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

Tosto, Gennaro Di; Walker, Daniel M.; Sieck, Cynthia J.; Wallace, Lorraine S.; MacEwan, Sarah R.; Gregory, Megan E.; Scarborough, Seth; Huerta, Timothy R.; McAlearney, Ann Scheck

doi:10.1055/s-0042-1751239

Cited by 8 publications

(3 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Taken in combination, our findings suggest that the technology and touch interventions may have provided technology access as well as skills and digital literacy training, 39 but did not overcome other barriers that disproportionately impact Black individuals. These additional barriers to inpatient portal use may include medical mistrust, privacy concerns, and/or unwillingness to share information a Other includes African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race and ethnicity.…”

Section: Discussionmentioning

confidence: 79%

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Walker,

Hefner,

MacEwan

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceDifferences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap.ObjectiveTo compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups.Design, Setting, and ParticipantsThis secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023.InterventionsA 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]).Main Outcomes and MeasuresPrimary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs.ResultsOf 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race.Conclusions and RelevanceIn this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity.Trial RegistrationClinicalTrials.gov Identifier: NCT02943109

show abstract

Section: Discussionmentioning

confidence: 79%

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Walker,

Hefner,

MacEwan

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…[94][95][96][97] Higher utilization of portals, resulting in increased patient engagement, was associated with sociodemographic characteristics such as age and race but also impacted by factors associated with the technology including the usability of the platform and the digital literacy of the patient. [98][99][100]…”

Section: Portalsmentioning

confidence: 99%

A Decade of Health Information Technology and the Impact on Health Care in the U.S.: Systematic Review (Preprint)

Harris,

Goldwater,

Swain

et al. 2024

Preprint

View full text Add to dashboard Cite

BACKGROUND In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established to facilitate the nationwide adoption and use of health information technology (health IT). Since its inception, the health IT landscape has evolved with a diverse array of federal investments, programs, and policies to advance its use. Previous systematic reviews of literature related to health IT focused on assessing the adoption and use of technology. As health IT has evolved, research has pivoted from tracking adoption of specific health IT features to assessing the impact of these technologies and tools. OBJECTIVE This paper provides a comprehensive review of peer-reviewed publications published over the past decade to closely examine the impacts of health IT including the impact of federal policies, changing priorities, and how the expanded use of EHR features, and effect of health IT on people, processes, and outcomes. METHODS All health IT-related peer-reviewed published between January 2013 and June 2023 were evaluated to identify articles that focused on the impact of health IT. Articles and studies were extracted through a review of PubMed. A stepwise process was used to identify articles that met the inclusion criteria, focused on the impact of health IT, and demonstrated sufficient scientific rigor. RESULTS The resulting 408 articles were coded based on their primary focus (provider-facing or patient-facing technology), or based on topics that pertained to the systemwide use of health IT. Within each of these categories, articles were organized around key themes. Overwhelmingly, research studies reported that health IT generated a positive impact. More than half of all articles focused on provider-facing technology with a focus on measurable outcomes including quality, safety, and costs. A number of studies evaluated the increased use of patient portals and other tools to support engagement. Studies on interoperability highlighted the value of increased health information exchange. An emerging area of study included a focus on the role of health IT in advancing public and population health. Over three-quarters of the published literature concluded that health IT generated a positive, mixed, or neutral impact. These effects were consistent across the different categories of health IT that were examined whether provider-facing, patient-facing, or systemwide impact of health IT. CONCLUSIONS Over the past decade, the focus of studies on the impact of health IT has evolved, transitioning from a concentration on health IT adoption to optimizing its potential. This includes assessing the effectiveness of EHR functions as well as increasing information exchange. As the landscape evolved with broader acceptance of health IT, the focus shifted with greater interest in technology’s impact on patient engagement, and opportunities to use data to advance health care including population and public health. CLINICALTRIAL N/A

show abstract

“…Researchers should focus on how to sustainably address structural barriers to portal engagement. With the exception of initiatives that provide tablets to patients, 96,117,118 existing solutions have largely focused on patient education or have bypassed portals altogether, instead using other modes of communication such as telephone. While telephone communication may be acceptable in some cases, video visits have advantages such as allowing for some visual assessments.…”

Section: Health Care Organizationsmentioning

confidence: 99%

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Reynolds,

Cobb,

Steitz

et al. 2023

Appl Clin Inform

View full text Add to dashboard Cite

Background and Objective Recent external factors—the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic—have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. Methods To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. Results Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). Conclusion Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

show abstract

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

Cited by 8 publications

References 36 publications

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

A Decade of Health Information Technology and the Impact on Health Care in the U.S.: Systematic Review (Preprint)

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Contact Info

Product

Resources

About