Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital (Preprint)

Abstract

BACKGROUND Offering hospitalized patients’ enrollment into a health system’s patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. OBJECTIVE The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system’s portal among hospitalized patients and reasons for no interest. METHODS Nurses assessed interest in a Web-based patient portal, expressed by the patient as “yes” or “no,” as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. RESULTS Among 23,994 hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/internet 29.59% (4551/15,380), doesn’t speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. CONCLUSIONS In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal—a required step before enrollment—is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies.

Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use

“…Third, our study followed the AMC's protocol for offering tablets in which nursing staff assessed a patient's ability to utilize a portal as part of the decision to offer the portal; this approach could have biased our sample toward patients who had higher perceived HLN. 31 As prior work has highlighted bias in perceptions of patients' ability to use the portal and provisioning of portals, 32 33 34 future work should take this potential bias into account and focus on the importance of asking all patients if they are interested in using a portal as well as consider how to systematically assess patients' capacities to use portals when evaluating overall use and impacts. This effort should extend to include non-English speakers and members of underrepresented groups.…”