A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity

Abstract

Background: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). Methods: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients’ neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. Results: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07–6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23–2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. Conclusions: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.

Real-Time Electronic Patient Portal Use Among Emergency Department Patients

“…Literature about ED portal use is sparse, which is problematic because the ED represents the primary care environment for many medically underserved and underinsured patients who use portals at lower rates despite equally or more complex care needs . Preliminary studies suggested that portal access initiated in the ED, especially among patients experiencing houselessness, is associated with increased clinic attendance and care adherence . Improved care adherence may follow from the ability to manage care asynchronously by scheduling appointments, messaging care teams, and reviewing results, which extends the care network beyond the doors of the ED .…”

“… 6 , 11 Preliminary studies suggested that portal access initiated in the ED, especially among patients experiencing houselessness, is associated with increased clinic attendance and care adherence. 12 , 13 , 14 Improved care adherence may follow from the ability to manage care asynchronously by scheduling appointments, messaging care teams, and reviewing results, which extends the care network beyond the doors of the ED. 15 , 16 More acutely, real-time ED portal access might facilitate sooner identification of critical results or empower patients to detect missed incidental findings.…”

Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting

“…8 Particularly, in the US, the 21st Century Cures Act has mandated the sharing of clinical documentation with patients and families. [9][10][11][12] While many studies have yielded important lessons for successful portal implementations in primary and acute care settings (e.g., the importance of engaging patients and families and clinical workflows), 8,[13][14][15] in the mental health domain, it is still relatively uncommon to share health information with patients and families due to stigma and impact on therapy. 16 Despite growth in this area, [17][18][19][20] there has been significant concern and apprehension around sharing notes with patients.…”