Background
Financial and regulatory incentives have encouraged and increased the availability of online patient portals that provide caregivers access to their child's electronic health records ...(EHR). Such access is believed to promote better engagement and outcomes of care. Little is known about the use of portals by caregivers of children with cancer. This study sought to examine whether sociodemographic and clinical care variables are associated with portal activation in a pediatric oncology sample.
Methods
Sociodemographic and clinical characteristics were extracted from the EHR of pediatric oncology patients treated for their first cancer in the Nemours Center for Cancer and Blood Disorders between 2012 and 2017. A Child Opportunity Index (COI) was calculated based on home zip code. Characteristics of children whose caregivers did and did not activate the portal were compared.
Results
Sixty‐six percent of caregivers activated a portal account with a peak within 90 days of diagnosis. In logistic regression, caregivers with a younger aged child, spoke English, lived closer to the hospital, lived in higher COI area, with longer treatment length, and more radiology tests had greater odds of portal activation. Those with private health insurance or White race were overrepresented among those who activated an account in univariate analysis.
Conclusion
The majority of caregivers of children with cancer activate portal accounts; however, differences in sociodemographic and clinical variables across those who did and did not activate accounts emerged. As portals become ubiquitous, we must understand how they are used and mitigate widening inequities caused by disparate portal use.
Abstract
Objective
To rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic.
Materials and Methods
We created ...a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories—emergent, urgent, nonurgent, or self-care—and then connected with the appropriate level of care via direct scheduling or telephone hotline.
Results
This self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7–98.5%).
Discussion
This self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits.
Conclusion
Patient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.
More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit ...all populations.
To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use.
A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias.
Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias.
Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
AbstractEntrepreneurship is widely acknowledged to be a phenomenon of central importance in our society. Within the arena of entrepreneurship policy, a more specific trend has been an increase in ...recent years in informal entrepreneurship, especially in developing countries. Therefore, this article seeks to contribute to filling a knowledge gap in the entrepreneurship literature using empirical evidence to assess the impact of the implementation of the Individual Micro Entrepreneur Act on the formalization of small businesses in Brazil. Based on empirical data retrieved from e-government portals, our study provides evidence that this legislation is being used as a large-scale legal instrument for labor market deregulation in many sectors. Additionally, we could also observe a strong increase in the number of Brazilian citizens officially registered as individual micro entrepreneurs, especially in urban areas and focusing on activities, such as hairdressers, manicures, pedicures, masonry works, and sales promotion. It was possible to observe that rather many informal workers did not become an entrepreneur, but a formal employee after the implementation if the Individual Micro Entrepreneur Act. Key-words: informal entrepreneurship; firm formalization; public policy; regional development; Brazil
Effective management and care of diabetes is crucial to reducing associated risks such as heart disease and kidney failure. With increasing access and use of the Internet, online chronic disease ...management is being explored as a means of providing patients with support and the necessary tools to monitor and manage their disease.
The objective of our study was to evaluate the experience of patients and providers using an online diabetes management portal for patients.
Participants were recruited from a large sample population of 887 for a follow-up questionnaire to be completed after 6 months of using the patient portal. Participants were presented with the option to participate in an additional interview and, if the participant agreed, a time and date was scheduled for the interview. A 5-item, open-ended questionnaire was used to capture providers' opinions of the patient portal. Providers included general practitioners (GPs), nurses, nurse practitioners (NPs), dieticians, diabetes educators (DECs), and other clinical staff.
A total of 854 patients were consented for the questionnaire. Seventeen (8 male, 9 female) patients agreed to participate in a telephone interview. Sixty-four health care providers completed the five open-ended questions; however, an average of 48.2 responses were recorded per question. Four major themes were identified and will be discussed in this paper. These themes have been classified as: facilitators of disease management, barriers to portal use, patient-provider communication and relationship, and recommendations for portal improvements.
This qualitative study shows that online chronic disease management portals increase patient access to information and engagement in their health care, but improvements in the portal itself may improve usability and reduce attrition. Furthermore, this study identifies a grey area that exists in the roles that GPs and AHPs should play in the facilitation of online disease management.
Background
Collection of patient‐reported data has been demonstrated to improve asthma outcomes. One method to collect information is through the electronic patient portal. In practice, patient ...portal use in pediatrics and, specifically for asthma management, has had low uptake.
Objective
To understand parental/caregiver experience of pediatric asthma care management, and perceptions of the use of patient portal questionnaires before the clinic visit.
Methods
We conducted semi‐structured interviews with caregivers of children 5–11 years old with asthma in the University of California, Los Angeles (UCLA) Health System. We included patient portal “users” (n = 20) and “non‐users” (n = 5). Interview questions were developed based on clinic visit workflow with a focus on perceived usefulness and ease of use to complete pediatric asthma questionnaires in the patient portal before the visit. Interviews were audio‐recorded, transcribed, and codes were generated from themes using constant comparative analysis.
Results
We identified eight themes related to caregiver‐physician communication, perception of portal questionnaires, facilitators, and barriers to portal questionnaire use. A salient finding was that caregivers considered the portal questionnaire as a tool to be integrated into the visit to facilitate a conversation about their child's asthma. Caregiver portal‐based questionnaire use was more likely if the ongoing data entered was accessible to caregivers to track and update, and if caregivers were reassured the clinicians would use questionnaire responses during the visit.
Conclusion
Caregivers of children with asthma are more likely to complete a patient portal intake questionnaire before the visit if they trust their responses will be used during the visit to inform care.
With increased access to technology and the internet, there are many opportunities for utilizing electronic health (eHealth), internet, or technology-delivered health services and information for the ...prevention and management of chronic diseases.
The aim of this paper was to explore (1) the differences in technology use, (2) Web-based health information seeking and use behaviors, (3) attitudes toward seeking health information on the Web, and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease.
A cross-sectional internet survey was conducted in March 2017 with 401 US adults. Participant responses were examined to understand associations between chronic disease status and eHealth behaviors such as internet health-seeking behaviors and Web-based behaviors related to health, tracking health indicators with a mobile app, patient portal use, and preferences for health information.
About 1 in 3 (252/401, 37.2%) participants reported at least 1 chronic disease diagnosis. Seventy-five percent (301/401) of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0% 48/120 vs 25.8% 46/178, χ
=6.7; P=.01; 43.3% 52/120 vs 27.9% 50/179; χ
=7.6; P=.006). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% 59/120 vs 35.0% 63/180, χ
=6.7; P=.04), changing the way they cope with a chronic condition or manage pain (40.8% 49/120 vs 19.4% 35/180, χ
=16.3; P<.001), and leading them to ask a doctor new questions or get a second opinion (37.5% 45/120 vs 19.6% 35/179, χ
=11.8; P<.001). Chronic disease participants were significantly more likely to be tracking health indicators (43.9% 65/148 vs 28.3%, 71/251 χ
=10.4; P=.006). In addition, participants with chronic disease diagnosis reported significantly higher rates of patient portal access (55.0% 82/149 vs 42.1% 106/252, χ
=6.3; P=.01) and use (40.9% 61/149 vs 21.0% 53/252, χ
=18.2; P<.001). Finally, both groups reported similar perceived skills in using the internet for health information on the eHealth Literacy Scale (eHEALS). The majority of participants responded positively when asked about the usefulness of health information and importance of accessing health resources on the Web.
The high rates of reported information seeking and use of internet-based health technology among participants with chronic disease may reflect the uptake in eHealth to help manage chronic disease conditions. Health care providers and educators should continue to seek ways to interact and support patients in their management of chronic disease through eHealth platforms, including capitalizing on Web-based resources, patient portals, and mobile phone apps for disease education and monitoring.
Patient portal secure messaging can support age-friendly dementia care, yet little is known about care partner use of the portal and how message concerns relate to age-friendly issues.
We conducted a ...two-part observational study. We first assessed the feasibility of automating care partner identification from patient portal messages by developing and testing a natural language processing (NLP) rule-based classification system from portal messages of 1973 unique patients 65 and older. Second, two independent reviewers manually coded a randomly selected sample of portal messages for 987 persons with dementia to identify the frequency of expressed needs from the 4M domains of an Age-Friendly Health System (medications, mentation, mobility, and what matters).
A total of 267 (13.53%) of 1973 messages sent from older adults' portal accounts were identified through manual coding as sent by a nonpatient author. The NLP model performance to identify nonpatient authors demonstrated an AUC of 0.90. Most messages sent from the accounts of persons with dementia contained content relevant to the 4Ms (60%, 601/987), with the breakdown as follows: medications-36% (357/987), mobility-10% (101/987), mentation-16% (153/987), and what matters (aligning care with specific health goals and care preferences)-21%, 207/987.
Patient portal messaging offers an avenue to identify care partners and meet the informational needs of persons with dementia and their care partners.
Patient portals and broadband internet inequality Perzynski, Adam T; Roach, Mary Joan; Shick, Sarah ...
Journal of the American Medical Informatics Association : JAMIA,
09/2017, Letnik:
24, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Abstract
Background: Patient portals have shown potential for increasing health care quality and efficiency. Internet access and other factors influencing patient portal use could worsen health ...disparities.
Methods: Observational study of adults with 1 or more visits to the outpatient clinics of an urban public health care system from 2012 to 2015. We used mixed effects logistic regression to evaluate the association between broadband internet access and (1) patient portal initiation (whether a patient logged in at least 1 time) and (2) messaging, controlling for demographic and neighborhood characteristics.
Results: There were 243 248 adults with 1 or more visits during 2012–2015 and 70 835 (29.1%) initiated portal use. Portal initiation was 34.1% for whites, 23.4% for blacks, and 23.8% for Hispanics, and was lower for Medicaid (26.5%), Medicare (23.4%), and uninsured patients (17.4%) than commercially insured patients (39.3%). In multivariate analysis, both initiation of portal use (odds ratio OR = 1.24 per quintile, 95% confidence interval CI, 1.23–1.24, P < .0001) and sending messages to providers (OR = 1.15, 95%CI, 1.09–1.14, P < .0001) were associated with neighborhood broadband internet access.
Conclusions: The majority of adults with outpatient visits to a large urban health care system did not use the patient portal, and initiation of use was lower for racial and ethnic minorities, persons of lower socioeconomic status, and those without neighborhood broadband internet access. These results suggest the emergence of a digital divide in patient portal use. Given the scale of investment in patient portals and other internet-dependent health information technologies, efforts are urgently needed to address this growing inequality.
BACKGROUND Patient portals provide parents access to their child’s health information and direct communication with providers. Our study aimed to improve portal activation rates of newborns during ...nursery hospitalization to >70% over 6 months. Secondarily, we describe the facilitators and barriers to portal use. METHODS The study design used a mixed-methodology framework of quality improvement (QI) and cross-sectional analyses. The Model for Improvement guided QI efforts. The primary outcome was the proportion of portals activated for newborns during nursery hospitalization. Interventions included portal activation algorithm, staff huddles, and documentation templates. Telephone interviews were conducted with a randomized sample of mothers of infants who activated the portal. These mothers were divided into portal “users” and “nonusers.” We examined sociodemographic variables and health care utilization outcomes in the 2 groups. RESULTS Portal activation increased from 12.9% to 85.4% after interventions. Among 482 mothers with active portals, 127 (26.3%) were interviewed. Of those, 70% (89 of 127) reported using the portal, and 85.4% (76 of 89) found it useful. Reasons for accessing the portal included checking appointments and reviewing test results. Lack of knowledge of portal functionality was the main barrier to portal use (42.1%). Portal users were less likely to have a no-show to primary care appointments compared with nonusers (44.9% versus 78.9%, P < .001). CONCLUSIONS Portal activation rates increased after QI interventions in the nursery. Most parents accessed the portal and found it useful. Portals can improve health care delivery and patient engagement in the newborn period.
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