Patients with complex chronic conditions

Health care use and clinical events associated with access to a patient portal

Mary E. Reed, Jie Huang, Richard J. Brand, Romain Neugebauer, Ilana Yonas, John Hsu, Dustin W. Ballard, Richard Grant

Research output: Contribution to journalArticle

Abstract

Background For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. Objective To examine the impact of portal access on the number of outpatient visits, emergency visits, and preventable hospitalizations. Design Observational study comparing patients’ visit rates with and without portal access, using marginal structural modeling with inverse probability weighting estimates to account for potential bias due to confounding and attrition. Setting Large integrated delivery system which implemented a patient portal (2006–2007). Measurements We examined rates of outpatient office visits, emergency room visits, and preventable hospitalizations (for ambulatory care sensitive conditions). Results Access to a patient portal was associated with significantly higher rates of outpatient office visits, in both patients with diabetes only and in patients with multiple complex conditions (p<0.05). In patients with multiple complex chronic conditions, portal use was also associated with significantly fewer emergency room visits (3.9 fewer per 1,000 patients per month, p<0.05) and preventable hospital stays (0.8 fewer per 1,000 patients per month, p<0.05). In patients with only diabetes, the results were directionally consistent but not statistically significantly associated with emergency room visits and preventable hospital stays. Limitations Observational study in an integrated delivery system. Conclusion Access to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions.

Original languageEnglish (US)
Article numbere0217636
JournalPloS one
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Health care
health services
Delivery of Health Care
Emergency rooms
Medical problems
Outpatients
Integrated Delivery of Health Care
Hospital Emergency Service
Office Visits
Observational Studies
Length of Stay
Hospitalization
diabetes
Patient Portals
observational studies
Emergency Medical Services
Ambulatory Care
Self Care
Health
Health Services

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Patients with complex chronic conditions : Health care use and clinical events associated with access to a patient portal. / Reed, Mary E.; Huang, Jie; Brand, Richard J.; Neugebauer, Romain; Yonas, Ilana; Hsu, John; Ballard, Dustin W.; Grant, Richard.

In: PloS one, Vol. 14, No. 6, e0217636, 01.06.2019.

Research output: Contribution to journalArticle

Reed, Mary E. ; Huang, Jie ; Brand, Richard J. ; Neugebauer, Romain ; Yonas, Ilana ; Hsu, John ; Ballard, Dustin W. ; Grant, Richard. / Patients with complex chronic conditions : Health care use and clinical events associated with access to a patient portal. In: PloS one. 2019 ; Vol. 14, No. 6.
@article{25e390fbd6fa4643959d8c388f4dd0ae,
title = "Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal",
abstract = "Background For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. Objective To examine the impact of portal access on the number of outpatient visits, emergency visits, and preventable hospitalizations. Design Observational study comparing patients’ visit rates with and without portal access, using marginal structural modeling with inverse probability weighting estimates to account for potential bias due to confounding and attrition. Setting Large integrated delivery system which implemented a patient portal (2006–2007). Measurements We examined rates of outpatient office visits, emergency room visits, and preventable hospitalizations (for ambulatory care sensitive conditions). Results Access to a patient portal was associated with significantly higher rates of outpatient office visits, in both patients with diabetes only and in patients with multiple complex conditions (p<0.05). In patients with multiple complex chronic conditions, portal use was also associated with significantly fewer emergency room visits (3.9 fewer per 1,000 patients per month, p<0.05) and preventable hospital stays (0.8 fewer per 1,000 patients per month, p<0.05). In patients with only diabetes, the results were directionally consistent but not statistically significantly associated with emergency room visits and preventable hospital stays. Limitations Observational study in an integrated delivery system. Conclusion Access to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions.",
author = "Reed, {Mary E.} and Jie Huang and Brand, {Richard J.} and Romain Neugebauer and Ilana Yonas and John Hsu and Ballard, {Dustin W.} and Richard Grant",
year = "2019",
month = "6",
day = "1",
doi = "10.1371/journal.pone.0217636",
language = "English (US)",
volume = "14",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "6",

}

TY - JOUR

T1 - Patients with complex chronic conditions

T2 - Health care use and clinical events associated with access to a patient portal

AU - Reed, Mary E.

AU - Huang, Jie

AU - Brand, Richard J.

AU - Neugebauer, Romain

AU - Yonas, Ilana

AU - Hsu, John

AU - Ballard, Dustin W.

AU - Grant, Richard

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. Objective To examine the impact of portal access on the number of outpatient visits, emergency visits, and preventable hospitalizations. Design Observational study comparing patients’ visit rates with and without portal access, using marginal structural modeling with inverse probability weighting estimates to account for potential bias due to confounding and attrition. Setting Large integrated delivery system which implemented a patient portal (2006–2007). Measurements We examined rates of outpatient office visits, emergency room visits, and preventable hospitalizations (for ambulatory care sensitive conditions). Results Access to a patient portal was associated with significantly higher rates of outpatient office visits, in both patients with diabetes only and in patients with multiple complex conditions (p<0.05). In patients with multiple complex chronic conditions, portal use was also associated with significantly fewer emergency room visits (3.9 fewer per 1,000 patients per month, p<0.05) and preventable hospital stays (0.8 fewer per 1,000 patients per month, p<0.05). In patients with only diabetes, the results were directionally consistent but not statistically significantly associated with emergency room visits and preventable hospital stays. Limitations Observational study in an integrated delivery system. Conclusion Access to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions.

AB - Background For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. Objective To examine the impact of portal access on the number of outpatient visits, emergency visits, and preventable hospitalizations. Design Observational study comparing patients’ visit rates with and without portal access, using marginal structural modeling with inverse probability weighting estimates to account for potential bias due to confounding and attrition. Setting Large integrated delivery system which implemented a patient portal (2006–2007). Measurements We examined rates of outpatient office visits, emergency room visits, and preventable hospitalizations (for ambulatory care sensitive conditions). Results Access to a patient portal was associated with significantly higher rates of outpatient office visits, in both patients with diabetes only and in patients with multiple complex conditions (p<0.05). In patients with multiple complex chronic conditions, portal use was also associated with significantly fewer emergency room visits (3.9 fewer per 1,000 patients per month, p<0.05) and preventable hospital stays (0.8 fewer per 1,000 patients per month, p<0.05). In patients with only diabetes, the results were directionally consistent but not statistically significantly associated with emergency room visits and preventable hospital stays. Limitations Observational study in an integrated delivery system. Conclusion Access to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions.

UR - http://www.scopus.com/inward/record.url?scp=85067398813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067398813&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0217636

DO - 10.1371/journal.pone.0217636

M3 - Article

VL - 14

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 6

M1 - e0217636

ER -