Interventions to Increase Patient Portal Use in Vulnerable - - PowerPoint PPT Presentation

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Interventions to Increase Patient Portal Use in Vulnerable - - PowerPoint PPT Presentation

Nov 28, 2023 184 likes •445 views

1 Interventions to Increase Patient Portal Use in Vulnerable Populations: A Systematic Review S61: Patients as Partners in Healthcare Lisa V Grossman, Ruth M Masterson Creber, Natalie C Benda, Drew Wright, David K Vawdrey, Jessica S Ancker

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Interventions to Increase Patient Portal Use in Vulnerable Populations: A Systematic Review

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Lisa V Grossman, Ruth M Masterson Creber, Natalie C Benda, Drew Wright, David K Vawdrey, Jessica S Ancker

S61: Patients as Partners in Healthcare Columbia University, Weill Cornell Medicine, Geisinger

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Purposes of Patient Portals

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Educate or instruct patients Increase patient satisfaction Collect patient-reported outcomes Medical record verification Communicate costs Develop shared care plans Patient-provider communication Monitor patient safety concerns Manage medications remotely

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Portal Use by Year

70%

Portal Availability ( ) and Use ( ) in the U.S. 2014

95%

2017

17% 28%

Accessible Healthcare

Online Refills Messaging Telemedicine Symptom Monitoring Education Medical Records

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Disparities in Portal Use

Severity of illness Disability status Level of education Internet & computer access Functional or health literacy Computer skills Age Race & Ethnicity Socioeconomic status, income

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Intervention-Generated Inequity

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Smoking Rate by Education Level in the U.S.

Smoking Rate Year

60% 0% 40% 20% 1940 2000 1950 1960 1970 1980 1990 2010

High school College or higher

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The Question What interventions could help ensure that portals benefit vulnerable patients?

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Methods

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Guideline: PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Eligibility Criteria [PICOS]

Populations Interventions Study Designs Vulnerable populations [PROGRESS-Plus] Any intervention [no limitations] Outcomes (1) Portal use, (2) predictors of portal use, (3) disparities in portal use Any design [no limitations] Comparisons Any comparison [pre-post, concurrent control, etc.]

1 2 3

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Study Selection

Database Search

MEDLINE EMBASE CINAHL Cochrane Reviews

Supplemental Search

References Personal libraries Journal table-of-contents Author correspondence

1st Screening

Title & abstract

2nd Screening

Full text articles

Included

In the review

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Data Extraction

Risk of Bias [AHRQ Methods Guide] Intensity of Intervention [Cochrane Guide]

Results Comparison Objective Design Intervention Eligibility Criteria Setting Measures Sample size Participant characteristics

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SEIPS Model

Tool or Technology Organization Task Environment Individual Processes & Outcomes

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Results

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Included Studies

719 studies

Title & abstract

91 studies

Full text

18 studies

Included

15 of 18 [83%] studied impact on portal use 7 of 18 [39%] studied impact on predictors of portal use 1 of 18 [6%] studied impact on disparities in portal use

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Study Characteristics (n=18)

Designs

5 Time series 5 RCTs 5 Pre-post 3 Other

Measures

Login days Total logins Activation rates Clicks Features viewed And more!

Risk of Bias

Medium Low Unclear High

Intensity of Intervention

Medium Low Unclear High 4 9 3 2 5 7 5 1

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Intervention Types

13 [72%] Individual

e.g., training or help registering

5 [28%] Tool or Tech

e.g., updating the portal itself

4 [22%] Organization

e.g., policy or workflow changes

1 [6%] Task

e.g., doctors assigning tasks

2 [11%] Environment

e.g., free access to computers

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Key Findings: Training

How does training and assistance impact portal use in vulnerable populations? # of Studies Effectiveness

Neutral Benefit Harm Mixed 6 1 1

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Universal Access

=

Everyone is

  • ffered portal

enrollment

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Key Findings: Disparities

How does a universal access policy impact disparities in portal use? The policy greatly reduced disparities in portal use.

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Conclusions

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The Takeaway Let us move beyond identifying disparities in portal use to start addressing them.

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Intervention Types

Most interventions were individual-level. Future interventions should be multi-level. Individual

=

Task, Tool, Environment, Organization

=

Strong Actions

many people at a time

Weak Actions

  • ne person

at a time

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More Takeaways

Future studies should measure impact on disparities directly. Standardized measures of portal use could improve comparability

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Acknowledgments

Ruth M Masterson Creber Natalie C Benda Drew Wright David K Vawdrey Jessica S Ancker George Hripcsak Suzanne Bakken Meghan Reading Turchioe Annie Myers

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Lisa V Grossman lvg2104@cumc.columbia.edu https://bit.ly/2Wl4QKS