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Ko SMA, Warm EJ, Schauer DP, Ko DG. Secure Messaging Use Among Patients with Depression: An Analysis Using Real-World Data. Telemed J E Health 2024. [PMID: 38916859 DOI: 10.1089/tmj.2024.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: Although depression is one of the most common mental health disorders outpacing other diseases and conditions, poor access to care and limited resources leave many untreated. Secure messaging (SM) offers patients an online means to bridge this gap by communicating nonurgent medical questions. We focused on self-care health management behaviors and delved into SM initiation as the initial act of engagement and SM exchanges as continuous engagement patterns. This study examined whether those with depression might be using SM more than those without depression. Methods: Patient portal data were obtained from a large academic medical center's electronic health records spanning 5 years, from January 2018 to December 2022. We organized and analyzed SM initiations and exchanges using the linear mixed-effects modeling technique. Results: Our predictors correlated with SM initiations, accounting for 25.1% of variance explained. In parallel, 24.9% of SM exchanges were attributable to these predictors. Overall, our predictors demonstrate stronger associations with SM exchanges. Discussion: We examined patients with and without depression across 2,629 zip codes over five years. Our findings reveal that the predictors affecting SM initiations and exchanges are multifaceted, with certain predictors enhancing its utilization and others impeding it. Conclusions: SM telehealth service provided support to patients with mental health needs to a greater extent than those without. By increasing access, fostering better communication, and efficiently allocating resources, telehealth services not only encourage patients to begin using SM but also promote sustained interaction through ongoing SM exchanges.
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Affiliation(s)
- Seung-Min A Ko
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eric J Warm
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel P Schauer
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dong-Gil Ko
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
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Alexander J, Beatty A. Association of Patient Portal Messaging with Survival Among Radiation Oncology Patients. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00626-6. [PMID: 38723754 DOI: 10.1016/j.ijrobp.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The shift to electronic health records has led to both patient portal messaging and large amounts of digital, real-world data for research. The objective of this study was to examine the association between portal messaging and survival among radiation oncology patients, using real-world data. METHODS AND MATERIALS This retrospective cohort study included patients at least 21 years old and seen by radiation oncology providers between January 14, 2014, and April 23, 2023, at the University of California, San Francisco. We developed Cox proportional hazards models for the outcome of death and examined factors associated with portal messaging using logistic regression models. RESULTS Among 25,367 patients, the median age was 64 (interquartile range [IR], 54-72), 13,175 (52%) were White, and 14,389 (57%) were male. Overall, as the first message in a thread, 8986 (35%) patients sent messages to radiation oncology providers, and 4218 (17%) patients were sent messages from radiation oncology providers. Patients with head and neck or genitourinary malignancies were more likely than those with other diagnoses to send portal messages to and be sent portal messages from radiation oncology providers. Both sending portal messages to radiation oncology providers (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.84-0.96; P = .001) and being sent messages from radiation oncology providers (HR, 0.77; CI, 0.70-0.84; P < .001) as the first message in a thread were associated with patient survival after adjusting for socioeconomic, disease, and treatment characteristics. There were disparities among patients sending portal messages to radiation oncology providers, including for Black versus White patients (odds ratio [OR], 0.60; CI, 0.51-0.69; P < .001) and for Medicaid versus Medicare patients (OR, 0.70; CI, 0.62-0.79; P < .001). There were also disparities among patients being sent portal messages by radiation oncology providers, including for Black versus White patients (OR, 0.77; CI, 0.64-0.91; P = .003), for Medicaid versus Medicare patients (OR, 0.76; CI, 0.65-0.89; P < .001), and for patients with female versus male providers (OR, 1.47; CI 1.34-1.62; P < .001). CONCLUSIONS Sending portal messages to and being sent portal messages from radiation oncology providers were associated with better survival. Future studies should elucidate how best to support patient and provider engagement.
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Affiliation(s)
- Jes Alexander
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Alexis Beatty
- Department of Epidemiology and Biostatistics and Department of Medicine, Division of Cardiology, University of California, San Francisco, California
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Holder K, Feinglass J, Niznik C, Yee LM. Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study. JMIR Mhealth Uhealth 2024; 12:e51637. [PMID: 38686560 PMCID: PMC11146248 DOI: 10.2196/51637] [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: 08/06/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Background The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals. Objective The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic. Methods This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system's Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse. Results Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity. Conclusions Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.
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Affiliation(s)
- Kai Holder
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charlotte Niznik
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
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Semere W, Karter AJ, Lyles CR, Reed ME, Karliner L, Kaplan C, Liu JY, Livaudais-Toman J, Schillinger D. Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study. JMIR Diabetes 2024; 9:e49491. [PMID: 38335020 PMCID: PMC10891488 DOI: 10.2196/49491] [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: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. OBJECTIVE We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. METHODS This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). RESULTS The mean age of the cohort (N=7659) at this study's start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95% CI 20.2-21.2 vs 10.9, 95% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95% CI 5.8-6.1 vs 2.9, 95% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. CONCLUSIONS Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners' SM involvement on diabetes-related quality of care and clinical outcomes.
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Affiliation(s)
- Wagahta Semere
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Courtney R Lyles
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Mary E Reed
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Leah Karliner
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Celia Kaplan
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Jennifer Livaudais-Toman
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Dean Schillinger
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Reiter A, Tov EY, Hochberg I. Do patients read emails from their physician containing tips on improving lifestyle habits? A pilot study. Int J Med Inform 2023; 170:104967. [PMID: 36587533 DOI: 10.1016/j.ijmedinf.2022.104967] [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: 03/23/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Healthcare providers and organizations occasionally use electronic messages to provide information to patients. There is insufficient data on whether patients actually read the emails they receive. In this study, we aimed to assess the cooperation of patients in reading multiple information pages sent over 6 months from their diabetologist via email. METHODS Adults with non-optimally controlled type 2 diabetes received via email, once every 2 weeks for 6 months, a message containing information and tips on how to improve diabetes control through lifestyle choices. The information was provided in a format that required the recipient to actively click on a "read more" tab in order to reveal the entire text. Each email contained a short questionnaire requesting a response. Analysis compared the effect of patient variables on co-operation with reading the emails and answering the questionnaires. MAIN FINDINGS 45 patients completed the study, 53.3% of them read 66-100% of the emails, 17.8% read 34-65% of the emails and only 26.7% read less than 33% of the emails. Women answered more questionnaires than men did. Answering a questionnaire on nutrition or medications correlated with reading the following email sent. CONCLUSIONS This study is the first to demonstrate that most patients do indeed read a significant portion of emails sent by their physician. Email could be an effective means of sharing information and improving patient engagement with treatment.
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Affiliation(s)
- Adam Reiter
- Maccabi Health Services, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Elad Yom Tov
- Microsoft Research, Herzelya, Israel; Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Israel
| | - Irit Hochberg
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Fan X, Ning K, Liu C, Zhong H, Lau JTF, Hao C, Hao Y, Li J, Li L, Gu J. Uptake of an app-based case management service for HIV-positive men who have sex with men in China: a process evaluation study (Preprint). J Med Internet Res 2022; 25:e40176. [PMID: 37099367 PMCID: PMC10173030 DOI: 10.2196/40176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/15/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model. OBJECTIVE We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework. METHODS Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders. RESULTS A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as "very helpful" or "helpful." The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (β=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group. CONCLUSIONS The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence. TRIAL REGISTRATION Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-020-8171-5.
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Affiliation(s)
- Xiaoyan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ke Ning
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cong Liu
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Haidan Zhong
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
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Markese A, Tonick S, Leavitt AO, Hall J, Harrison MS. Use of electronic health record messaging to manage patients with pregnancy of unknown location. Eur J Obstet Gynecol Reprod Biol 2022; 271:278-280. [PMID: 35249776 DOI: 10.1016/j.ejogrb.2022.02.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/27/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Amy Markese
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States.
| | - Shawna Tonick
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States
| | | | - Jessica Hall
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States
| | - Margo S Harrison
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States
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Heisey-Grove D, McClelland LE, Rathert C, Jackson K, DeShazo J. Associations Between Patient-Provider Secure Message Content and Patients' Health Care Visits. Telemed J E Health 2021; 28:690-698. [PMID: 34569867 DOI: 10.1089/tmj.2021.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Between-visit communications can play a vital role in improving intermediate patient outcomes such as access to care and satisfaction. Secure messaging is a growing modality for these communications, but research is limited about the influence of message content on those intermediate outcomes. We examined associations between secure message content and patients' number of health care visits. Methods: Our study included 2,111 adult patients with hypertension and/or diabetes and 18,309 patient- and staff-generated messages. We estimated incident rate ratios (IRRs) for associations between taxonomic codes assigned to message content, and the number of office, emergency department, and inpatient visits. Results: Patients who initiated message threads in 2017 had higher numbers of outpatient visits (p < 0.001) compared with patients who did not initiate threads. Among patients who initiated threads, we identified an inverse relationship between outpatient visits and preventive care scheduling requests (IRR = 0.92; 95% confidence interval [CI]: 0.86-0.98) and requests for appointments for new conditions (IRR = 0.95; 95% CI: 0.92-0.99). Patients with higher proportions of request denials or more follow-up appointment requests had more emergency department visits compared with patients who received or sent other content (IRR = 1.18; 95% CI: 1.03-1.34 and IRR = 1.14; 95% CI: 1.07-1.23, respectively). We identified a positive association between outpatient visits and the proportion of threads that lacked a clinic response (IRR = 1.02; 95% CI: 1.00-1.03). Discussion: We report on the first analyses to examine associations between message content and health care visits. Conclusions: Our findings are relevant to understanding how to better use secure messaging to support patients and their care.
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Affiliation(s)
| | - Laura E McClelland
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cheryl Rathert
- Department of Health Management and Policy, Saint Louis University, St. Louis, Missouri, USA
| | - Kevin Jackson
- Allied Health Department, Norfolk State University, Norfolk, Virginia, USA
| | - Jonathan DeShazo
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, USA
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Heisey-Grove D, Rathert C, McClelland LE, Jackson K, DeShazo JP. Patient and Clinician Characteristics Associated With Secure Message Content: Retrospective Cohort Study. J Med Internet Res 2021; 23:e26650. [PMID: 34420923 PMCID: PMC8414300 DOI: 10.2196/26650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/25/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Good communication has been shown to affect patient outcomes; however, the effect varies according to patient and clinician characteristics. To date, no research has explored the differences in the content of secure messages based on these characteristics. OBJECTIVE This study aims to explore characteristics of patients and clinic staff associated with the content exchanged in secure messages. METHODS We coded 18,309 messages that were part of threads initiated by 1031 patients with hypertension, diabetes, or both conditions, in communication with 711 staff members. We conducted four sets of analyses to identify associations between patient characteristics and the types of messages they sent, staff characteristics and the types of messages they sent, staff characteristics and the types of messages patients sent to them, and patient characteristics and the types of messages they received from staff. Logistic regression was used to estimate the strength of the associations. RESULTS We found that younger patients had reduced odds of sharing clinical updates (odds ratio [OR] 0.77, 95% CI 0.65-0.91) and requesting prescription refills (OR 0.77, 95% CI 0.65-0.90). Women had reduced odds of self-reporting biometrics (OR 0.78, 95% CI 0.62-0.98) but greater odds of responding to a clinician (OR 1.20, 95% CI 1.02-1.42) and seeking medical guidance (OR 1.19, 95% CI 1.01-1.40). Compared with White patients, Black patients had greater odds of requesting preventive care (OR 2.68, 95% CI 1.30-5.51) but reduced odds of requesting a new or changed prescription (OR 0.72, 95% CI 0.53-0.98) or laboratory or other diagnostic procedures (OR 0.66, 95% CI 0.46-0.95). Staff had lower odds of sharing medical guidance with younger patients (OR 0.83, 95% CI 0.69-1.00) and uninsured patients (OR 0.21, 95% CI 0.06-0.73) but had greater odds of sharing medical guidance with patients with public payers (OR 2.03, 95% CI 1.26-3.25) compared with patients with private payers. Staff had reduced odds of confirming to women that their requests were fulfilled (OR 0.82, 95% CI 0.69-0.98). Compared with physicians, nurse practitioners had greater odds of sharing medical guidance with patients (OR 2.74, 95% CI 1.12-6.68) and receiving prescription refill requests (OR 3.39, 95% CI 1.49-7.71). Registered nurses had greater odds of deferred information sharing (OR 1.61, 95% CI 1.04-2.49) and receiving responses to messages (OR 3.93, 95% CI 2.18-7.11) than physicians. CONCLUSIONS The differences we found in content use based on patient characteristics could lead to the exacerbation of health disparities when content is associated with health outcomes. Disparities in the content of secure messages could exacerbate disparities in patient outcomes, such as satisfaction, trust in the system, self-care, and health outcomes. Staff and administrators should evaluate how secure messaging is used to ensure that disparities in care are not perpetuated via this communication modality.
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Affiliation(s)
| | - Cheryl Rathert
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Laura E McClelland
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Kevin Jackson
- Health Services Management, Department of Nursing and Allied Health, Norfolk State University, Norfolk, VA, United States
| | - Jonathan P DeShazo
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
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Zocchi MS, Robinson SA, Ash AS, Vimalananda VG, Wolfe HL, Hogan TP, Connolly SL, Stewart MT, Am L, Netherton D, Shimada SL. Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. J Am Med Inform Assoc 2021; 28:2176-2183. [PMID: 34339500 DOI: 10.1093/jamia/ocab115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study sought to investigate whether consistent use of the Veterans Health Administration's My HealtheVet (MHV) online patient portal is associated with improvement in diabetes-related physiological measures among new portal users. MATERIALS AND METHODS We conducted a retrospective cohort study of new portal users with type 2 diabetes that registered for MHV between 2012 and 2016. We used random-effect linear regression models to examine associations between months of portal use in a year (consistency) and annual means of the physiological measures (hemoglobin A1c [HbA1c], low-density lipoproteins [LDLs], and blood pressure [BP]) in the first 3 years of portal use. RESULTS For patients with uncontrolled HbA1c, LDL, or BP at baseline, more months of portal use in a year was associated with greater improvement. Compared with 1 month of use, using the portal 12 months in a year was associated with annual declines in HbA1c of -0.41% (95% confidence interval [CI], -0.46% to -0.36%) and in LDL of -6.25 (95% CI, -7.15 to -5.36) mg/dL. Twelve months of portal use was associated with minimal improvements in BP: systolic BP of -1.01 (95% CI, -1.33 to -0.68) mm Hg and diastolic BP of -0.67 (95% CI, -0.85 to -0.49) mm Hg. All associations were smaller or not present for patients in control of these measures at baseline. CONCLUSIONS We found consistent use of the patient portal among new portal users to be associated with modest improvements in mean HbA1c and LDL for patients at increased risk at baseline. For patients with type 2 diabetes, self-management supported by online patient portals may help control HbA1c, LDL, and BP.
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Affiliation(s)
- Mark S Zocchi
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hill L Wolfe
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen T Stewart
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Linda Am
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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11
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Sun R, Burke LE, Korytkowski MT, Saul MI, Li D, Sereika SM. A longitudinal examination of patient portal use on glycemic control among patients with uncontrolled type 2 diabetes. Diabetes Res Clin Pract 2020; 170:108483. [PMID: 33038473 DOI: 10.1016/j.diabres.2020.108483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/23/2020] [Accepted: 09/25/2020] [Indexed: 01/22/2023]
Abstract
AIM This study examined glycemia level over a 2-year period between portal users and non-users. METHODS This retrospective cohort study used data from electronic health records (EHRs) of a large academic medical center and its ancillary patient portal. A total of 15,528 patients with uncontrolled type 2 diabetes mellitus (T2DM) were included. Using propensity score matching (PSM), portal users and non-users were balanced on demographic and clinical characteristics. Mixed-effects polynomial regression modeling was employed to evaluate the HbA1c change over time between groups. RESULTS The patient sample was 85.9% (13,333) white and 52.5% (7375) male. On average, patients were 62.8 (SD, 11.7) years old and with obesity (mean BMI: 34.2 ± 7.2 kg/m2) with uncontrolled T2DM (initial HbA1c: 8.5 ± 1.5%). After PSM, portal users (n = 4924) and non-users (n = 4924) were matched on all variables except for the insurance. The mixed-effects modeling showed a nonlinear decrease of HbA1c in both groups over time. A significant interaction was observed with a greater decline, followed by a smaller rise of HbA1c in portal users than non-users. CONCLUSIONS The use of the patient portal was significantly associated with a lower HbA1c. This finding supports patient portals as a promising tool for improving clinical outcomes in patients with uncontrolled T2DM.
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Affiliation(s)
- Ran Sun
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA.
| | - Lora E Burke
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
| | - Mary T Korytkowski
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Melissa I Saul
- University of Pittsburgh School of Health and Rehabilitation Sciences, 3600 Atwood St, Pittsburgh, PA 15260, USA
| | - Dan Li
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
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12
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Cemballi AG, Karter AJ, Schillinger D, Liu JY, McNamara DS, Brown W, Crossley S, Semere W, Reed M, Allen J, Lyles CR. Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study. J Am Med Inform Assoc 2020; 28:1252-1258. [PMID: 33236117 DOI: 10.1093/jamia/ocaa281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
The substantial expansion of secure messaging (SM) via the patient portal in the last decade suggests that it is becoming a standard of care, but few have examined SM use longitudinally. We examined SM patterns among a diverse cohort of patients with diabetes (N = 19 921) and the providers they exchanged messages with within a large, integrated health system over 10 years (2006-2015), linking patient demographics to SM use. We found a 10-fold increase in messaging volume. There were dramatic increases overall and for patient subgroups, with a majority of patients (including patients with lower income or with self-reported limited health literacy) messaging by 2015. Although more physicians than nurses and other providers messaged throughout the study, the distribution of health professions using SM changed over time. Given this rapid increase in SM, deeper understanding of optimizing the value of patient and provider engagement, while managing workflow and training challenges, is crucial.
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Affiliation(s)
- Anupama Gunshekar Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Andrew J Karter
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - William Brown
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
| | - Scott Crossley
- Department of Applied Linguistics and ESL, Georgia State University, Atlanta, Georgia, USA
| | - Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jill Allen
- Kaiser Research Insights and Operations, Kaiser Permanente, Pleasanton, California, USA
| | - Courtney Rees Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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13
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Heisey-Grove DM, McClelland LE, Rathert C, Tartaglia A, Jackson K, DeShazo JP. Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study. J Med Internet Res 2020; 22:e19477. [PMID: 33118938 PMCID: PMC7661231 DOI: 10.2196/19477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. Objective To examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes. Methods We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff–generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. Results Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=–.30; 95% CI –0.56 to –0.04), as were staffs’ action responses (β=–30; 95% CI –0.58 to –0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (β=–4.03; 95% CI –7.94 to –0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19). Conclusions This is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.
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Affiliation(s)
- Dawn M Heisey-Grove
- MITRE Corporation, McLean, VA, United States.,College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Laura E McClelland
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Cheryl Rathert
- Department of Health Management and Policy, Saint Louis University, St Louis, MO, United States
| | - Alexander Tartaglia
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Kevin Jackson
- Department of Nursing and Allied Health, College of Science, Engineering, and Technology, Norfolk State University, Norfolk, VA, United States
| | - Jonathan P DeShazo
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
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14
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Casillas A, Abhat A, Mahajan A, Moreno G, Brown AF, Simmons S, Szilagyi P. Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations. J Med Internet Res 2020; 22:e16835. [PMID: 33094732 PMCID: PMC7647808 DOI: 10.2196/16835] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Anish Mahajan
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Sara Simmons
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Peter Szilagyi
- Department of Pediatrics, David Geffen School of Medicine, Los Angeles, CA, United States
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15
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Heisey-Grove DM, Carretta HJ. Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys. J Med Internet Res 2020; 22:e12611. [PMID: 32356775 PMCID: PMC7229528 DOI: 10.2196/12611] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/31/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who—among both patients and clinicians—is using secure messaging. Objective Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians, and to explore the clinical practice and physician characteristics and patient sociodemographic characteristics associated with the use of secure messaging. Methods We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access, and the patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). The NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included 7340 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health information technology (IT), and practice size and ownership associated with secure messaging access and use. Results By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.70% in 2013. The percentage of US residents who reported sending an email to their clinician, however, only increased from 7.22% to 16.67% between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (odds ratio [OR] 11.46, 95% CI 7.55-17.39). Individuals who were black, had lower levels of education, had Medicaid or other public payer insurance, or those who were uninsured had reduced odds for using email to communicate with clinicians. No differences were observed in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR 0.46, 95% CI 0.35-0.60 in solo practices vs nonsolo practices) and practice ownership (P<.001 for the different categories). Conclusions This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the United States. The survey findings complement each other: one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging.
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Affiliation(s)
- Dawn M Heisey-Grove
- Department of Clinical Quality and Informatics, Health Technical Center, MITRE Corporation, McLean, VA, United States
| | - Henry J Carretta
- College of Medicine, Florida State University, Tallahassee, FL, United States
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16
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Heisey-Grove DM, DeShazo JP. Look Who's Talking: Application of a Theory-Based Taxonomy to Patient-Clinician E-mail Messages. Telemed J E Health 2020; 26:1345-1352. [PMID: 32074474 DOI: 10.1089/tmj.2019.0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patient-clinician communication between office visits may improve patient outcomes by increasing patients' information retention and offering opportunities for patient-centered communication. Secure electronic messaging offers one such communication modality, but evidence of associations between its use and patient outcomes is mixed. To date, no study has examined the relationship between message content and patient outcomes. Introduction: Secure message content provides context around patients' requests and whether clinicians responded in ways that improve care and outcomes. This study evaluates the use of a theory-based taxonomy to classify patients' and clinicians' message content and describes characteristics associated with coded content. Methods: We coded message threads initiated in 2017 by 73 randomly selected patients with hypertension and/or diabetes. Multiple codes could be applied to each message. Chi-square analyses identified differences by patients' demographics and health condition. Results: We analyzed 658 message threads composed of 1,751 clinician- and patient-generated messages, to which 2,055 taxonomic codes were assigned. Eighteen percent of patients' threads were unanswered. Most codes assigned to patient-generated messages were task-oriented (46%) or information seeking (26%) requests; 30% of clinician responses left those requests unfulfilled or unaddressed. Clinicians were more likely to recommend a patient be seen in the office based on patients' sex, age, and health condition. Furthermore, white patients were more likely to send, and receive from their clinicians, messages with praise and appreciation content compared with black patients. Conclusion: Further research is needed to better understand how and why these differences exist so that patient-clinician electronic messaging is optimized to improve patient outcomes.
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Affiliation(s)
- Dawn M Heisey-Grove
- Department of Clinical Quality and Informatics, MITRE Corporation, McLean, Virginia, USA.,Virginia Commonwealth University, Richmond, Virginia, USA
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17
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Yin Z, Harrell M, Warner JL, Chen Q, Fabbri D, Malin BA. The therapy is making me sick: how online portal communications between breast cancer patients and physicians indicate medication discontinuation. J Am Med Inform Assoc 2019; 25:1444-1451. [PMID: 30380083 DOI: 10.1093/jamia/ocy118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/10/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Online platforms have created a variety of opportunities for breast patients to discuss their hormonal therapy, a long-term adjuvant treatment to reduce the chance of breast cancer occurrence and mortality. The goal of this investigation is to ascertain the extent to which the messages breast cancer patients communicated through an online portal can indicate their potential for discontinuing hormonal therapy. Materials and Methods We studied the de-identified electronic medical records of 1106 breast cancer patients who were prescribed hormonal therapy at Vanderbilt University Medical Center over a 12-year period. We designed a data-driven approach to investigate patients' patterns of messaging with healthcare providers, the topics they communicated, and the extent to which these messaging behaviors associate with the likelihood that a patient will discontinue a prescribed 5-year regimen of therapy. Results The results indicates that messaging rate over time [hazard ratio (HR) = 1.373, P = 0.002], mentions of side effects (HR = 1.214, P = 0.006), and surgery-related topics (HR = 1.170, P = 0.034) were associated with increased risk of early medication discontinuation. In contrast, seeking professional suggestions (HR = 0.766, P = 0.002), expressing gratitude to healthcare providers (HR = 0.872, P = 0.044), and mentions of drugs used to treat side effects (HR = 0.807, P = 0.013) were associated with decreased risk of medication discontinuation. Discussion and Conclusion This investigation suggests that patient-generated content can inform the study of health-related behaviors. Given that approximately 50% of breast cancer patients do not complete a course of hormonal therapy as described, the identification of factors associated with medication discontinuation can facilitate real-time interventions to prevent early discontinuation.
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Affiliation(s)
- Zhijun Yin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeremy L Warner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Qingxia Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
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18
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Wong JIS, Steitz BD, Rosenbloom ST. Characterizing the impact of health literacy, computer ability, patient demographics, and portal usage on patient satisfaction with a patient portal. JAMIA Open 2019; 2:456-464. [PMID: 32025642 PMCID: PMC6994001 DOI: 10.1093/jamiaopen/ooz058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/31/2019] [Accepted: 10/04/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We sought to measure patient portal satisfaction with patient portals and characterize its relationship to attitude towards computers, health literacy, portal usage, and patient demographics. MATERIALS AND METHODS We invited 13 040 patients from an academic medical center to complete a survey measuring satisfaction, perceived control over computers, and health literacy using validated instruments (End User Computing Satisfaction, Computer Attitude Measure, and Brief Health Literacy Screen). We extracted portal usage and demographic information from the medical center data warehouse. RESULTS A total of 6026 (46.2%) patients completed the survey. The median (IQR) scores for satisfaction, computer control, and health literacy were 87% (20%), 86% (22%), and 95% (15%), respectively. The normalized mean (SD) usage of messaging, lab, appointment, medication, and immunization functions were 6.6 (2.6), 4.6 (2.4), 3.1 (1.7), 1.5 (1.2), and 0.88 (0.91) times, respectively. Logistic regression yielded significant odds ratios [99% CI] for computer control (3.6 [2.5-5.2]), health literacy (12 [6.9-23]), and immunization function usage (0.84 [0.73-0.96]). DISCUSSION Respondents were highly satisfied and had high degrees of computer control and health literacy. Statistical analysis revealed that higher computer control and health literacy predicted higher satisfaction, whereas usage of the immunization function predicted lower satisfaction. Overall, the analytical model had low predictive capability, suggesting that we failed to capture the main drivers of satisfaction, or there was inadequate variation in satisfaction to delineate its contributing factors. CONCLUSION This study provides insight into patient satisfaction with and usage of a patient portal. These data can guide the development of the patient portal, with the ultimate goal of increasing functionality and usability to enhance the patient experience.
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Affiliation(s)
| | - Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Ukoha EP, Feinglass J, Yee LM. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. J Med Internet Res 2019; 21:e14445. [PMID: 31586367 PMCID: PMC6818527 DOI: 10.2196/14445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. Objective This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients’ demographics or clinical characteristics exist. Methods This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients’ characteristics. Results Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23). Conclusions Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care.
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Affiliation(s)
- Erinma P Ukoha
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Edmonds S, Lou Y, Robinson B, Cram P, Roblin DW, Wright NC, Saag K, Wolinsky FD. Characteristics of older adults using patient web portals to view their DXA results. BMC Med Inform Decis Mak 2019; 19:187. [PMID: 31533717 PMCID: PMC6751667 DOI: 10.1186/s12911-019-0904-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sharing test results with patients via patient web portals is a new trend in healthcare. No research has been done examining patient web portal use with bone density test results. The objective of our study was to identify patient characteristics associated with the use of patient web portals to view their bone density test results. Methods A secondary analysis of data from a pragmatic randomized controlled trial of 7749 participants ≥50 years old that had presented for a dual energy X-ray absorptiometry (DXA) bone density test. Patients were interviewed at enrollment and 12 weeks later. Multivariable logistic regression identified patient characteristics that differentiated those who used the web portal from those who did not. Results Our sample included 4669 patients at the two (University of Iowa [UI], and Kaiser Permanente of Georgia [KPGA]) clinical sites that had patient web portals. Of these patients, 3399 (72.8%) reported knowing their test results 12 weeks post-DXA, with 649 (13.9%) reporting that they viewed their DXA results using the web portal. Web portal users were more likely to be from UI than KPGA, and were younger, more educated, had higher health literacy, had osteopenia, and had the same sex as their referring physician (all p < 0.05). Conclusion Only 19.1% of the 3399 patients who knew their DXA results used the available patient web portals to find out about them. Web portal users differed from non-users on several characteristics. This suggests that simply making patient web portals available for use may not be sufficient to appreciably enhance patient awareness of their test results. Based on these findings, a better understanding of the reasons why older, less educated, and less activated patients do not access their test results through patient web portals is needed.
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Affiliation(s)
- Stephanie Edmonds
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, 200 Newton Rd. 5231 WL, Iowa City, IA, 52242, USA. .,CADRE, Iowa City VA Health System, Iowa City, IA, USA.
| | - Yiyue Lou
- College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Brandi Robinson
- Kaiser Permanente, Center for Clinical and Outcomes Research, Atlanta, GA, USA
| | - Peter Cram
- College of Medicine, Department of Internal Medicine, University of Toronto, Toronto, Canada.,University of Toronto Health Network, Toronto, Canada
| | | | - Nicole C Wright
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Kenneth Saag
- School of Medicine, Department of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Fredric D Wolinsky
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, 200 Newton Rd. 5231 WL, Iowa City, IA, 52242, USA.,College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.,College of Nursing, University of Iowa, Iowa City, IA, USA
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21
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Sun R, Korytkowski MT, Sereika SM, Saul MI, Li D, Burke LE. Patient Portal Use in Diabetes Management: Literature Review. JMIR Diabetes 2018; 3:e11199. [PMID: 30401665 PMCID: PMC6246970 DOI: 10.2196/11199] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background Health information technology tools (eg, patient portals) have the potential to promote engagement, improve patient-provider communication, and enhance clinical outcomes in the management of chronic disorders such as diabetes mellitus (DM). Objectives The aim of this study was to report the findings of a literature review of studies reporting patient portal use by individuals with type 1 or type 2 DM. We examined the association of the patient portal use with DM-related outcomes and identified opportunities for further improvement in DM management. Methods Electronic literature search was conducted through PubMed and PsycINFO databases. The keywords used were “patient portal*,” “web portal,” “personal health record,” and “diabetes.” Inclusion criteria included (1) published in the past 10 years, (2) used English language, (3) restricted to age ≥18 years, and (4) available in full text. Results This review included 6 randomized controlled trials, 16 observational, 4 qualitative, and 4 mixed-methods studies. The results of these studies revealed that 29% to 46% of patients with DM have registered for a portal account, with 27% to 76% of these patients actually using the portal at least once during the study period. Portal use was associated with the following factors: personal traits (eg, sociodemographics, clinical characteristics, health literacy), technology (eg, functionality, usability), and provider engagement. Inconsistent findings were observed regarding the association of patient portal use with DM-related clinical and psychological outcomes. Conclusions Barriers to use of the patient portal were identified among patients and providers. Future investigations into strategies that engage both physicians and patients in use of a patient portal to improve patient outcomes are needed.
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Affiliation(s)
- Ran Sun
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
| | - Mary T Korytkowski
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
| | - Melissa I Saul
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Dan Li
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
| | - Lora E Burke
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
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22
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Haun J, Chavez M, Hathaway W, Antinori N, Melillo C, Cotner BA, McMahon-Grenz J, Zilka B, Patel-Teague S, Messina W, Nazi K. Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e11262. [PMID: 30111531 PMCID: PMC6115597 DOI: 10.2196/11262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is making system-wide efforts to increase integrated use of health information technology (HIT), including My HealtheVet (MHV), the Veterans Affairs (VA) electronic patient portal, Vet Link kiosks, telehealth, and mobile apps. Integrated use of HIT can increase individual and system efficiency, maximize resources, and enhance patient outcomes. Prior research indicates that provider endorsement and reinforcement are key determinants of patient adoption of HIT. HIT implementation strategies need to reflect providers’ perspectives to promote adoption and endorsement of these tools; however, providers often lack awareness or are unmotivated to incorporate HIT into clinical care with their patients. When these modalities are used by patients, the approach is often fragmented rather than integrated within and across care settings. Research is needed to identify effective implementation strategies for increasing patient-aligned care team (PACT) member (ie, the VHA’s Patient Centered Medical Home) awareness and motivation to use HIT in a proactive and integrated approach with patients. Objective This paper describes the rationale, design, and methods of the PACT protocol to promote proactive integrated use of HIT. Methods In Aim 1, focus groups (n=21) were conducted with PACT members (n=65) along with questionnaires and follow-up individual interviews (n=16). In Aim 2, the team collaborated with VA clinicians, electronic health researchers and operational partners to conduct individual expert interviews (n=13), and an environmental scan to collect current and emerging provider-focused implementation tools and resources. Based on Aim 1 findings, a gap analysis was conducted to determine what implementation strategies and content needed to be adapted or developed. Following the adaptation or development of resources, a PACT expert panel was convened to evaluate the resultant content. In Aim 3, a local implementation of PACT-focused strategies to promote integrated use of HIT was evaluated using pre- and postquestionnaire surveys, brief structured interviews, and secondary data analysis with PACT members (n=63). Results Study enrollment for Aim 1 has been completed. Aims 1 and 2 data collection and analysis are underway. Aim 3 activities are scheduled for year 3. Conclusions This work highlights the practical, technological, and participatory factors involved in facilitating implementation research designed to engage PACT clinical members in the proactive integrated use of HIT. These efforts are designed to support the integrated and proactive use of VA HIT to support clinical care coordination in ways that are directly aligned with PACT member preferences. This study evaluated integrated VA HIT use employing mixed-methods and multiple data sources. Deliverables included PACT-focused strategies to support integrated use of HIT in the ambulatory care setting that will also inform strategy development in other systems of care and support subsequent implementation efforts at regional and national levels. Registered Report Identifier RR1-10.2196/11262
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Affiliation(s)
- Jolie Haun
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States.,Department of Community & Family Health, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Margeaux Chavez
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States
| | - Wendy Hathaway
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States
| | - Nicole Antinori
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States
| | - Christine Melillo
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States
| | - Bridget A Cotner
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States.,Department of Anthropology, University of South Florida, Tampa, FL, United States
| | - Julie McMahon-Grenz
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States
| | - Brian Zilka
- Primary Care, James A Haley VA Medical Center, Tampa, FL, United States
| | - Shilpa Patel-Teague
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States.,Veterans Integrated Service Network 8 Network Office, St Petersburg, FL, United States
| | - William Messina
- Primary Care, James A Haley VA Medical Center, Tampa, FL, United States
| | - Kim Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
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23
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Mold F, Raleigh M, Alharbi NS, de Lusignan S. The Impact of Patient Online Access to Computerized Medical Records and Services on Type 2 Diabetes: Systematic Review. J Med Internet Res 2018; 20:e235. [PMID: 29980499 PMCID: PMC6054706 DOI: 10.2196/jmir.7858] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/28/2017] [Accepted: 05/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background Online access to computerized medical records has the potential to improve convenience, satisfaction, and care for patients, and to facilitate more efficient organization and delivery of care. Objective The objective of this review is to explore the use and impact of having online access to computerized medical records and services for patients with type 2 diabetes mellitus in primary care. Methods Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016. No limitations were placed on study design, though we applied detailed inclusion and exclusion criteria to each study. Thematic analysis was used to synthesize the evidence. The Mixed Methods Appraisal Toolkit was used to appraise study quality. Results A search identified 917 studies, of which 28 were included. Five themes were identified: (1) disparities in uptake by age, gender, ethnicity, educational attainment, and number of comorbidities, with young men in full-time employment using these services most; (2) improved health outcomes: glycemic control was improved, but blood pressure results were mixed; (3) self-management support from improved self-care and shared management occurred especially soon after diagnosis and when complications emerged. There was a generally positive effect on physician-patient relationships; (4) accessibility: patients valued more convenient access when online access to computerized medical records and services work; and (5) technical challenges, barriers to use, and system features that impacted patient and physician use. The Mixed Methods Appraisal Toolkit rated 3 studies as 100%, 19 studies as 75%, 4 studies as 50%, and 1 study scored only 25%. Conclusions Patients valued online access to computerized medical records and services, although in its current state of development it may increase disparities. Online access to computerized medical records appears to be safe and is associated with improved glycemic control, but there was a lack of rigorous evidence in terms of positive health outcomes for other complications, such as blood pressure. Patients remain concerned about how these systems work, the rules, and timeliness of using these systems.
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Affiliation(s)
- Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mary Raleigh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Nouf Sahal Alharbi
- Department of Health Sciences, College of Applied Studies & Community Service, King Saud University, Riyadh, Saudi Arabia
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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24
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Kranz AM, Dalton S, Damberg C, Timbie JW. Using Health IT to Coordinate Care and Improve Quality in Safety-Net Clinics. Jt Comm J Qual Patient Saf 2018; 44:731-740. [PMID: 30064959 DOI: 10.1016/j.jcjq.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/05/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States. METHODS Cross-sectional secondary data from the 2015 Health Resources and Services Administration's Uniform Data System was used to examine 6 measures of HIT capability related to care coordination and clinical decision support and 16 measures of quality (12 process measures, 3 outcome measures, 1 composite measure) for health centers in the United States. Adjusted logistic regressions were used to examine health center characteristics associated with use of HIT capabilities, and adjusted linear regressions were used to examine associations between HIT capabilities and quality of care. RESULTS Many health centers reported using HIT for care coordination activities, including coordinating enabling services (67.3%) or engaging patients (81.0%). Health center size and medical home recognition were associated with significantly greater odds of using HIT for enabling services and engaging patients. These HIT capabilities were associated with higher overall quality and higher rates of six process measures (adult screening and maternal and child health) and hemoglobin A1c control. CONCLUSION Use of HIT for such activities as arranging enabling services and engaging patients are underleveraged tools for care coordination. There may be opportunities to further improve quality of care for vulnerable patients by promoting health centers' use of these HIT capabilities.
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25
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Ukoha EP, Yee LM. Use of Electronic Patient Portals in Pregnancy: An Overview. J Midwifery Womens Health 2018; 63:335-339. [PMID: 29758124 DOI: 10.1111/jmwh.12761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
Electronic patient portals are increasingly utilized in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, particularly in management of chronic diseases. However, there are disparities within portal use. For example, individuals who are racial and ethnic minorities and persons from lower socioeconomic status are less likely to enroll and use patient portals than non-Hispanic white persons and persons with higher socioeconomic status. Because portal use and, specifically, patient-provider secure messaging has been associated with favorable health outcomes, disparities in use of these portals could affect health outcomes. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. This article reviews the current literature regarding electronic patient portal use and highlights the need for further maternity care-focused research regarding this new avenue of care delivery during pregnancy.
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26
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Wagg AJ, Callanan MM, Hassett A. The use of computer mediated communication in providing patient support: A review of the research literature. Int J Nurs Stud 2018; 82:68-78. [PMID: 29609154 DOI: 10.1016/j.ijnurstu.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study is to explore how computer mediated communication has been used by a variety of healthcare,professionals to support their patients and discuss the implication that this may have for future practice. DESIGN A systematized review of the literature. DATA SOURCES A review of empirical studies within the literature was carried out in April 2016 in CINAHL, MEDLINE, ASSIA, BNI, Psychinfo, and Web of Science databases. REVIEW METHODS The databases searched produced 2930 titles, of which 190 publications were considered relevant to the objectives. Titles and abstracts were then reviewed and duplicates removed producing 67 publications. Exclusion and inclusion criteria were applied. The inclusion criteria were (1) interventions that facilitate two-way communication between any healthcare professional and their patients via a computer; (2) Interventions aimed at providing any type of support e.g. emotional, tangible, informational, or esteem support; (3) English language; (4) Primary empirical studies. Data quality was assessed and thematic analysis applied. RESULTS Thirty-one publications were included in this study. Intervention types included Email (n = 8), Videoconferencing (n = 7), Online Social Support Groups (n = 9) and multifaceted interventions (n = 7). Three themes emerged from the data including increasing access to healthcare, adding value to healthcare delivery and improving patient outcomes. Twenty-five (81%) of the studies found that computer mediated communication could produce positive effects. CONCLUSIONS Computer mediated communication could be both what patients want and a way of delivering support to patients in a resource tight environment. This has implications for a range of health support needs and professionals including nurses, midwives and allied healthcare professionals. Reviewing the lessons learnt will ensure future interventions are tailored to the support needs of the patients, carefully planned and mindful of the risks.
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Affiliation(s)
| | - Margie M Callanan
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Kent, UK
| | - Alexander Hassett
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Kent, UK
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27
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Ochoa A, Kitayama K, Uijtdehaage S, Vermillion M, Eaton M, Carpio F, Serota M, Hochman ME. Patient and provider perspectives on the potential value and use of a bilingual online patient portal in a Spanish-speaking safety-net population. J Am Med Inform Assoc 2018; 24:1160-1164. [PMID: 28460130 DOI: 10.1093/jamia/ocx040] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. Materials and Methods We captured patient and provider perspectives through the administration of surveys to assess Internet access, barriers, and facilitators to patient portal adoption, along with portal preferences. We report on these survey results using descriptive and comparative statistics. Results Four hundred patients (82% response rate) and 59 providers (80% response rate) participated in the study. Although 73% of providers believed that the patient portal would increase patient satisfaction, just 39% planned to recommend portal use to patients, citing concerns related to time and reimbursement. In contrast, 72% of patients believed the patient portal would strengthen the patient-provider relationship and 77% believed it would improve the quality of care. Latino patients in particular believed the patient portal would strengthen the patient-provider relationship. Seventy-five percent of patients reported interest in a mobile version of the portal. Discussion Patients from a safety-net health system, most of whom were Spanish-speaking, reported a high level of interest in the patient portal. Providers at the same health system expressed reluctance about the portal due to concerns related to time and reimbursement. Conclusion Bilingual patient portal implementation has considerable potential to promote health care engagement within Spanish-speaking safety-net populations; however, lack of provider engagement in the process could undermine the effort.
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Affiliation(s)
- Alejandro Ochoa
- UCLA PRIME, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ken Kitayama
- UCLA PRIME, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sebastian Uijtdehaage
- Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Michael Eaton
- AltaMed Health Services Corporation, Commerce, CA, USA
| | - Felix Carpio
- AltaMed Health Services Corporation, Commerce, CA, USA
| | - Martin Serota
- AltaMed Health Services Corporation, Commerce, CA, USA
| | - Michael E Hochman
- Gehr Family Center for Implementation Science, Keck School of Medicine of USC, Los Angeles, CA, USA
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28
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Haun JN, Hathaway W, Chavez M, Antinori N, Vetter B, Miller BK, Martin TL, Kendziora L, Nazi KM, Melillo C. Clinical Practice Informs Secure Messaging Benefits and Best Practices. Appl Clin Inform 2017; 8:1003-1011. [PMID: 29241240 DOI: 10.4338/aci-2017-05-ra-0088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans.
Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow.
Methods This project implemented a single-item cross-sectional qualitative electronic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics.
Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow.
Conclusion VA clinical care team members can use SM proactively to create an integrated SM culture. With adequate knowledge and motivation to proactively use this technology, all clinical team members within the VA system can replicate best practices shared by other clinical care teams to generate meaningful and useful interactions with SM to enrich veterans' health care experience.
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Affiliation(s)
- Jolie N Haun
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States.,Department of Community and Family Health, University of South Florida College of Public Health, Tampa, Florida, United States
| | - Wendy Hathaway
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Margeaux Chavez
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Nicole Antinori
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Brian Vetter
- Department of Veterans Affairs, St. Cloud VA Medical Center, St. Cloud, Minnesota, United States
| | - Brian K Miller
- Northwest Innovation Center, VA Portland Health Care System, Portland, Oregon, United States
| | - Tracey L Martin
- Department of Veterans Affairs, VA New England Health Care System, Bedford, Massachusetts, United States
| | - Lisa Kendziora
- Department of Veterans Affairs, Erie VA Medical Center, Erie, Pennsylvania, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Veterans Health Administration, Department of Veterans Affairs, Washington, District of Columbia, United States
| | - Christine Melillo
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
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Chung S, Panattoni L, Chi J, Palaniappan L. Can Secure Patient-Provider Messaging Improve Diabetes Care? Diabetes Care 2017; 40:1342-1348. [PMID: 28807977 DOI: 10.2337/dc17-0140] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. RESEARCH DESIGN AND METHODS Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied (N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering. RESULTS Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages. CONCLUSIONS Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.
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Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Laura Panattoni
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeffrey Chi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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30
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Hartzler AL, Venkatakrishnan A, Mohan S, Silva M, Lozano P, Ralston JD, Ludman E, Rosenberg D, Newton KM, Nelson L, Pirolli P. Acceptability of a team-based mobile health (mHealth) application for lifestyle self-management in individuals with chronic illnesses. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3277-3281. [PMID: 28269007 DOI: 10.1109/embc.2016.7591428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
With increased incidence of chronic illnesses arising due to unhealthy lifestyle habits, it is increasingly important to leverage technology applications to promote and sustain health behavior change. We developed a smartphone-based application, NutriWalking (NW), which recommends personalized daily exercise goals and promotes healthy nutritional habits in small peer teams. Here, we demonstrate an early study of usability and acceptability of this app in patients with type 2 Diabetes Mellitus and Depression. Our goal was to evaluate the potential of NW as a self-management support tool. Findings point to design considerations for team-based self-management tools delivered via mHealth platforms.
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31
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Coughlin SS, Prochaska JJ, Williams LB, Besenyi GM, Heboyan V, Goggans DS, Yoo W, De Leo G. Patient web portals, disease management, and primary prevention. Risk Manag Healthc Policy 2017; 10:33-40. [PMID: 28435342 PMCID: PMC5391175 DOI: 10.2147/rmhp.s130431] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Efforts aimed at health care reform and continued advances in information technologies have prompted interest among providers and researchers in patient web portals. Patient web portals are password-protected online websites that offer the patients 24-hour access to personal health information from anywhere with an Internet connection. METHODS This article, which is based upon bibliographic searches in PubMed, reviews important developments in web portals for primary and secondary disease prevention, including patient web portals tethered to electronic medical records, disease-specific portals, health disparities, and health-related community web portals. RESULTS Although findings have not been uniformly positive, several studies of the effectiveness of health care system patient portals in chronic disease management have shown promising results with regard to patient outcomes. Patient web portals have also shown promising results in increasing adherence with screening recommendations. Racial and ethnic minorities, younger persons, and patients who are less educated or have lower health literacy have been found to be less likely to use patient portals. CONCLUSION Additional studies are needed of the utility and effectiveness of different elements of web portals for different patient populations. This should include additional diseases and health topics such as smoking cessation and weight management.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | - Judith J Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA
| | - Lovoria B Williams
- Department of Biobehavioral Nursing, College of Nursing, Augusta University
| | - Gina M Besenyi
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | - Vahé Heboyan
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | | | - Wonsuk Yoo
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
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Gimbel R, Shi L, Williams JE, Dye CJ, Chen L, Crawford P, Shry EA, Griffin SF, Jones KO, Sherrill WW, Truong K, Little JR, Edwards KW, Hing M, Moss JB. Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol. JMIR Res Protoc 2017; 6:e38. [PMID: 28264792 PMCID: PMC5359418 DOI: 10.2196/resprot.6993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. OBJECTIVE We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. METHODS This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. RESULTS We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. CONCLUSIONS The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. TRIAL REGISTRATION ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei).
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Affiliation(s)
- Ronald Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Joel E Williams
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Cheryl J Dye
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Paul Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Eric A Shry
- Madigan Army Medical Center, Tacoma, WA, United States
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Karyn O Jones
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Windsor W Sherrill
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Jeanette R Little
- MHIC Laboratory Lead, Telemedicine & Advanced Technology Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States
| | - Karen W Edwards
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Marie Hing
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Jennie B Moss
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
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Schillinger D, McNamara D, Crossley S, Lyles C, Moffet HH, Sarkar U, Duran N, Allen J, Liu J, Oryn D, Ratanawongsa N, Karter AJ. The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging. J Diabetes Res 2017; 2017:1348242. [PMID: 28265579 PMCID: PMC5318623 DOI: 10.1155/2017/1348242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022] Open
Abstract
Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients' literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems' journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Danielle Oryn
- Redwood Community Health Coalition, Petaluma, CA, USA
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Coughlin SS, Williams LB, Hatzigeorgiou C. A systematic review of studies of web portals for patients with diabetes mellitus. Mhealth 2017; 3:23. [PMID: 28736732 PMCID: PMC5505929 DOI: 10.21037/mhealth.2017.05.05] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/26/2017] [Indexed: 11/06/2022] Open
Abstract
Patient web portals are password-protected online websites that offer patients 24-hour access to personal health information from anywhere with an Internet connection. Due to advances in health information technologies, there has been increasing interest among providers and researchers in patient web portals for use by patients with diabetes and other chronic conditions. This article, which is based upon bibliographic searches in PubMed, reviews web portals for patients with diabetes mellitus including patient web portals tethered to electronic medical records and web portals developed specifically for patients with diabetes. Twelve studies of the impact of patient web portals on the management of diabetes patients were identified. Three had a cross-sectional design, 1 employed mixed-methods, one had a matched-control design, 3 had a retrospective cohort design, and 5 were randomized controlled trials. Six (50%) of the studies examined web portals tethered to electronic medical records and the remainder were web portals developed specifically for diabetes patients. The results of this review suggest that secure messaging between adult diabetic patients and their clinician is associated with improved glycemic control. However, results from observational studies indicate that many diabetic patients do not take advantage of web portal features such as secure messaging, perhaps because of a lack of internet access or lack of experience in navigating web portal resources. Although results from randomized controlled trials provide stronger evidence of the efficacy of web portal use in improving glycemic control among diabetic patients, the number of trials is small and results from the trials have been mixed. Studies suggest that secure messaging between adult diabetic patients and their clinician is associated with improved glycemic control, but negative findings have also been reported. The number of randomized controlled trials that have examined the efficacy of web portal use in improving glycemic control among diabetic patients is still small. Additional research is needed to identify specific portal features that may impact quality of care or improve glycemic control.
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Affiliation(s)
- Steven S. Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia
| | - Lovoria B. Williams
- Department of Biobehavioral Nursing, College of Nursing, Augusta University, Augusta, Georgia
| | - Christos Hatzigeorgiou
- Division of General Internal Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
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Price-Haywood EG, Luo Q. Primary Care Practice Reengineering and Associations With Patient Portal Use, Service Utilization, and Disease Control Among Patients With Hypertension and/or Diabetes. Ochsner J 2017; 17:103-111. [PMID: 28331456 PMCID: PMC5349620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND We describe the role of primary care reengineering in the Ochsner Health System (OHS) patient portal implementation strategy and compare subsequent trends in service utilization and disease control among portal users vs nonusers within this context. METHODS This retrospective cohort study includes 101,019 patients with hypertension or diabetes who saw an OHS primary care provider (PCP) between 2012 and 2014. Inverse probability treatment weighting was used to reduce case-mix differences between study groups. We used generalized estimating equation modeling to compare changes in encounter rates (PCP, telephone, specialty services, emergency department [ED], inpatient hospitalization), blood pressure (BP), and hemoglobin A1c (HbA1c). RESULTS Age, sex, race, comorbidities, insurance, preindex utilization, and portal use were associated with changes in utilization, BP, and HbA1C; however, the strength and direction of these differences varied. An adjusted analysis comparing portal users to nonusers showed an increase in PCP (rate ratio per patient per year of 1.18, 95% confidence interval [CI] 1.14-1.22) and telephone encounter rates (1.15, 95% CI 1.08-1.22; both P<0.001) but no significant differences in specialty, ED, or inpatient hospitalization encounters. Among patients with preindex systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, portal users compared to nonusers had a greater decline in their BP, although the between-group difference was small (mmHg [SE], -1.1 [0.42] and -1.2 [0.34], respectively; both P<0.01). Portal users with diabetes compared to nonusers with diabetes also had greater decreases in HbA1c (all patients, % [SE], -0.13 [0.06]; patients with a preindex HbA1c ≥8, -0.43 [0.13], both P<0.05). CONCLUSION Our findings may reflect patient factors and system-level portal implementation strategies that focused heavily on accessibility to care.
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Affiliation(s)
- Eboni G. Price-Haywood
- Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Qingyang Luo
- Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, LA
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Petullo B, Noble B, Dungan KM. Effect of Electronic Messaging on Glucose Control and Hospital Admissions Among Patients with Diabetes. Diabetes Technol Ther 2016; 18:555-60. [PMID: 27398824 PMCID: PMC5035368 DOI: 10.1089/dia.2016.0105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Electronic messaging (EM) is increasingly utilized among patients with diabetes, but it is unclear whether it is associated with improved glycemic control, hospital admissions, or emergency visits. METHODS Patients who were seen over a 1 year period at an academic endocrinology clinic with a diagnosis of diabetes were categorized according to portal activation and whether EMs were actually sent. The association between EM and HbA1c and inpatient or emergency department (ED) visits was further characterized using multivariable (MV) linear or logistic regression models. RESULTS A total of 867 patients were using EM (active user group), 1207 patients had activated the patient portal but did not use the EM function (active nonuser group), and 1542 patients had not activated the patient portal (inactive group). There were important disparities in race, age, income, and other variables across groups. The HbA1c was 7.7% ± 1.5%, 8.4% ± 1.9%, and 8.2% ± 1.8% among the active user, active nonuser, and inactive groups, respectively (P < 0.0001). After controlling for other factors, EM was associated with a 0.25% (SE 0.04%) lower HbA1c compared with the active nonuser group and a 0.19% (SE 0.04%) lower HbA1c compared with the inactive group (P < 0.0001 for both). However, EM frequency was not associated with HbA1c. EM use was not associated with inpatient or ED visits in MV analysis. CONCLUSIONS EM use was associated with improved glycemic control, even after controlling for electronic portal access and other variables, but not with hospitalizations or emergency visits. EM frequency was not associated with glycemic control, justifying the need for prospective studies.
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Affiliation(s)
- Brian Petullo
- Division of General Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Byron Noble
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, Ohio
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Oramasionwu CU, Vitko ML, Johnson TL, Sage AJ, Chung AE, Bailey SC. Assessing the Quality and Suitability of Multimedia Resources to Assist Patients With Patient Portal Use. Am J Med Qual 2016; 32:453-455. [PMID: 27577935 DOI: 10.1177/1062860616667212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Adam J Sage
- 1 The University of North Carolina at Chapel Hill, NC
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Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, West CP. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc 2016; 91:836-48. [PMID: 27313121 DOI: 10.1016/j.mayocp.2016.05.007] [Citation(s) in RCA: 580] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate associations between the electronic environment, clerical burden, and burnout in US physicians. PARTICIPANTS AND METHODS Physicians across all specialties in the United States were surveyed between August and October 2014. Physicians provided information regarding use of electronic health records (EHRs), computerized physician order entry (CPOE), and electronic patient portals. Burnout was measured using validated metrics. RESULTS Of 6375 responding physicians in active practice, 5389 (84.5%) reported that they used EHRs. Of 5892 physicians who indicated that CPOE was relevant to their specialty, 4858 (82.5%) reported using CPOE. Physicians who used EHRs and CPOE had lower satisfaction with the amount of time spent on clerical tasks and higher rates of burnout on univariate analysis. On multivariable analysis, physicians who used EHRs (odds ratio [OR]=0.67; 95% CI, 0.57-0.79; P<.001) or CPOE (OR=0.72; 95% CI, 0.62-0.84; P<.001) were less likely to be satisfied with the amount of time spent on clerical tasks after adjusting for age, sex, specialty, practice setting, and hours worked per week. Use of CPOE was also associated with a higher risk of burnout after adjusting for these same factors (OR=1.29; 95% CI, 1.12-1.48; P<.001). Use of EHRs was not associated with burnout in adjusted models controlling for CPOE and other factors. CONCLUSION In this large national study, physicians' satisfaction with their EHRs and CPOE was generally low. Physicians who used EHRs and CPOE were less satisfied with the amount of time spent on clerical tasks and were at higher risk for professional burnout.
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Affiliation(s)
| | - Lotte N Dyrbye
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Omar Hasan
- American Medical Association, Chicago, IL
| | - Daniel Satele
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jeff Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Shimada SL, Allison JJ, Rosen AK, Feng H, Houston TK. Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures. J Med Internet Res 2016; 18:e179. [PMID: 27369696 PMCID: PMC4947193 DOI: 10.2196/jmir.5663] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background Personal health records (PHRs) have the potential to improve patient self-management for chronic conditions such as diabetes. However, evidence is mixed as to whether there is an association between PHR use and improved health outcomes. Objective The aim of this study was to evaluate the association between sustained use of specific patient portal features (Web-based prescription refill and secure messaging—SM) and physiological measures important for the management of type 2 diabetes. Methods Using a retrospective cohort design, including Veterans with diabetes registered for the My Health e Vet patient portal who had not yet used the Web-based refill or SM features and who had at least one physiological measure (HbA1c, low-density lipoprotein (LDL) cholesterol, blood pressure) in 2009-2010 (baseline) that was above guideline recommendations (N=111,686), we assessed portal use between 2010 and 2014. We calculated the odds of achieving control of each measure by 2013 to 2014 (follow-up) by years of using each portal feature, adjusting for demographic and clinical characteristics associated with portal use. Results By 2013 to 2014, 34.13% (38,113/111,686) of the cohort was using Web-based refills, and 15.75% (17,592/111,686) of the cohort was using SM. Users were slightly younger (P<.001), less likely to be eligible for free care based on economic means (P<.001), and more likely to be women (P<.001). In models adjusting for both features, patients with uncontrolled HbA1c at baseline who used SM were significantly more likely than nonusers to achieve glycemic control by follow-up if they used SM for 2 years (odds ratio—OR=1.24, CI: 1.14-1.34) or 3 or more years (OR=1.28, CI: 1.12-1.45). However, there was no significant association between Web-based refill use and glycemic control. Those with uncontrolled blood pressure at baseline who used Web-based refills were significantly more likely than nonusers to achieve control at follow-up with 2 (OR=1.07, CI: 1.01-1.13) or 3 (OR=1.08, CI: 1.02-1.14) more years of Web-based refill use. Both features were significantly associated with improvements in LDL cholesterol levels at follow-up. Conclusions Although rates of use of the refill function were higher within the population, sustained SM use had a greater impact on HbA1c. Evaluations of patient portals should consider that individual components may have differential effects on health improvements.
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Affiliation(s)
- Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.
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Lyles CR, Sarkar U, Schillinger D, Ralston JD, Allen JY, Nguyen R, Karter AJ. Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. J Am Med Inform Assoc 2016; 23:e28-33. [PMID: 26335983 PMCID: PMC4954621 DOI: 10.1093/jamia/ocv126] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the online refill function in patient portals had similar changes over time compared with Whites. METHODS We examined a retrospective cohort of diabetes patients who were existing patient portal users. The primary exposure was initiating online refill use (either exclusively for all statin refills or occasionally for some refills), compared with using the portal for other tasks (eg, exchanging secure messages with providers). The primary outcome was change in statin adherence, measured as the percentage of time a patient was without a supply of statins. Adjusted generalized estimating equation models controlled for race/ethnicity as a primary interaction term. RESULTS Fifty-eight percent of patient portal users were white, and all racial/ethnic minority groups had poorer baseline statin adherence compared with Whites. In adjusted difference-in-difference models, statin adherence improved significantly over time among patients who exclusively refilled prescriptions online, even after comparing changes over time with other portal users (4% absolute decrease in percentage of time without medication). This improvement was statistically similar across all racial/ethnic groups. DISCUSSION Patient portals may encourage or improve key health behaviors, such as medication adherence, for engaged patients, but further research will likely be required to reduce underlying racial/ethnic differences in adherence. CONCLUSION In a well-controlled examination of diabetes patients' behavior when using a new online feature for their healthcare management, patient portals were linked to better medication adherence across all racial/ethnic groups.
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Affiliation(s)
- Courtney R Lyles
- University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Urmimala Sarkar
- University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA
| | - Dean Schillinger
- University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | | | - Jill Y Allen
- Kaiser Permanente, National Market Research, Oakland, CA, USA
| | - Robert Nguyen
- Kaiser Permanente, National Market Research, Oakland, CA, USA
| | - Andrew J Karter
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
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Kuo A, Dang S. Secure Messaging in Electronic Health Records and Its Impact on Diabetes Clinical Outcomes: A Systematic Review. Telemed J E Health 2016; 22:769-77. [PMID: 27027337 DOI: 10.1089/tmj.2015.0207] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED In 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act, which aims for the universal adoption of electronic health records (EHRs) in primary care settings and "meaningful use" of this technology. The objectives of "meaningful use" are well defined and executed in stages; one of the objectives of stage 2, beginning in 2014, was implementation of a secure messaging system between patients and providers. Secure messaging has been shown to positively affect patients who struggle with managing chronic diseases on a day to day basis. This review aims to assess the clinical evidence supporting the use of secure messaging in EHRs in self-management of diabetes. METHODS A systematic search of PubMed was conducted, and 320 results were returned. Of these, 11 were selected based on outlined criteria. CONCLUSIONS Evidence from 7 of the 11 included studies suggests significant improvement in patients' hemoglobin A1c (HbA1c) with the use of secure messaging. However, improvements in patients' secondary outcomes, such as blood pressure and cholesterol, were inconsistent. Further work must be done to determine how to best maximize the potential of available tools such as secure messaging and EHRs to improve patient outcomes.
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Affiliation(s)
- Alyce Kuo
- 1 University of Miami , Coral Gables, Florida
| | - Stuti Dang
- 2 Miami VA Healthcare System Geriatric, Research Education and Clinical Center and Extended Care and Research Services , Miami, Florida.,3 Division of Geriatrics and Palliative Care, Department of Medicine, University of Miami Miller School of Miami , Miami, Florida
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Haun JN, Patel NR, Lind JD, Antinori N. Large-Scale Survey Findings Inform Patients' Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment. J Med Internet Res 2015; 17:e282. [PMID: 26690761 PMCID: PMC4704939 DOI: 10.2196/jmir.5152] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging. Objective To quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample. Methods A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. Results The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared with individuals with lower reported health literacy. Many respondents (n=328, 40.0%) reported that they would like to receive education and/or felt other veterans would benefit from education on how to access and use the electronic patient portal and secure messaging (n=652, 79.6%). Conclusions Survey findings validated qualitative findings found in previous research, such that veterans perceive secure email messaging as a useful tool for communicating with health care teams. To maximize sustained utilization of secure email messaging, marketing, education, skill building, and system modifications are needed. These findings can inform ongoing efforts to promote the sustained use of this electronic tool to support for patient-provider communication.
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Affiliation(s)
- Jolie N Haun
- Veterans Health Administration, HSR&D Center of Innovation on Disability and Rehabilitation Research, Tampa, FL, United States.
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Meng D, Palen TE, Tsai J, McLeod M, Garrido T, Qian H. Association between secure patient-clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study. BMJ Open 2015; 5:e009557. [PMID: 26553841 PMCID: PMC4654385 DOI: 10.1136/bmjopen-2015-009557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess associations between secure patient-clinician email use and clinical services utilisation over time. DESIGN Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient-clinician email users and non-users for utilisation 1-12 months before and 7-18 months after first email (users) or a randomly assigned index date (non-users). SETTING US integrated healthcare delivery system. PARTICIPANTS 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. PRIMARY OUTCOME MEASURES Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. RESULTS After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88-237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI -0.3 to -0.1), from a mean of 4.1 calls per person 1-12 months before first use to a mean of 3.8 calls per person 7-18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI -0.2 to 0.0), from a mean of 4.2 calls per person 1-12 months before the index date to mean of 4.1 calls per person 7-18 months after the index date. CONCLUSIONS Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7-18 months after first use.
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Affiliation(s)
- Di Meng
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Joanne Tsai
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Melanie McLeod
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Terhilda Garrido
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Heather Qian
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
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Sandefer RH, Westra BL, Khairat SS, Pieczkiewicz DS, Speedie SM. Determinants of Consumer eHealth Information Seeking Behavior. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1121-1129. [PMID: 26958251 PMCID: PMC4765703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients are increasingly using the Internet and other technologies to engage in their own healthcare, but little research has focused on the determinants of consumer eHealth behaviors related to Internet use. This study uses data from 115,089 respondents to four years of the National Health Interview Series to identify the associations between one consumer eHealth behavior (information seeking) and demographics, health measures, and Personal Health Information Management (PHIM) (messaging, scheduling, refills, and chat). Individuals who use PHIM are 7.5 times more likely to search the internet for health related information. Just as health has social determinants, the results of this study indicate there are potential social determinants of consumer eHealth behaviors including personal demographics, health status, and healthcare access.
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Mirsky JB, Tieu L, Lyles C, Sarkar U. A Mixed-Methods Study of Patient-Provider E-Mail Content in a Safety-Net Setting. JOURNAL OF HEALTH COMMUNICATION 2015; 21:85-91. [PMID: 26332306 PMCID: PMC5431571 DOI: 10.1080/10810730.2015.1033118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To explore the content of patient-provider e-mails in a safety-net primary care clinic, we conducted a content analysis using inductive and deductive coding of e-mail exchanges (n = 31) collected from January through November 2013. Participants were English-speaking adult patients with a chronic condition (or their caregivers) cared for at a single publicly funded general internal medicine clinic and their primary care providers (attending general internist physicians, clinical fellows, internal medicine residents, and nurse practitioners). All e-mails were nonurgent. Patients included a medical update in 19% of all e-mails. Patients requested action in 77% of e-mails, and the most common requests overall were for action regarding medications or treatment (29%). Requests for information were less common (45% of e-mails). Patient requests (n = 56) were resolved in 84% of e-mail exchanges, resulting in 63 actions. These results show that patients in safety-net clinics are capable of safely and effectively using electronic messaging for between-visit communication with providers. Safety-net systems should implement electronic communications tools as soon as possible to increase health care access and enhance patients' involvement in their care.
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Affiliation(s)
- Jacob B Mirsky
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Lina Tieu
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Courtney Lyles
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Urmimala Sarkar
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
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Abstract
Courtney Lyles and colleagues highlight how the expansion of patient-facing electronic health record portals could exacerbate existing healthcare disparities.
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Jones JB, Weiner JP, Shah NR, Stewart WF. The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes. J Med Internet Res 2015; 17:e42. [PMID: 25707036 PMCID: PMC4376207 DOI: 10.2196/jmir.3157] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 06/16/2014] [Accepted: 08/16/2014] [Indexed: 11/13/2022] Open
Abstract
Background As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. Objective In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. Methods We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. Results We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). Conclusions There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies.
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Affiliation(s)
- James Brian Jones
- Research, Development and Dissemination, Sutter Health, Walnut Creek, CA, United States.
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Otte-Trojel T, de Bont A, van de Klundert J, Rundall TG. Characteristics of patient portals developed in the context of health information exchanges: early policy effects of incentives in the meaningful use program in the United States. J Med Internet Res 2014; 16:e258. [PMID: 25447837 PMCID: PMC4260079 DOI: 10.2196/jmir.3698] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/21/2014] [Accepted: 09/13/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online. Patient portals are electronic means to engage patients by enabling secure access to personal medical records, communication with providers, various self-management tools, and administrative functionalities. Outcomes of patient portals have mainly been reported in large integrated health systems. This may now change as the EHR Incentive Program enables and supports the use of patient portals in other types of health systems. In this paper, we focus on Health Information Exchanges (HIE): entities that facilitate data exchange within networks of independent providers. OBJECTIVE In response to the EHR Incentive Program, some Health Information Exchanges in the United States are developing patient portals and offering them to their network of providers. Such patient portals hold high value for patients, especially in fragmented health system contexts, due to the portals' ability to integrate health information from an array of providers and give patients one access point to this information. Our aim was to report on the early effects of the EHR incentives on patient portal development by HIEs. Specifically, we describe the characteristics of these portals, identify factors affecting adoption by providers during the 2013-2014 time frame, and consider what may be the primary drivers of providers' adoption of patient portals in the future. METHODS We identified four HIEs that were developing patient portals as of spring 2014. We collected relevant documents and conducted interviews with six HIE leaders as well as two providers that were implementing the portals in their practices. We performed content analysis on these data to extract information pertinent to our study objectives. RESULTS Our findings suggest that there are two primary types of patient portals available to providers in HIEs: (1) portals linked to EHRs of individual providers or health systems and (2) HIE-sponsored portals that link information from multiple providers' EHRs. The decision of providers in the HIEs to adopt either one of these portals appears to be a trade-off between functionality, connectivity, and cost. Our findings also suggest that while the EHR Incentive Program is influencing these decisions, it may not be enough to drive adoption. Rather, patient demand for access to patient portals will be necessary to achieve widespread portal adoption and realization of potential benefits. CONCLUSIONS Optimizing patient value should be the main principle underlying policies intending to increase online patient engagement in the third stage of the EHR Incentive Program. We propose a number of features for the EHR Incentive Program that will enhance patient value and thereby support the growth and sustainability of patient portals provided by Health Information Exchanges.
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Affiliation(s)
- Terese Otte-Trojel
- Health Services Management & Organization, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
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Amante DJ, Hogan TP, Pagoto SL, English TM. A systematic review of electronic portal usage among patients with diabetes. Diabetes Technol Ther 2014; 16:784-93. [PMID: 24999599 DOI: 10.1089/dia.2014.0078] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objectives of this review were (1) to examine characteristics associated with enrollment and utilization of portals among patients with diabetes and (2) to identify barriers and facilitators of electronic patient portal enrollment and utilization. PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were systematically searched for papers reporting original research using quantitative or qualitative methods on characteristics, barriers, and facilitators associated with portal enrollment and utilization among patients with diabetes in the United States. The search was limited to articles published between February 1, 2005 (the date of the national symposium on personal health records) and January 1, 2014. Sixteen articles were identified. Of these, nine were quantitative, three were qualitative, and four used mixed-methods. Several demographic characteristics, having better-controlled diabetes, and providers who engaged in and encouraged portal use were associated with increased portal enrollment and utilization. Barriers to portal enrollment included a lack of patient (1) capacity, (2) desire, and (3) awareness of portal/portal functions. Barriers to portal utilization included (1) patient capacity, (2) lack of provider and patient buy-in to portal benefits, and (3) negative patient experiences using portals. Facilitators of portal enrollment and utilization were providers and family members recommending and engaging in portal use. Improved usability, increased access, educating patients how to use and benefit from portals, and greater endorsement by providers and family members might increase portal enrollment and utilization. As more providers and hospitals offer portals, addressing barriers and leveraging facilitators may help patients with diabetes achieve potential benefits.
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Affiliation(s)
- Daniel J Amante
- 1 Clinical & Population Health Research Doctoral Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
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Morgan TO, Everett DL, Dunlop AL. How Do Interventions That Exemplify the Joint Principles of the Patient Centered Medical Home Affect Hemoglobin A1C in Patients With Diabetes: A Review. Health Serv Res Manag Epidemiol 2014; 1:2333392814556153. [PMID: 28462247 PMCID: PMC5289069 DOI: 10.1177/2333392814556153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To review the impact of the Joint Principle of the Patient Centered Medical Home (PCMH) on hemoglobin A1C (HbA1C) in primary care patients with diabetes. Methods: Systematic review of English articles using approximate terms for (1) the 7 principles of the PCMH, (2) primary care, and (3) HbA1C. We included experimental and observational studies. Three authors independently extracted data and obtained summary estimates for concepts with more than 2 high-quality studies. Results: Forty-three studies published between 1998 and 2012 met inclusion criteria, 33 randomized and 10 controlled before–after studies. A physician-directed medical practice (principle 2) lowered HbA1C values when utilizing nursing (mean difference [MD] −0.36, 95% confidence interval [CI] −0.43 to −0.28) or pharmacy care management (MD −0.76; 95% CI −0.93 to −0.59). Whole-person orientation (principle 3) also lowered HbA1C (MD −0.72, 95% CI −0.98 to −0.45). Studies of coordinated and integrated care (principle 4) and quality and safety interventions (principle 5) did not consistently lower HbA1C when reviewed in aggregate. We did not identify high-quality studies to make conclusions for personal physician (principle 1), enhanced access (principle 6), and payment (principle 7). Conclusion: Our review found individual interventions that reduced the HbA1C by up to 2.0% when they met the definitions set by of the Joint Principles of the PCMH. Two of the principles—physician-led team and whole-person orientation—consistently lowered the HbA1C. Other principles had limited data or made little to no impact. Based on current evidence, PCMH principles differentially influence the HbA1C, and there are opportunities for additional research.
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Affiliation(s)
- Toyosi O Morgan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcie L Everett
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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