Abstract
BackgroundFor 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.ObjectiveTo examine the impact of portal access on the number of outpatient visits, emergency visits, and preventable hospitalizations.DesignObservational 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.SettingLarge integrated delivery system which implemented a patient portal (2006–2007).PatientsWe 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).MeasurementsWe examined rates of outpatient office visits, emergency room visits, and preventable hospitalizations (for ambulatory care sensitive conditions).ResultsAccess 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.LimitationsObservational study in an integrated delivery system.ConclusionAccess 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.
Highlights
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
Diabetes and other chronic diseases account for significant levels of morbidity and mortality in the United States, with an increasing proportion of patients living with multiple complex chronic conditions [1,2,3]
Complex patients with multiple chronic conditions, we examined the association between portal access and office visits and health events as captured by emergency department (ED) visits and hospitalizations
Summary
Diabetes and other chronic diseases account for significant levels of morbidity and mortality in the United States, with an increasing proportion of patients living with multiple complex chronic conditions [1,2,3]. Electronic patient portals, linked to the patient’s clinical electronic health record (EHR), offer patients secure access to their own medical information and the ability to manage several aspects of their health care at any time of day or night through interactive tools, including lab result review, visit summaries, secure messages to providers, and medication refill orders. In some situations, this convenience may allow patients to communicate with health care providers while avoiding traveling to medical facilities and pharmacies, and without requiring timeoff from work or care-giving[27,28,29,30]. 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
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