Patient Electronic Health Record Portal Use and Patient-Centered Outcomes in CKD

Tome, June; Ahmed, Shahbaz; Fagerlin, Angela; Powell, Corey; Mourão, Márcio; Chen, Emily; Harrison, Sam; Segal, Jonathan H.; Abdel-Kader, Khaled; Nunes, Julie Wright

doi:10.1016/j.xkme.2020.11.014

Cited by 5 publications

(6 citation statements)

References 41 publications

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“…Families who used only Dexcom receivers would have had limitations to passive data upload. Emerging studies report that medical record messaging is less utilized and accepted by historically underrepresented individuals, including those from racial and ethnic minority, low-income, and limited English proficiency groups . The lack of linguistically and culturally congruent clinicians, a well-documented national problem, may also have played a role.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging studies report that medical record messaging is less utilized and accepted by historically underrepresented individuals, including those from racial and ethnic minority, low-income, and limited English proficiency groups. 38 , 39 , 40 The lack of linguistically and culturally congruent clinicians, a well-documented national problem, 41 , 42 , 43 may also have played a role. Finally, providing access to CGM, while an important step, does not overcome the structural and social determinants of health, medical racism, health policy, and language barriers that impact health outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

et al. 2023

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ImportanceContinuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.ObjectiveTo determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.Design, Setting, and ParticipantsThis cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.ExposuresAll eligible participants were offered CGM within 1 month of diabetes diagnosis.Main Outcomes and MeasuresTo assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.ResultsThe Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]).Conclusions and RelevanceThe findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.Trial RegistrationClinicalTrials.gov Identifier: NCT04336969

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

et al. 2023

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“…Prior research has shown that access to patient portals resulted in improved diabetes-related outcomes and adherence to hypertensive medication [16,17]. Additionally, a recent study of patients with chronic kidney disease (CKD) found that the use of EHR improves patient-centered outcomes such as CKD-specific knowledge, while reducing CKD-related stress [5]. The ongoing COVID-19 pandemic has accelerated the use of technologies such as patient portals for health care delivery [18,19].…”

Section: Introductionmentioning

confidence: 99%

“…Patient portals also provide effective communication tools with the potential to increase patient engagement in self-care management. Patients can also use patient portals for prescription renewal, appointment management, checking lab results, and messaging their providers [ 5 ]. Therefore, the use of patient portals is an increasingly common approach in patient-centered care practices [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis

Calixte

Islam

Osakwe

et al. 2021

IJERPH

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Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging with providers, to request refills, to make clinical decisions, or to share medical records with another provider. The results indicate that respondents with multimorbidity are more likely to share their medical records with other providers. However, respondents who are 75 and older are less likely to share their medical records with another provider. Additionally, respondents who are 65 and older are less likely to use the EHR for secure direct messaging with their provider. Additional health care strategies and provider communication should be developed to encourage older patients with chronic conditions to leverage the use of patient portals for effective disease management.

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“…9 Notably, studies have associated patient portal use with better patientreported outcomes, including increased knowledge and reduced disease-related stress. 10 Poor access to portals thereby further exacerbates health care disparities.…”

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confidence: 99%

Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

Johnson,

Ibrahim,

Rosenbloom

2023

JAMA Health Forum

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Over the past 25 years, patient portals have expanded from small demonstration projects, such as seminal work by Masys et al 1 and Cimino et al, 2 to nearly ubiquitous components of electronic health records. This success has been associated with several factors, including regulatory pressures-eg, the Meaningful Use program and the 21st Century Cures Act-and recent changes to health care delivery models supporting asynchronous and virtual telehealth care. Use of patient portals is also influenced by important but relatively understudied cultural changes in people's expectations of seamless access to all data, including banking, entertainment, social media, and health data.Recent studies suggest that patient portal access is associated with greater engagement by patients in their health care. 3 For patients, being in a partnership with a health care team implies full access to one's health information, participation in decision-making, and engaging in self-managed health care. Today's portals enable this degree of partnership by sharing access to most electronic clinical information, including test results, clinical notes taken by health care professionals, and information regarding the patient's general health management. Modern patient portals also uniformly provide patients with tools to send secure messages to their health care team in the context of their medical record, to manage their prescription renewals, arrange appointments, and pay their bills. In many cases, patient portals have become a source of context-based educational materials for many patients and have offered interfaces that support self-management of chronic diseases such as hypertension and diabetes.Adoption and use of patient portals have surged in the US in the past 5 years, making them a crucial channel for timely health care access. 4 They now facilitate various health care services, including telehealth, virtual visits, secure messaging, preventive care alerts, previsit screening forms, and patient-reported outcome measures. Patient portals are no longer a tool for only motivated and engaged patients who wish to partner with their health care professionals. Instead, portals are now central to how basic health care services are delivered. For example, patients increasingly use portal-based secure messaging rather than calling the physician's office; they pay bills via a portal rather than mailing checks; and they schedule clinical visits and ancillary testing primarily using a portal.A concerning trend has emerged with the growing reliance on digital health care tools. The concept of "techquity" underscores the need for technology solutions to enhance health equity, but persistent evidence reveals disparities in patient portal access and utilization. 5 The current user community is overrepresented by middle-aged, English-speaking, affluent, and educated White women. 6 This digital divide is especially pronounced among historically marginalized groups, such as Black, Hispanic, and non-English-speaking individuals, who have faced long-stan...

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Patient Electronic Health Record Portal Use and Patient-Centered Outcomes in CKD

Cited by 5 publications

References 41 publications

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis

Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

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Patient Electronic Health Record Portal Use and Patient-Centered Outcomes in CKD

Cited by 5 publications

References 41 publications

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis

Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

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Product

Resources

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring