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Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal

dataset
posted on 19.06.2019 by Mary E. Reed, Jie Huang, Richard J. Brand, Romain Neugebauer, Ilana Graetz, John Hsu, Dustin W. Ballard, Richard Grant

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).

Patients

We examined 165,447 patients with diabetes defined using clinical registries. Our study included both patients with diabetes-only and patients with multiple complex chronic conditions (diabetes plus asthma, congestive artery disease, congestive heart failure, or hypertension).

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.

History

Licence

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