Abstract
BackgroundThe number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes.ObjectiveTo examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes.MethodsWe applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff–generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension.ResultsPatients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=–.30; 95% CI –0.56 to –0.04), as were staffs’ action responses (β=–30; 95% CI –0.58 to –0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (β=–4.03; 95% CI –7.94 to –0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19).ConclusionsThis is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.
Highlights
Background and SignificanceThe use of secure messaging—email messages exchanged between patients and clinical staff through a secure platform—has increased significantly over the last 2 decades as patients’ access to the functionality increased [1,2,3,4,5]
Decreases among patients who received confirmation of action, systolic blood pressure (SBP) increases in response to Information sharing/Deferral, and diastolic blood pressure (DBP) increases associated with Scheduling request/New condition
We hypothesized that Self-reporting, patients’ Appreciation and praise for clinic staff, and staff Encouragement would be associated with improved outcomes but we found the opposite: poorer DBP and A1C values in 2018 were associated with the Encouragement and Appreciation and praise taxa and patients who self-reported http://www.jmir.org/2020/10/e19477/
Summary
The use of secure messaging—email messages exchanged between patients and clinical staff through a secure platform—has increased significantly over the last 2 decades as patients’ access to the functionality increased [1,2,3,4,5]. Message threads that include communication functions identified by Street et al [11] should be associated with better health outcomes. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. Conclusions: This is the first research to find associations between message content and patients’ health outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes
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