of patient portals among primary healthcare professionals: a cross-sectional study. Singapore Med J 2024:00077293-990000000-00144. [PMID: 39256965 DOI: 10.4103/singaporemedj.smj-2023-088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 02/19/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Yingxian Natalie Ong
- SingHealth Polyclinics, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore
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Brands MR, Haverman L, Muis JJ, Driessens MHE, Meijer S, van der Meer FJM, de Jong M, van der Bom JG, Cnossen MH, Fijnvandraat K, Gouw SC. Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study. JMIR Hum Factors 2024; 11:e48359. [PMID: 39226550 PMCID: PMC11408883 DOI: 10.2196/48359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/07/2023] [Accepted: 06/28/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial. OBJECTIVE This study aims to assess patients' and health care providers' perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns. METHODS In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities. RESULTS Participants expected a PHR would increase the transparency of health information, improve patients' understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload. CONCLUSIONS People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition.
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Affiliation(s)
- Martijn R Brands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Child and Adolescent Psychiatry & Psychological Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Jelmer J Muis
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Child and Adolescent Psychiatry & Psychological Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | | | - Stephan Meijer
- Netherlands Hemophilia Patient Society, Nijkerk, Netherlands
| | - Felix J M van der Meer
- HemoNED Foundation, Leiden, Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | | | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
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Thielmann RR, Hoving C, Schutgens-Kok E, Cals JW, Crutzen R. Patient online access to general practice medical records: A qualitative study on patients' needs and expectations. HEALTH INF MANAG J 2024; 53:166-173. [PMID: 36655702 PMCID: PMC11401335 DOI: 10.1177/18333583221144666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient online access to medical records is assumed to foster patient empowerment and advance patient-centred healthcare. Since July 2020, patients in the Netherlands have been legally entitled to electronically access their medical record in general practice. Experience from pioneering countries has shown that despite high patient interest, user rates often remain low. How to best support implementation depends on individual needs and expectations of patient populations, which are as yet unknown in the Dutch context. OBJECTIVE To understand Dutch patients' needs and expectations with regard to online access to their medical record in general practice. METHOD Twenty participants completed semi-structured individual interviews via video or telephone call. Transcripts of interviews underwent template analysis combining deductive and inductive coding using Atlas.ti software. RESULTS Patients' needs and expectations ranged across three overlapping areas: (i) prerequisites for getting online access; (ii) using online access; and (iii) the impact on interaction with healthcare providers. Patients expected benefits from online access such as better overview, empowerment and improved communication with their general practitioner but identified needs regarding technological difficulties, data privacy and complex medical language in their record. CONCLUSION The concerns and obstacles participants identified point towards the need for organisational changes in general practice, for example, adjusted documentation practices, and the key role of the general practitioner and staff in promoting and facilitating online access. IMPLICATIONS Implementation strategies addressing needs identified in this study may help to unlock the full potential of online access to achieve desired outcomes of patient involvement and satisfaction.
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Affiliation(s)
- Rosa Rlc Thielmann
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Esther Schutgens-Kok
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Naimark J, Tinetti ME, Delbanco T, Dong Z, Harcourt K, Esterson J, Charpentier P, Walker J. Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions. JMIR Form Res 2024; 8:e56332. [PMID: 39207829 PMCID: PMC11393498 DOI: 10.2196/56332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/10/2024] [Accepted: 05/27/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. OBJECTIVE The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. METHODS The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. RESULTS In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. CONCLUSIONS Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.
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Affiliation(s)
- Jody Naimark
- Department of Family Medicine, Winchester Hospital, Winchester, MA, United States
| | - Mary E Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Zhiyong Dong
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kendall Harcourt
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jessica Esterson
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Peter Charpentier
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- CRI Web Tools LLC, Durham, CT, United States
| | - Jan Walker
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Ren Y, Wu Y, Fan JW, Khurana A, Fu S, Wu D, Liu H, Huang M. Automatic uncovering of patient primary concerns in portal messages using a fusion framework of pretrained language models. J Am Med Inform Assoc 2024; 31:1714-1724. [PMID: 38934289 PMCID: PMC11258404 DOI: 10.1093/jamia/ocae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES The surge in patient portal messages (PPMs) with increasing needs and workloads for efficient PPM triage in healthcare settings has spurred the exploration of AI-driven solutions to streamline the healthcare workflow processes, ensuring timely responses to patients to satisfy their healthcare needs. However, there has been less focus on isolating and understanding patient primary concerns in PPMs-a practice which holds the potential to yield more nuanced insights and enhances the quality of healthcare delivery and patient-centered care. MATERIALS AND METHODS We propose a fusion framework to leverage pretrained language models (LMs) with different language advantages via a Convolution Neural Network for precise identification of patient primary concerns via multi-class classification. We examined 3 traditional machine learning models, 9 BERT-based language models, 6 fusion models, and 2 ensemble models. RESULTS The outcomes of our experimentation underscore the superior performance achieved by BERT-based models in comparison to traditional machine learning models. Remarkably, our fusion model emerges as the top-performing solution, delivering a notably improved accuracy score of 77.67 ± 2.74% and an F1 score of 74.37 ± 3.70% in macro-average. DISCUSSION This study highlights the feasibility and effectiveness of multi-class classification for patient primary concern detection and the proposed fusion framework for enhancing primary concern detection. CONCLUSIONS The use of multi-class classification enhanced by a fusion of multiple pretrained LMs not only improves the accuracy and efficiency of patient primary concern identification in PPMs but also aids in managing the rising volume of PPMs in healthcare, ensuring critical patient communications are addressed promptly and accurately.
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Affiliation(s)
- Yang Ren
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC 29208, United States
| | - Yuqi Wu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, United States
| | - Jungwei W Fan
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, United States
| | - Aditya Khurana
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Sunyang Fu
- Department of Health Data Science and Artificial Intelligence, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Dezhi Wu
- Department of Integrated Information Technology, University of South Carolina, Columbia, SC 29208, United States
| | - Hongfang Liu
- Department of Health Data Science and Artificial Intelligence, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, United States
- Department of Health Data Science and Artificial Intelligence, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Thielmann RR, Hoving C, Cals JW, Crutzen R. Patient online access to medical records in general practice: Perceived effects after one year follow-up. PATIENT EDUCATION AND COUNSELING 2024; 125:108309. [PMID: 38705022 DOI: 10.1016/j.pec.2024.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Online access to medical records is expected to foster patient empowerment and patient-centred healthcare. However, data on actual experienced effects remain limited. We aimed to examine the development of effects patients perceive from online access. METHODS A nationwide online survey (N = 1769) evaluated Dutch patients' use of online access and beliefs about its effects on 16 outcomes at baseline and one-year follow-up. Analyses of Variance (ANOVA) were used to examine within-person belief changes across three user groups: patients who 1) used online access before the study, 2) started use during the study, and 3) did not use it at all. RESULTS There was a small decline in five beliefs around online access facilitating patient empowerment and participation in participants who started using online access during the study compared to at least one other user group. Most changes in beliefs did not differ between groups. CONCLUSION No evidence of benefits from online access was found. The findings might indicate inadequacies in the current system of online access. Possibly, the benefits of online access are contingent upon portal improvements and changes in documentation practices. PRACTICE IMPLICATION Records need to be easily accessible and comprehensible for patients. Consultation practices should enable patient participation.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Maastricht University, the Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University, the Netherlands
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Matthews AK, Steffen AD, Akufo J, Burke L, Diaz H, Dodd D, Hughes A, Madrid S, Onyiapat E, Opuada H, Sejo J, Vilona B, Williams BJ, Donenberg G. Factors Associated with Uptake of Patient Portals at a Federally Qualified Health Care Center. Healthcare (Basel) 2024; 12:1505. [PMID: 39120208 PMCID: PMC11311389 DOI: 10.3390/healthcare12151505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/27/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
Federally qualified health centers (FQHC) aim to improve cancer prevention by providing screening options and efforts to prevent harmful behavior. Patient portals are increasingly being used to deliver health promotion initiatives. However, little is known about patient portal activation rates in FQHC settings and the factors associated with activation. This study examined patient portal activation among FQHC patients and assessed correlations with demographic, clinical, and health service use variables. We analyzed electronic health record data from adults >18 years old with at least one appointment. Data were accessed from the electronic health records for patients seen between 1 September 2018 and 31 August 2022 (n = 40,852 patients). We used multivariate logistic regression models to examine the correlates of having an activated EPIC-supported MyChart patient portal account. One-third of patients had an activated MyChart portal account. Overall, 35% of patients with an activated account had read at least one portal message, 69% used the portal to schedule an appointment, and 90% viewed lab results. Demographic and clinical factors associated with activation included younger age, female sex, white race, English language, being partnered, privately insured, non-smoking, and diagnosed with a chronic disease. More frequent healthcare visits were also associated with an activated account. Whether or not a patient had an email address in the EHR yielded the strongest association with patient portal activation. Overall, 39% of patients did not have an email address; only 2% of those patients had activated their accounts, compared to 54% of those with an email address. Patient portal activation rates were modest and associated with demographic, clinical, and healthcare utilization factors. Patient portal usage to manage one's healthcare needs is increasing nationally. As such, FQHC clinics should enhance efforts to improve the uptake and usage of patient portals, including educational campaigns and eliminating email requirements for portal activation, to reinforce cancer prevention efforts.
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Affiliation(s)
- Alicia K. Matthews
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Alana D. Steffen
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Jennifer Akufo
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Larisa Burke
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Hilda Diaz
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Darcy Dodd
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Ashley Hughes
- Department of Biomedical and Health Information Science, The University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Samantha Madrid
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Enuma Onyiapat
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Hope Opuada
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Jessica Sejo
- College of Medicine, The University of Illinois Chicago, Chicago, IL 60612, USA; (J.S.); (G.D.)
| | - Brittany Vilona
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | | | - Geri Donenberg
- College of Medicine, The University of Illinois Chicago, Chicago, IL 60612, USA; (J.S.); (G.D.)
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Powell DS, Wu MMJ, Nothelle S, Smith JM, Gleason K, Oh ES, Lum HD, Reed NS, Wolff JL. The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss? J Am Geriatr Soc 2024. [PMID: 39058421 DOI: 10.1111/jgs.19111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/02/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. METHODS We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care. RESULTS Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race. CONCLUSION Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.
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Affiliation(s)
- Danielle S Powell
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Mingche M J Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jamie M Smith
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly Gleason
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Sriraman S, Saadoon R, Bochner R, Khandakar S. Improving Patient Portal Activation for Newborns in the Well Baby Nursery. Pediatrics 2024; 154:e2023063274. [PMID: 38867690 DOI: 10.1542/peds.2023-063274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Patient portals provide parents access to their child's health information and direct communication with providers. Our study aimed to improve portal activation rates of newborns during nursery hospitalization to >70% over 6 months. Secondarily, we describe the facilitators and barriers to portal use. METHODS The study design used a mixed-methodology framework of quality improvement (QI) and cross-sectional analyses. The Model for Improvement guided QI efforts. The primary outcome was the proportion of portals activated for newborns during nursery hospitalization. Interventions included portal activation algorithm, staff huddles, and documentation templates. Telephone interviews were conducted with a randomized sample of mothers of infants who activated the portal. These mothers were divided into portal "users" and "nonusers." We examined sociodemographic variables and health care utilization outcomes in the 2 groups. RESULTS Portal activation increased from 12.9% to 85.4% after interventions. Among 482 mothers with active portals, 127 (26.3%) were interviewed. Of those, 70% (89 of 127) reported using the portal, and 85.4% (76 of 89) found it useful. Reasons for accessing the portal included checking appointments and reviewing test results. Lack of knowledge of portal functionality was the main barrier to portal use (42.1%). Portal users were less likely to have a no-show to primary care appointments compared with nonusers (44.9% versus 78.9%, P < .001). CONCLUSIONS Portal activation rates increased after QI interventions in the nursery. Most parents accessed the portal and found it useful. Portals can improve health care delivery and patient engagement in the newborn period.
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Affiliation(s)
- Sheetal Sriraman
- Department of Pediatrics, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics, New York City Health and Hospital, Kings County, Brooklyn, New York
| | - Reem Saadoon
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Risa Bochner
- Department of Pediatrics, New York City Health and Hospital, Harlem, New York, New York
| | - Saema Khandakar
- Department of Pediatrics, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics, New York City Health and Hospital, Kings County, Brooklyn, New York
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Muniyappa A, Weia B, Ling N, O'Brien J, Tamerat M, Soulsby WD, Yim J, Oates A. A novel approach to patient portal activation data to power equity improvements. J Am Med Inform Assoc 2024:ocae152. [PMID: 38887009 DOI: 10.1093/jamia/ocae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/17/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND There are significant disparities in access and utilization of patient portals by age, language, race, and ethnicity. MATERIALS AND METHODS We developed ambulatory and inpatient portal activation equity dashboards to understand disparities in initial portal activation, identify targets for improvement, and enable monitoring of interventions over time. We selected key metrics focused on episodes of care and filters to enable high-level overviews and granular data selection to meet the needs of health system leaders and individual clinical units. RESULTS In addition to highlighting disparities by age, preferred language, race and ethnicity, and insurance payor, the dashboards enabled development and monitoring of interventions to improve portal activation and equity. DISCUSSION AND CONCLUSIONS Data visualization tools that provide easily accessible, timely, and customizable data can enable a variety of stakeholders to understand and address healthcare disparities, such as patient portal activation. Further institutional efforts are needed to address the persistent inequities highlighted by these dashboards.
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Affiliation(s)
- Anoop Muniyappa
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Benjamin Weia
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Nicole Ling
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Julie O'Brien
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Mariamawit Tamerat
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, United States
| | - William Daniel Soulsby
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Joanne Yim
- Health Informatics, UCSF Health, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Aris Oates
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, United States
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12
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Ward MJ, Matheny ME, Rubenstein MD, Bonnet K, Dagostino C, Schlundt DG, Anders S, Reese T, Mixon AS. Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration. BMC Health Serv Res 2024; 24:640. [PMID: 38760660 PMCID: PMC11102113 DOI: 10.1186/s12913-024-11082-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Despite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration. METHODS We conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process. RESULTS We conducted semi-structured interviews with 66 participants: clinicians (N = 25), stakeholders (N = 24), and Veterans (N = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal. CONCLUSIONS The diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.
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Affiliation(s)
- Michael J Ward
- Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA.
- Medicine Service, Tennessee Valley Healthcare System, Nashville, TN, USA.
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael E Matheny
- Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa D Rubenstein
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Chloe Dagostino
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Shilo Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda S Mixon
- Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Khatib R, Glowacki N, Chang E, Lauffenburger J, Pletcher MJ, Siddiqi A. Disparities in Patient Portal Engagement Among Patients With Hypertension Treated in Primary Care. JAMA Netw Open 2024; 7:e2411649. [PMID: 38748420 PMCID: PMC11096988 DOI: 10.1001/jamanetworkopen.2024.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Patient portals are increasingly used for patient-clinician communication and to introduce interventions aimed at improving blood pressure control. Objective To characterize patient portal use among patients with hypertension managed in primary care. Design, Settings, and Participants This retrospective cohort study used electronic health records linked with patient portal log file data from a large, diverse Midwestern health care system. Patients with hypertension who had a primary care visit from January 1, 2021, to December 31, 2021, were included. The first visit in 2021 was considered the baseline visit; patient portal engagement was evaluated during the following year. Multivariate logistic regressions, presented as odds ratios (ORs) and 95% CIs, were used to evaluate associations between patient characteristics and patient portal engagement, adjusting for potential confounders. Exposures Primary exposures included 4 sociodemographic factors routinely collected in the electronic health record: race and ethnicity, insurance, preferred language, and smoking status. Main Outcomes and Measures Indicators of patient engagement with the patient portal included accessing the patient portal at least once, accessing the portal within 7 days of at least 50.0% of primary care physician (PCP) visits, frequent logins (<28 vs ≥28), messaging (<2 vs ≥2), and sharing home blood pressure readings. Results Among 366 871 patients (mean [SD], 63.5 [12.6] years), 52.8% were female, 3.4% were Asian, 7.8% were Hispanic, 19.7% were non-Hispanic Black, 66.9% were non-Hispanic White, and 2.3% were of other race or ethnicity. During the 1-year study period starting in 2021, 70.5% accessed the patient portal at least once, 60.2% accessed around the time of their PCP visits, 35.7% accessed the portal frequently, 28.9% engaged in messaging, and 8.7% shared home blood pressure readings. Compared with White patients, non-Hispanic Black and Hispanic patients had lower odds of any access (Black: OR, 0.53; 95% CI, 0.52-0.54; Hispanic: OR, 0.66; 95% CI, 0.64-0.68), access around PCP visit time (Black: OR, 0.49; 95% CI, 0.48-0.50; Hispanic: OR, 0.62; 95% CI, 0.60-0.64), frequent access (Black: OR, 0.56; 95% CI, 0.55-0.57; Hispanic: OR, 0.71; 95% CI, 0.69-0.73), and messaging (Black: OR, 0.63; 95% CI, 0.61-0.64); Hispanic: OR, 0.71; 95% CI, 0.69-0.73). Conclusions and Relevance This cohort study of patients with hypertension found clear sociodemographic disparities in patient portal engagement among those treated in primary care. Without special efforts to engage patients with portals, interventions that use patient portals to target hypertension may exacerbate disparities.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Health, Rolling Meadows, Illinois
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Ganeshan S, Liu AW, Kroeger A, Anand P, Seefeldt R, Regner A, Vaughn D, Odisho AY, Mourad M. An Electronic Health Record-Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study. J Med Internet Res 2024; 26:e52071. [PMID: 38502159 PMCID: PMC10988365 DOI: 10.2196/52071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/23/2023] [Accepted: 01/22/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician's schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. OBJECTIVE We evaluated an electronic health record (EHR)-based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. METHODS In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. RESULTS From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. CONCLUSIONS Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access.
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Affiliation(s)
- Smitha Ganeshan
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Andrew W Liu
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Anne Kroeger
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Prerna Anand
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Richard Seefeldt
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Alexis Regner
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Diana Vaughn
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Anobel Y Odisho
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Michelle Mourad
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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15
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Zaretsky J, Kim JM, Baskharoun S, Zhao Y, Austrian J, Aphinyanaphongs Y, Gupta R, Blecker SB, Feldman J. Generative Artificial Intelligence to Transform Inpatient Discharge Summaries to Patient-Friendly Language and Format. JAMA Netw Open 2024; 7:e240357. [PMID: 38466307 DOI: 10.1001/jamanetworkopen.2024.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Importance By law, patients have immediate access to discharge notes in their medical records. Technical language and abbreviations make notes difficult to read and understand for a typical patient. Large language models (LLMs [eg, GPT-4]) have the potential to transform these notes into patient-friendly language and format. Objective To determine whether an LLM can transform discharge summaries into a format that is more readable and understandable. Design, Setting, and Participants This cross-sectional study evaluated a sample of the discharge summaries of adult patients discharged from the General Internal Medicine service at NYU (New York University) Langone Health from June 1 to 30, 2023. Patients discharged as deceased were excluded. All discharge summaries were processed by the LLM between July 26 and August 5, 2023. Interventions A secure Health Insurance Portability and Accountability Act-compliant platform, Microsoft Azure OpenAI, was used to transform these discharge summaries into a patient-friendly format between July 26 and August 5, 2023. Main Outcomes and Measures Outcomes included readability as measured by Flesch-Kincaid Grade Level and understandability using Patient Education Materials Assessment Tool (PEMAT) scores. Readability and understandability of the original discharge summaries were compared with the transformed, patient-friendly discharge summaries created through the LLM. As balancing metrics, accuracy and completeness of the patient-friendly version were measured. Results Discharge summaries of 50 patients (31 female [62.0%] and 19 male [38.0%]) were included. The median patient age was 65.5 (IQR, 59.0-77.5) years. Mean (SD) Flesch-Kincaid Grade Level was significantly lower in the patient-friendly discharge summaries (6.2 [0.5] vs 11.0 [1.5]; P < .001). PEMAT understandability scores were significantly higher for patient-friendly discharge summaries (81% vs 13%; P < .001). Two physicians reviewed each patient-friendly discharge summary for accuracy on a 6-point scale, with 54 of 100 reviews (54.0%) giving the best possible rating of 6. Summaries were rated entirely complete in 56 reviews (56.0%). Eighteen reviews noted safety concerns, mostly involving omissions, but also several inaccurate statements (termed hallucinations). Conclusions and Relevance The findings of this cross-sectional study of 50 discharge summaries suggest that LLMs can be used to translate discharge summaries into patient-friendly language and formats that are significantly more readable and understandable than discharge summaries as they appear in electronic health records. However, implementation will require improvements in accuracy, completeness, and safety. Given the safety concerns, initial implementation will require physician review.
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Affiliation(s)
- Jonah Zaretsky
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
| | - Jeong Min Kim
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
| | | | - Yunan Zhao
- Department of Population Health, NYU Langone Health, New York
| | - Jonathan Austrian
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
- Department of Health Informatics, NYU Langone Medical Center Information Technology, New York
| | - Yindalon Aphinyanaphongs
- Department of Population Health, NYU Langone Health, New York
- Predictive Analytics Unit, NYU Langone Health, New York
| | - Ravi Gupta
- Department of Internal Medicine, Long Island Community Hospital, NYU Langone Health, New York
| | - Saul B Blecker
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
- Department of Population Health, NYU Langone Health, New York
| | - Jonah Feldman
- Department of Medicine, NYU Long Island School of Medicine, Mineola
- Department of Health Informatics, NYU Langone Medical Center Information Technology, New York
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Short-Russell M, Thompson J, Waldrop J. Secure Messaging: Demonstration and Enrollment Patient Portal Program: Patient Portal Use in Vulnerable Populations. Comput Inform Nurs 2024; 42:104-108. [PMID: 38206326 DOI: 10.1097/cin.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Vulnerable populations face challenges gaining access to quality healthcare, which places them at a high risk for poor health outcomes. Using patient portals and secure messaging can improve patient activation, access to care, patient follow-up adherence, and health outcomes. Developing and testing quality improvement strategies to help reduce disparities is vital to ensure patient portals benefit all, especially vulnerable populations. This quality improvement initiative aimed to increase enrollment in a patient portal, use secure messages, and adhere to follow-up appointments. Before the project, no patients were enrolled in the portal at this practice site. Over 8 weeks, 61% of invited patients were enrolled in the patient portal. Eighty-five percent were Medicaid recipients, and the others were underinsured. Eight patients utilized the portal for secure messaging. The follow-up appointment attendance rate was better in the enrolled patients than in those who did not enroll. The majority of survey respondents reported satisfaction in using the patient portal. Patient portal utilization and adoption in vulnerable groups can improve when a one-on-one, hands-on demonstration and technical assistance are provided.
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Noureldin M, Newman KL, Higgins PDR, Piette JD, Resnicow K, Louissaint J, Kenney B, Berinstein J, Waljee AK, Zhu J, Cohen-Mekelburg S. Profiles of Web-based Portal Users with Inflammatory Bowel Disease. Inflamm Bowel Dis 2024; 30:83-89. [PMID: 37071851 PMCID: PMC10769793 DOI: 10.1093/ibd/izad056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 04/20/2023]
Abstract
BACKGROUND Web-based portals can enhance communication between patients and providers to support IBD self-management and improve care. We aimed to identify portal use patterns of patients with inflammatory bowel disease (IBD) to inform future web portal-based interventions and portal design. METHODS Patients with IBD receiving care at the University of Michigan between 2012 and 2021 were identified. Meta-data from electronic logs of each patient's most recent year of portal use were abstracted. Portal engagement was characterized in terms of intensity (ie, frequency of use); comprehensiveness (ie, number of portal functions used); and duration (ie, quarters per year of portal use). We used k-means clustering, a machine-learning technique, to identify groupings of portal users defined in terms of engagement features. RESULTS We found 5605 patients with IBD who had accessed their portal account at least once. The average age was 41.2 years (SD 16.7), 3035 (54.2%) were female, and 2214 (39.5%) received immune-targeted therapies. We identified 3 patterns of portal engagement: (1) low intensity users (29.5%); (2) moderate intensity, comprehensive, and sustained users (63.3%); and (3) high intensity, comprehensive, sustained users (7.2%). Patients with more intense, comprehensive, and sustained use of the portal were older, female, with more comorbidities, and were more likely to receive immune-targeted therapies. CONCLUSION Understanding distinct patterns of portal use can inform portal-based interventions and portal design. Patient portals may be particularly helpful in delivering assistance to those with comorbidities and those receiving immune-targeted therapies-many of whom demonstrate more intense, comprehensive, and sustained portal use.
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Affiliation(s)
- Mohamed Noureldin
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Kira L Newman
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - John D Piette
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health care System, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jeremy Louissaint
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brooke Kenney
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Jeffrey Berinstein
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health care System, Ann Arbor, MI, USA
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health care System, Ann Arbor, MI, USA
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Lim WL, Koh YLE, Tan ZE, Tan YQ, Tan NC. Self-Efficacy in Patients With Hypertension and Their Perceived Usage of Patient Portals. J Prim Care Community Health 2024; 15:21501319231224253. [PMID: 38212904 PMCID: PMC10785728 DOI: 10.1177/21501319231224253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Self-efficacy in individuals optimizes their hypertension management. Electronic patient portals are being increasingly used to support chronic disease management, as they raise the health literacy of patients and enable them in self-management. However, the association between the use of patient portals and self-efficacy in hypertension management remains unclear. The study aimed to determine the association between self-efficacy among patients with hypertension who are managed in primary care and their demographic characteristics and usage patterns of patient portals. METHOD A cross-sectional survey was conducted at a public primary care clinic in urban Singapore. Multi-ethnic adult patients with hypertension were invited to participate in a self-administered electronic questionnaire. Chi-square test was performed for bivariate analysis; adjusted logistic regression models were used for factors with P value <.1. RESULTS A total of 310 patients (66.8% Chinese, 55.5% males, mean age of 63.1 years) completed the survey. Patient portal users had higher self-efficacy scores than non-users (mean score=63 vs 60, maximum = 80, P = .011). The factors associated with increased patient portal access included younger age <65 years (absolute odds ratio [AOR] = 2.634, 95%CI = 1.432-4.847; P = .002), monthly income >$5000 (AOR = 2.324, 95%CI = 1.104-4.892; P = .026), and post-secondary education level (AOR = 3.128, 95%CI = 1.675-5.839; P < .001). Most patients (93.1%) used the portal to check medical appointments but only1.3% of them used it to record home blood pressure measurements (HBPM). CONCLUSIONS Patient portal usage was associated with higher self-efficacy scores in patients with hypertension. These users were younger, more educated, and earned more than the non-users, but only 1.3% of them used it for HBPM documentation.
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Affiliation(s)
| | | | - Zhi En Tan
- SingHealth Polyclinics, Singapore, Singapore
| | - Yu Quan Tan
- SingHealth Polyclinics, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Fridriksdottir N, Ingadottir B, Skuladottir K, Zoëga S, Gunnarsdottir S. Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study. JMIR Form Res 2023; 7:e50550. [PMID: 38015268 PMCID: PMC10770793 DOI: 10.2196/50550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. OBJECTIVE This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. METHODS This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. RESULTS The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. CONCLUSIONS This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.
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Affiliation(s)
- Nanna Fridriksdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Kristin Skuladottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigridur Zoëga
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Sigridur Gunnarsdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- Cancer Registry, The Icelandic Cancer Society, Reykjavik, Iceland
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20
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Matthews AK, Steffen A, Burke L, Harris Vilona B, Donenberg G. MiQuit: A Study Protocol to Link Low-Income Smokers to a State Tobacco Quitline. Ethn Dis 2023; DECIPHeR:44-51. [PMID: 38846727 PMCID: PMC11099521 DOI: 10.18865/ed.decipher.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Purpose To conduct a randomized controlled trial to compare 3 implementation strategies and the impact of facilitated referrals on linkage of Federally Qualified Health Center patients to the Illinois Tobacco Quitline (ITQL). Methods This study will be a hybrid type 3 implementation-effectiveness trial guided by 2 implementation science frameworks: reach, effectiveness, adoption, implementation, and maintenance and exploration preparation implementation sustainment. We will evaluate whether sending provider messages through the patient electronic health portal increases patient linkage to the ITQL. We will (1) randomly assign all eligible patients to receive 1 of 3 messages (information about quitting, advice to quit, and advice to quit or cut down), and (2) we will offer a facilitated linkage to the ITQL. For patients who opt into a facilitated referral, we will share their contact information with the ITQL, who will contact them. Four weeks after the initial message, patients who expressed interest in services but were not reached by the ITQL will be rerandomized to 1 of 2 arms, an offer to reconnect to the ITQL or an offer to engage a peer navigator who can help them reconnect to the ITQL. We will assess the implementation strategies' reach, adoption, linkage, and sustainability with the ITQL. Discussion This study will provide a new cost-effective and efficient model to link low-income smokers to state tobacco quitlines. Message delivery via patient health portals has important implications for addressing other tobacco-related morbidities.
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Affiliation(s)
- Alicia K. Matthews
- Behavioral Science, School of Nursing, Columbia University, New York, NY
| | - Alana Steffen
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Larisa Burke
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Brittany Harris Vilona
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
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21
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Sands DZ. Beyond the EHR: How Digital Health Tools Foster Participatory Health and Self-Care for Patients with Diabetes. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100043. [PMID: 39035248 PMCID: PMC11256240 DOI: 10.1016/j.ajmo.2023.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/27/2023] [Indexed: 07/23/2024]
Abstract
Just as physicians managing patients with diabetes find that it is a data-driven process, for patients living with diabetes, it is even more so, as physicians see them every few months, but patients need to live with diabetes all the time. Fortunately, the advent of the web has allowed patients to connect with information, medical care, and other patients, while mobile and connected technologies such as smartphones have provided the flexibility to do this-and to manage and share their health information-from anywhere. Healthcare professionals who care for patients with diabetes should be aware of the digital health technologies that enable patients to better care for themselves, be more active participants in their healthcare, and improve the quality of their lives.
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Affiliation(s)
- Daniel Z. Sands
- Beth Israel Deaconess Medical Center, Harvard Medical School, Society for Participatory Medicine, Boston, Mass
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22
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Gleason KT, Wu MMJ, Wec A, Powell DS, Zhang T, Gamper MJ, Green AR, Nothelle S, Amjad H, Wolff JL. Use of the patient portal among older adults with diagnosed dementia and their care partners. Alzheimers Dement 2023; 19:5663-5671. [PMID: 37354066 PMCID: PMC10808947 DOI: 10.1002/alz.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis. METHODS We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients. RESULTS Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%). DISCUSSION The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access.
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Affiliation(s)
- Kelly T. Gleason
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Mingche M. J. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle S. Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talan Zhang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ariel R. Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
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Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
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24
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Alturkistani A, Greenfield G, Beaney T, Norton J, Costelloe CE. Cross-sectional analyses of online appointment booking and repeat prescription ordering user characteristics in general practices of England in the years 2018-2020. BMJ Open 2023; 13:e068627. [PMID: 37827735 PMCID: PMC10583059 DOI: 10.1136/bmjopen-2022-068627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To explore the characteristics of the General Practice Patient Survey (GPPS) respondents using the different functionalities of the online services in the context of England's National Health Service General Practices. We hypothesised that respondents who are older, with lower socioeconomic status and non-white ethnicity would be less likely to use online services, while long-term conditions might increase their usage. DESIGN Cross-sectional study using respondent-level data from the GPPS in England of the years 2018, 2019 and 2020. We assessed the association between online services use and respondent characteristics using two-level mixed-effects logistic regression. PARTICIPANTS Survey respondents of the GPPS 2018-2020. PRIMARY OUTCOME MEASURES Online appointment booking and online repeat prescription ordering. RESULTS 1 807 049 survey respondents were included in this study. 15% (n=263 938) used online appointment booking in the previous 12 months, and 19% (n=339 449) had ordered a repeat prescription in the previous 12 months. Respondents with a long-term condition, on regular multiple medications, who have deafness or hearing loss and who are from the lowest deprivation quintile were more likely to have used online services. Male respondents (compared with females) and respondents with black and other ethnicity compared with white ethnicity were less likely to use online services. Respondents over 85 years old were less likely to use online appointment booking and online repeat prescription ordering compared with the younger age groups. CONCLUSIONS Specific groups of respondents were more likely to use online services such as patients with long-term conditions or those with deafness or hearing loss. While online services could provide efficiency to patients and practices it is essential that alternatives continue to be provided to those that cannot use or choose not to use online services. Understanding the different patients' needs could inform solutions to increase the uptake and use of the services.
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Affiliation(s)
- Abrar Alturkistani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Norton
- Applied Research Collaboration Northwest London, National Institute for Health Research, London, UK
| | - Ceire E Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Division of Clinical Studies, Institute of Cancer Research, London, UK
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25
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Zhao X, Cai X, Malterud A. Framing Effects in Youth E-Cigarette Use Prevention: Individual Text Messages Versus Simulated Text Exchanges. HEALTH EDUCATION & BEHAVIOR 2023; 50:683-692. [PMID: 36722218 DOI: 10.1177/10901981221148965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Electronic cigarettes are the most widely used tobacco product among youth in the United States. Although rapidly growing, research on effective message strategies for e-cigarette use prevention is still limited. This study examined the relative effectiveness of gain framing versus loss framing in youth-targeting prevention text messages delivered either as individual expository texts or simulated text exchanges between a youth patient and a pediatrician. A national sample of 1,084 youth susceptible to future e-cigarette use was randomized to condition in an online message testing experiment featuring a 2 (framing: gain vs. loss) × 2 (format: individual texts vs. simulated exchange) factorial design. Results revealed a consistent interaction between framing and messaging format in message liking, positive affect, attitude toward e-cigarette use, and future e-cigarette use intentions. The gain frame outperformed the loss frame in the simulated exchange conditions while the reverse trend was true for the individual text conditions. Furthermore, the main effect of messaging format was significant on multiple outcomes in favor of simulated text exchanges. The main effect of framing was only significant on negative affective response with the loss frame eliciting stronger responses. These findings suggest that the relative effectiveness of gain framing versus loss framing depends on how messages are presented in youth-targeting text messaging interventions. When messages are likely to be delivered in a discrete manner, the loss frame should be preferred. When greater interactivity and narrative development are possible, the gain frame should be favored. E-cigarette prevention efforts should leverage these insights to enhance message effectiveness.
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26
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Chang H, Choi JY, Shim J, Kim M, Choi M. Benefits of Information Technology in Healthcare: Artificial Intelligence, Internet of Things, and Personal Health Records. Healthc Inform Res 2023; 29:323-333. [PMID: 37964454 PMCID: PMC10651408 DOI: 10.4258/hir.2023.29.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Systematic evaluations of the benefits of health information technology (HIT) play an essential role in enhancing healthcare quality by improving outcomes. However, there is limited empirical evidence regarding the benefits of IT adoption in healthcare settings. This study aimed to review the benefits of artificial intelligence (AI), the internet of things (IoT), and personal health records (PHR), based on scientific evidence. METHODS The literature published in peer-reviewed journals between 2016 and 2022 was searched for systematic reviews and meta-analysis studies using the PubMed, Cochrane, and Embase databases. Manual searches were also performed using the reference lists of systematic reviews and eligible studies from major health informatics journals. The benefits of each HIT were assessed from multiple perspectives across four outcome domains. RESULTS Twenty-four systematic review or meta-analysis studies on AI, IoT, and PHR were identified. The benefits of each HIT were assessed and summarized from a multifaceted perspective, focusing on four outcome domains: clinical, psycho-behavioral, managerial, and socioeconomic. The benefits varied depending on the nature of each type of HIT and the diseases to which they were applied. CONCLUSIONS Overall, our review indicates that AI and PHR can positively impact clinical outcomes, while IoT holds potential for improving managerial efficiency. Despite ongoing research into the benefits of health IT in line with advances in healthcare, the existing evidence is limited in both volume and scope. The findings of our study can help identify areas for further investigation.
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Affiliation(s)
- Hyejung Chang
- Department of Management, School of Management, Kyung Hee University, Seoul,
Korea
| | - Jae-Young Choi
- Department of Business Administration, College of Business, Hallym University, Chuncheon,
Korea
| | - Jaesun Shim
- Department of Municipal Hospital Policy & Management, Seoul Health Foundation, Seoul,
Korea
| | - Mihui Kim
- Department of Nursing Science, Jeonju University, Jeonju,
Korea
| | - Mona Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul,
Korea
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27
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Gleason KT, Powell DS, Wec A, Zou X, Gamper MJ, Peereboom D, Wolff JL. Patient portal interventions: a scoping review of functionality, automation used, and therapeutic elements of patient portal interventions. JAMIA Open 2023; 6:ooad077. [PMID: 37663406 PMCID: PMC10469545 DOI: 10.1093/jamiaopen/ooad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives We sought to understand the objectives, targeted populations, therapeutic elements, and delivery characteristics of patient portal interventions. Materials and Methods Following Arksey and O-Malley's methodological framework, we conducted a scoping review of manuscripts published through June 2022 by hand and systematically searching PubMed, PSYCHInfo, Embase, and Web of Science. The search yielded 5403 manuscripts; 248 were selected for full-text review; 81 met the eligibility criteria for examining outcomes of a patient portal intervention. Results The 81 articles described: trials involving comparison groups (n = 37; 45.7%), quality improvement initiatives (n = 15; 18.5%), pilot studies (n = 7; 8.6%), and single-arm studies (n = 22; 27.2%). Studies were conducted in primary care (n = 33, 40.7%), specialty outpatient (n = 24, 29.6%), or inpatient settings (n = 4, 4.9%)-or they were deployed system wide (n = 9, 11.1%). Interventions targeted specific health conditions (n = 35, 43.2%), promoted preventive services (n = 19, 23.5%), or addressed communication (n = 19, 23.4%); few specifically sought to improve the patient experience (n = 3, 3.7%). About half of the studies (n = 40, 49.4%) relied on human involvement, and about half involved personalized (vs exclusively standardized) elements (n = 42, 51.8%). Interventions commonly collected patient-reported information (n = 36, 44.4%), provided education (n = 35, 43.2%), or deployed preventive service reminders (n = 14, 17.3%). Discussion This scoping review finds that most patient portal interventions have delivered education or facilitated collection of patient-reported information. Few interventions have involved pragmatic designs or been deployed system wide. Conclusion The patient portal is an important tool in real-world efforts to more effectively support patients, but interventions to date rely largely on evidence from consented participants rather than pragmatically implemented systems-level initiatives.
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Affiliation(s)
- Kelly T Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD 21225, United States
| | - Danielle S Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Xingyuan Zou
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, MD 21225, United States
| | - Danielle Peereboom
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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28
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Chivela FL, Burch AE, Asagbra O. An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis. J Med Internet Res 2023; 25:e44399. [PMID: 37526967 PMCID: PMC10427930 DOI: 10.2196/44399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. OBJECTIVE This study aimed to explore the factors associated with portal messaging use by rural patients. METHODS We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. RESULTS A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. CONCLUSIONS Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.
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Affiliation(s)
- Fernando L Chivela
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Oghale Asagbra
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
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29
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Son EH, Nahm ES. Adult Patients' Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study. JMIR Hum Factors 2023; 10:e46044. [PMID: 37490316 PMCID: PMC10411420 DOI: 10.2196/46044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. OBJECTIVE The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. METHODS This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. RESULTS The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. CONCLUSIONS This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals.
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Affiliation(s)
- Elisa H Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Eun-Shim Nahm
- Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
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Wynn CS, Fiks AG, Localio R, Shults J, Nekrasova E, Shone LP, Torres A, Griffith M, Unger R, Ware LA, Kelly MK, Stockwell MS. Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study. JMIR Form Res 2023; 7:e39576. [PMID: 37389945 PMCID: PMC10365607 DOI: 10.2196/39576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. OBJECTIVE We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. METHODS As part of a National Institutes of Health (NIH)-funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. RESULTS Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference -7.2%, 95% CI -27.1 to -1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. CONCLUSIONS In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings.
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Affiliation(s)
- Chelsea S Wynn
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Alexander G Fiks
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Russell Localio
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Ekaterina Nekrasova
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Laura P Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Miranda Griffith
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Rebecca Unger
- Northwestern Children's Practice, Chicago, IL, United States
| | - Leigh Ann Ware
- Building Blocks Pediatrics, Pleasanton, TX, United States
| | - Mary Kate Kelly
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
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Cascini F, Gentili A, Causio FA, Altamura G, Melnyk A, Beccia F, Pappalardo C, Lontano A, Ricciardi W. Strengthening and promoting digital health practice: results from a Global Digital Health Partnership's survey. Front Public Health 2023; 11:1147210. [PMID: 37404277 PMCID: PMC10315462 DOI: 10.3389/fpubh.2023.1147210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
Background and objective The capacity to promote and disseminate the best evidence-based practices in terms of digital health innovations and technologies represents an important goal for countries and governments. To support the digital health maturity across countries the Global Digital Health Partnership (GDHP) was established in 2019. The mission of the GDHP is to facilitate global collaboration and knowledge-sharing in the design of digital health services, through the administration of surveys and white papers. Objective The scope of this study is to critically analyze and discuss results from the Evidence and Evaluation GDHP Work Stream's survey, understand how governments and countries intend to address main obstacles to the digital health implementation, identify their strategies for a communication of effective digital health services, and promote the sharing of international based best practices on digital health. Methods This survey followed a cross-sectional study approach. A multiple-choice questionnaire was designed to gather data. Choices were extracted from research publications retrieved through a rapid review. Results Out of 29 countries receiving the survey, 10 returned it. On a scale from 1 to 5, eHealth systems/platforms (mean = 3.56) were indicated as the most important tool for centralized infrastructure to collect information on digital health, while primary care (mean = 4.0) represented the most voted item for healthcare services to collect information on digital health. Seven Countries out of 10 identified lack of organization, skepticism of clinicians, and accessibility of the population as a barriers to adopt digital health implementation, resulting to be the most voted items. Finally, the most endorsed priorities in digital health for Countries were the adoption of data-driven approaches (6 Countries), and telehealth (5 Countries). Conclusion This survey highlighted the main tools and obstacles for countries to promote the implementation of evidence-based digital health innovations. Identifying strategies that would communicate the value of health care information technology to healthcare professionals are particularly imperative. Effective communication programs for clinicians and the general population in addition to improved digital health literacy (both for clinicians and citizens) will be the key for the real implementation of future digital health technologies.
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Thielmann RRLC, Hoving C, Cals JWL, Crutzen R. The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study. J Med Internet Res 2023; 25:e47659. [PMID: 37266981 DOI: 10.2196/47659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. OBJECTIVE This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. METHODS A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. RESULTS Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. CONCLUSIONS Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.
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Affiliation(s)
- Rosa R L C Thielmann
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jochen W L Cals
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Ganta T, Appel JM, Genes N. Patient portal access for caregivers of adult and geriatric patients: reframing the ethics of digital patient communication. JOURNAL OF MEDICAL ETHICS 2023; 49:156-159. [PMID: 35437282 DOI: 10.1136/medethics-2021-107759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information-a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in patient privacy and confidentiality if not managed properly through proxy accounts. We present an ethical framework that guides policy and clinical workflow development for healthcare institutions to support the best use of patient portals. Caregivers are vital members of the care team and should be supported through novel forms of health information technology (IT). Patients, however, may not want all information to be shared with their proxies so healthcare institutions must support the development and use of separate proxy accounts as opposed to using the patient's own account as well provide controls for limiting the scope of information displayed in the proxy accounts. Lastly, as socioeconomic barriers to adoption of health IT persist, healthcare providers must work to ensure multiple streams of patient communication, to prevent further propagating health inequities.
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Affiliation(s)
- Teja Ganta
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob M Appel
- Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicholas Genes
- Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
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Does neurocognition contribute to age-related deficits in the online navigation of electronic patient health portals? J Int Neuropsychol Soc 2023:1-8. [PMID: 36756762 DOI: 10.1017/s1355617722000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The internet serves an increasingly critical role in how older adults manage their personal health. Electronic patient portals, for example, provide a centralized platform for older adults to access lab results, manage prescriptions and appointments, and communicate with providers. This study examined whether neurocognition mediates the effect of older age on electronic patient portal navigation. METHOD Forty-nine younger (18-35 years) and 35 older adults (50-75 years) completed the Test of Online Health Records Navigation (TOHRN), which is an experimenter-controlled website on which participants were asked to log-in, review laboratory results, read provider messages, and schedule an appointment. Participants also completed a neuropsychological battery, self-report questionnaires, and measures of health literacy and functional capacity. RESULTS Mediation analyses revealed a significant indirect effect of older age on lower TOHRN accuracy, which was fully mediated by the total cognitive composite. CONCLUSIONS Findings indicate that neurocognition may help explain some of the variance in age-related difficulties navigating electronic patient health portals. Future studies might examine the possible benefits of both structural (e.g., human factors web design enhancement) and individual (e.g., training and compensation) cognitive supports to improve the navigability of electronic patient health portals for older adults.
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Miller HN, Lindo S, Fish LJ, Roberts J, Stover J, Schwark EH, Eberlein N, Mack D, Falkovic M, Makarushka C, Chatterjee R. Describing current use, barriers, and facilitators of patient portal messaging for research recruitment: Perspectives from study teams and patients at one institution. J Clin Transl Sci 2023; 7:e96. [PMID: 37125060 PMCID: PMC10130833 DOI: 10.1017/cts.2023.522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The electronic health record (EHR) and patient portal are used increasingly for clinical research, including patient portal recruitment messaging (PPRM). Use of PPRM has grown rapidly; however, best practices are still developing. In this study, we examined the use of PPRM at our institution and conducted qualitative interviews among study teams and patients to understand experiences and preferences for PPRM. Methods We identified study teams that sent PPRMs and patients that received PPRMs in a 60-day period. We characterized these studies and patients, in addition to the patients' interactions with the PPRMs (e.g., viewed, responded). From these groups, we recruited study team members and patients for semi-structured interviews. A pragmatic qualitative inquiry framework was used by interviewers. Interviews were audio-recorded and analyzed using a rapid qualitative analysis exploratory approach. Results Across ten studies, 35,037 PPRMs were sent, 33% were viewed, and 17% were responded to. Interaction rates varied across demographic groups. Six study team members completed interviews and described PPRM as an efficient and helpful recruitment method. Twenty-eight patients completed interviews. They were supportive of receiving PPRMs, particularly when the PPRM was relevant to their health. Patients indicated that providing more information in the PPRM would be helpful, in addition to options to set personalized preferences. Conclusions PPRM is an efficient recruitment method for study teams and is acceptable to patients. Engagement with PPRMs varies across demographic groups, which should be considered during recruitment planning. Additional research is needed to evaluate and implement recommended changes by study teams and patients.
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Affiliation(s)
| | - Sierra Lindo
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Laura J. Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - John Stover
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Nicholas Eberlein
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Dalia Mack
- Duke University School of Medicine, Durham, NC 27710, USA
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Ranee Chatterjee
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, NC 27710, USA
- Address for correspondence: R. Chatterjee, MD, MPH, 710 W. Main Street, 1st floor, Durham, NC 27701, USA.
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Development, implementation and evaluation of the digital transformation of renal services in Wales: the journey from local to national. Int J Clin Pharm 2023; 45:4-16. [PMID: 36306061 PMCID: PMC9614750 DOI: 10.1007/s11096-022-01466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment for people with kidney disease is often associated with complicated combinations of medicines. Logistical challenges with traditiona paper-based prescribing means that these patients are particularly susceptible to medication-relation errors and harm. AIM To improve the quality of care that people with kidney disease receive across Wales through a Value-Based digital transformation programme. SETTING Renal units within the National Welsh Renal Clinical Network (WRCN). DEVELOPMENT A novel Electronic Prescribing & Medicines Administration (EPMA) system, integrated into a patient care record and linked to a patient portal was developed in South West Wales (SWW) region of the WRCN, enabled by the Welsh Government (WG) Efficiency Through Technology Fund. National upscale was enabled through the WG Transformation Fund. IMPLEMENTATION EPMA was designed and rolled out initially in SWW region of the WRCN (2018). A dedicated delivery team used the blueprint to finalise and implement a strategy for successful national roll-out eventually across all Wales (completed 2021). EVALUATION A multi-factorial approach was employed, as both the technology itself and the healthcare system within which it would be introduced, were complex. Continuous cycles of action research involving informal and formal qualitative interviews with service-users ensured that EPMA was accessible and optimally engaging to all target stakeholders (patients and staff). Results confirmed that EPMA was successful in improving the quality of care that people with kidney disease receive across Wales, contributed to Value-Based outcomes, and put people who deliver and access care at the heart of transformation. CONCLUSION Key findings of this study align directly with the national design principles to drive change and transformation, put forward by the WG in their plan for Health and Social Care: prevention and early intervention; safety; independence; voice; seamless care.
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Brands MR, Gouw SC, Beestrum M, Cronin RM, Fijnvandraat K, Badawy SM. Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review. J Med Internet Res 2022; 24:e43086. [PMID: 36548034 PMCID: PMC9816956 DOI: 10.2196/43086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. OBJECTIVE We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. METHODS We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. RESULTS Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. CONCLUSIONS The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.
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Affiliation(s)
- Martijn R Brands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Molly Beestrum
- Galter Health Sciences Library at Northwestern University, Chicago, IL, United States
| | - Robert M Cronin
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Using a Machine Learning Algorithm to Predict Online Patient Portal Utilization: A Patient Engagement Study. Online J Public Health Inform 2022; 14:e8. [PMID: 36685053 PMCID: PMC9831291 DOI: 10.5210/ojphi.v14i1.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective There is a low rate of online patient portal utilization in the U.S. This study aimed to utilize a machine learning approach to predict access to online medical records through a patient portal. Methods This is a cross-sectional predictive machine learning algorithm-based study of Health Information National Trends datasets (Cycles 1 and 2; 2017-2018 samples). Survey respondents were U.S. adults (≥18 years old). The primary outcome was a binary variable indicating that the patient had or had not accessed online medical records in the previous 12 months. We analyzed a subset of independent variables using k-means clustering with replicate samples. A cross-validated random forest-based algorithm was utilized to select features for a Cycle 1 split training sample. A logistic regression and an evolved decision tree were trained on the rest of the Cycle 1 training sample. The Cycle 1 test sample and Cycle 2 data were used to benchmark algorithm performance. Results Lack of access to online systems was less of a barrier to online medical records in 2018 (14%) compared to 2017 (26%). Patients accessed medical records to refill medicines and message primary care providers more frequently in 2018 (45%) than in 2017 (25%). Discussion Privacy concerns, portal knowledge, and conversations between primary care providers and patients predict portal access. Conclusion Methods described here may be employed to personalize methods of patient engagement during new patient registration.
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Griffin AC, Troszak LK, Van Campen J, Midboe AM, Zulman DM. Tablet distribution to veterans: an opportunity to increase patient portal adoption and use. J Am Med Inform Assoc 2022; 30:73-82. [PMID: 36269168 PMCID: PMC9748532 DOI: 10.1093/jamia/ocac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals. MATERIALS AND METHODS This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA's My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions. RESULTS In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01). CONCLUSION Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
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Affiliation(s)
- Ashley C Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Lara K Troszak
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amanda M Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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Cross DA, Adler-Milstein J, Holmgren AJ. Management Opportunities and Challenges After Achieving Widespread Health System Digitization. Adv Health Care Manag 2022; 21:67-87. [PMID: 36437617 DOI: 10.1108/s1474-823120220000021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery - demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with - particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave - the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks.
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Gleason KT, Peereboom D, Wec A, Wolff JL. Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review. JAMA Netw Open 2022; 5:e2248696. [PMID: 36576738 PMCID: PMC9857556 DOI: 10.1001/jamanetworkopen.2022.48696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Family and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood. OBJECTIVE To inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners' uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners' portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners' portal use. EVIDENCE REVIEW Following Arksey and O'Malley's methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included. FINDINGS Few adult patient portal accounts had 1 or more formally registered care partners (<3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported >30% use). Care partners less often authored portal messages with their own identity credentials (<3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles). CONCLUSIONS AND RELEVANCE In this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.
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Affiliation(s)
| | | | - Aleksandra Wec
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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MacEwan SR, Sieck CJ, McAlearney AS. Geographic Location Impacts Patient Portal Use via Desktop and Mobile Devices. J Med Syst 2022; 46:97. [PMID: 36383266 DOI: 10.1007/s10916-022-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
Disparities in patient portal use are impacted by individuals' access to technology and the internet as well as their skills and health behaviors. An individual's geographic location may impact these factors as well as contribute to their decision to use a portal, their choice of device to access the portal, and their use of portal functions. This study evaluated patient portal use by geographic location according to three comparators: proximity to the medical center offering the portal, urban/rural classification, and degree of digital distress. Patients residing farther from the medical center, in rural areas, or in areas of higher digital distress were less likely to be active portal users. Patients in areas of higher digital distress were more likely to use the mobile portal application instead of the desktop portal website alone. Users of the mobile portal application used portal functions more frequently, and being a mobile user had a greater impact on the use of some portal functions by patients residing in areas of higher digital distress. Mobile patient portal applications have the potential to increase portal use, but work is needed to ensure equitable internet access, to promote mobile patient portal applications, and to cultivate individuals' skills to use portals.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA.
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Cynthia J Sieck
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for Health Equity, Dayton Children's Hospital, Dayton, OH, USA
| | - Ann Scheck McAlearney
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Ganeshan S, Pierce L, Mourad M, Judson TJ, Kohli MD, Odisho AY, Brown W. Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities. J Am Med Inform Assoc 2022; 29:2096-2100. [PMID: 36063414 PMCID: PMC9667186 DOI: 10.1093/jamia/ocac152] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
While many case studies have described the implementation of self-scheduling tools, which allow patients to schedule visits and imaging studies asynchronously online, none have explored the impact of self-scheduling on equitable access to care.1 Using an electronic health record patient portal, University of California San Francisco deployed a self-scheduling tool that allowed patients to self-schedule diagnostic imaging studies. We analyzed electronic health record data for the imaging modalities with the option to be self-scheduled from January 1, 2021 to September 1, 2021. We used descriptive statistics to compare demographic characteristics and created a multivariable logistic regression model to identify predictors of patient self-scheduling utilization. Among all active patient portal users, Latinx, Black/African American, and non-English speaking patients were less likely to self-schedule studies. Patients with Medi-Cal, California's Medicaid program, and Medicare insurance were also less likely to self-schedule when compared with commercially insured patients. Efforts to facilitate use of patient portal-based applications are necessary to increase equitability and decrease disparities in access.
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Affiliation(s)
- Smitha Ganeshan
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Logan Pierce
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michelle Mourad
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Timothy J Judson
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Marc D Kohli
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anobel Y Odisho
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - William Brown
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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Sun CA, Perrin N, Maruthur N, Renda S, Levin S, Han HR. Predictors of Follow-Up Appointment No-Shows Before and During COVID Among Adults with Type 2 Diabetes. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chun-An Sun
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nisa Maruthur
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Renda
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Scott Levin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR Cancer 2022; 8:e34851. [PMID: 35969424 PMCID: PMC9412760 DOI: 10.2196/34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. OBJECTIVE The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. RESULTS The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
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Affiliation(s)
- Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Bruce W Robb
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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Kho A, Daumit GL, Truesdale KP, Brown A, Kilbourne AM, Ladapo J, Wali S, Cicutto L, Matthews AK, Smith JD, Davis PD, Schoenthaler A, Ogedegbe G, Islam N, Mills KT, He J, Watson KS, Winn RA, Stevens J, Huebschmann AG, Szefler SJ. The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance. Health Serv Res 2022; 57 Suppl 1:20-31. [PMID: 35383917 PMCID: PMC9108215 DOI: 10.1111/1475-6773.13983] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease. STUDY SETTING NHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma. STUDY DESIGN The initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration. CONCLUSIONS The DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.
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Affiliation(s)
- Abel Kho
- Center for Health Information Partnerships (CHiP)Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly P. Truesdale
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Arleen Brown
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Amy M. Kilbourne
- Department of Learning Health SciencesUniversity of Michigan MedicineAnn ArborMichiganUSA
- Quality Enhancement Research Initiative (QUERI)U.S. Department of Veterans AffairsWashington, D.C.USA
| | - Joseph Ladapo
- Department of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Soma Wali
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Lisa Cicutto
- Department of MedicineNational Jewish Health, Community Outreach and ResearchDenverColoradoUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Paris D. Davis
- Total Resource Community Development OrganizationNorthwestern UniversityChicagoIllinoisUSA
| | - Antoinette Schoenthaler
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Gbenga Ogedegbe
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Nadia Islam
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Katherine T. Mills
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Karriem S. Watson
- NIH All of Us Bethesda, MD; FormerlyUniversity of Illinois in Chicago Hospital and Health Sciences System, Mile Square Health Center ChicagoIllinoisUSA
| | - Robert A. Winn
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Amy G. Huebschmann
- Department of Medicine, Division of General Internal MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Stanley J. Szefler
- Department of PediatricsUniversity of Colorado Denver School of MedicineDenverColoradoUSA
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Hatch B, Tillotson C, Hoopes M, Huguet N, Marino M, DeVoe J. Patient-level factors associated with receipt of preventive care in the safety net. Prev Med 2022; 158:107024. [PMID: 35331782 PMCID: PMC9231228 DOI: 10.1016/j.ypmed.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Prevention is critical to optimizing health, yet most people do not receive all recommended preventive services. As the complexity of preventive recommendations increases, there is a need for new measurements to capture the degree to which a person is up to date, and identify individual-level barriers and facilitators to receiving needed preventive care. We used electronic health record data from a national network of community health centers (CHCs) in the United States (US) during 2014-2017 to measure patient-level up-to-date status with preventive ratios (measuring up-to-date person-time denoted as a percent) for 12 preventive services and an aggregate preventive index. We use negative binomial regression to identify factors associated with up-to-date preventive care. We assessed 267,767 patients across 165 primary care clinics. Mean preventive ratios ranged from 8.7% for Hepatitis C screening to 83.3% for blood pressure screening. The mean aggregate preventive index was 43%. Lack of health insurance, smoking, and homelessness were associated with lower preventive ratios for most cancer and cardiovascular screenings (p < 0.05). Having more ambulatory visits, better continuity of care, and enrollment in the patient portal were positively associated with the aggregate preventive index (p < 0.05) and higher preventive ratios for all services (p < 0.05) except chlamydia and HIV screening. Overall, receipt of preventive services was low. CHC patients experience many barriers to receiving needed preventive care, but certain healthcare behaviors - regular visits, usual provider continuity, and patient portal enrollment - were consistently associated with more up-to-date preventive care. These associations should inform future efforts to improve preventive care delivery.
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Affiliation(s)
- Brigit Hatch
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America; OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America.
| | - Carrie Tillotson
- OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America
| | - Megan Hoopes
- OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America
| | - Nathalie Huguet
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America; Oregon Health & Science University-Portland State University, School of Public Health, Biostatistics Group, United States of America
| | - Jennifer DeVoe
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
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Di Tosto G, Walker DM, Sieck CJ, Wallace L, MacEwan SR, Gregory ME, Scarborough S, Huerta TR, McAlearney AS. Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use. Appl Clin Inform 2022; 13:692-699. [PMID: 35793698 DOI: 10.1055/s-0042-1751239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The objective of this study is to investigate the relationships between health literacy and numeracy (HLN) and patient portal use, measured in inpatient and outpatient settings. METHODS Using data collected as part of a pragmatic randomized controlled trial conducted across the inpatient population of a U.S.-based academic medical center, the present study evaluated the relationships between patients' perceptions of health literacy and their skills, interpreting medical information with metrics of engagement with patient portals. RESULTS Self-reported levels of HLN for patients in the study sample (n = 654) were not significantly associated with inpatient portal use as measured by frequency of use or the number of different inpatient portal functions used. Use of the outpatient version of the portal over the course of 6 months following hospital discharge was also not associated with HLN. A subsequent assessment of patients after 6 months of portal use postdischarge (response rate 40%) did not reveal any differences with respect to portal use and health numeracy; however, a significant increase in self-reported levels of health literacy was found at this point. CONCLUSION While previous studies have suggested that low HLN might represent a barrier to inpatient portal adoption and might limit engagement with outpatient portals, we did not find these associations to hold. Our findings, however, suggest that the inpatient setting may be effective in facilitating technology acceptance. Specifically, the introduction of an inpatient portal made available on hospital-provided tablets may have practical implications and contribute to increased adoption of patient-facing health information technology tools.
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Affiliation(s)
- Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia J Sieck
- Center for Health Equity, Dayton Children's Hospital, Dayton, Ohio, United States
| | - Lorraine Wallace
- Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Megan E Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Seth Scarborough
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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Cross DA, Adler-Milstein J. Progress toward Digital Transformation in an Evolving Post-acute Landscape. Innov Aging 2022; 6:igac021. [PMID: 35712324 PMCID: PMC9196682 DOI: 10.1093/geroni/igac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Digitization has been a central pillar of structural investments to promote organizational capacity for transformation, and yet skilled nursing facilities (SNFs) and other post-acute providers have been excluded and/or delayed in benefitting from the past decade of substantial public and private sector investment in information technology (IT). These settings have limited internal capacity and resources to invest in digital capabilities on their own, propagating a limited infrastructure that may only further sideline SNFs and their role in an ever-evolving healthcare landscape that needs to be focused on age-friendly, high-value care. Meaningful progress will require continuous refinement of supportive policy, financial investment, and scalable organizational best practices specific to the SNF context. In this essay, we lay out an action agenda to move from age-agnostic to age-friendly digital transformation. Key to the value proposition of these efforts is a focus on interoperability- the seamless exchange of electronic health information across settings that is critical for care coordination and for providers to have the information they need to make safe and appropriate care decisions. Interoperability is not synonymous with digital transformation, but a foundational building block for its potential. We characterize the current state of digitization in SNFs in the context of key health IT policy advancements over the past decade, identifying ongoing and emergent policy work where the digitization needs of SNFs and other post-acute settings can be better addressed. We also discuss accompanying implementation considerations and strategies for optimally translating policy efforts into impactful practice change across an ever-evolving post-acute landscape. Acting on these insights at the policy and practice level provides cautious optimism that nursing home care – and care for older adults across the care continuum – may benefit more equitably from the promise of future digitization.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
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50
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Effect of Sociodemographic Factors on Utilization of an Online Patient Portal to Self-Schedule Screening Mammography: A Cross-Sectional Study. J Am Coll Radiol 2022; 19:866-873. [DOI: 10.1016/j.jacr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/26/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022]
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