An Explorative Longitudinal Study on the Five-Year Patient Portal Use among an Underserved Patient Population

Abstract

The purpose of the study was to identify and assess multiple aspects of patient portal usage behavior in an underserved urban patient population. Given the rise of patient-centered care, patients are required to take active roles to gather health information, make informed health decisions and manage their own healthcare, which behavior were associated with health outcome (Barry & Edgman-Levitan, 2012; Oates, Weston & Jordan, 2000). Patient portals serve as a mean to coordinate patient-centered care by delivering health information to patients (e.g. medical test results), exchanging information with healthcare providers (e.g., messaging providers), and facilitating the delivery of health care services (e.g., scheduling appointments). However, studies often showed that patients in underserved communities did not take full advantages of the patient portals (e.g,. Cazaja et al., 2015, Wallace et al., 2016). These disparities in patient portal usages were associated with many factors, including the complexities of the American healthcare system, lack of internet access, lack of support to navigate through the health systems, and the lack of health literacy among an underserved adult population. To better understand the current use of patient portal of an underserved patient population, we conducted an explorative analysis of portal usage at the University of Illinois Hospitals and Health Sciences System (UIHealth). UIHealth serves throughout the city of Chicago, including areas with high racial segregation (minority population higher than 75%), where patients’ household income is lower than the median of Chicago residents. The majority of patient populations in UIHealth are African Americans (61%) followed by Hispanic/Latino (17%) and White (17%). The study was conducted using a retrospective analysis of Google Analytics portal data from March 2015 to March 2019. User behavior data were extracted to show aspects of usage, including most popular portal functions, language used, time spent on each page, and returning user visits, etc. We used weekly summary data as individual data points (208 data points in total) in the analysis. We found that, over four years, both retuning and new users increased by more than 50%. Regarding the number of users per week, there were local drops in the overall growth which drops were associated with fewer visits to UIHealth during holidays or cold weather. Hence, portal visits were associated with clinic visits. With regards to the most popular functions, writing messages to healthcare providers and viewing medical test results were the most used functions over the years. Results suggested that patients would utilize portal to gather information about their health status (for later discussion with physicians or making informed decisions) and communicate with healthcare providers. Interestingly, we found the dominant devices used to access the portal have shifted from desktop computers (2015-2017) to mobile phones (2017-2019), suggesting the increasing need to present health information in bitable size in smaller screens; and the increasing smartphone adoptions of underserved adults as an alternative solution to get internet access. Overall, improving the accessibility of patient portals remains to be a major issue for empowering patients in contemporary value-based healthcare systems. The explorative study has shed lights on the longitudinal trends of portal usage among an underserved population, which creates practical implications on the design of a more efficient interface between patients and their healthcare providers with the ultimate goal to improve health equity.