Electronic Patient Portal Research Articles

When Patient Portals Break Bad News.

Electronic patient portals facilitate communication between providers and patients, but they can complicate the art of breaking bad news. Nearly half of oncology patients will view their diagnosis on a patient portal before speaking with a provider. Physicians and advanced practice providers receive training on how to deliver bad news in person and over the telephone. This is done in an empathetic and supportive manner. The patient's emotions are acknowledged, and questions are answered. While surveys of patients suggest that most people prefer an in-person or telephone conversation to receive bad news, the electronic portal can undermine this delicate conversation when oncology reports are prematurely accessed. Military providers should be aware of the impact electronic portal usage may have on patients. We provide suggestions for providers to adjust their practice accordingly, such as warning patients about their early access to results prior to a planned follow-up visit. We also suggest that MHS GENESIS, the electronic health record for the Military Health System (MHS), allows for sensitive reports to be released to patients after the results are discussed rather than automatically after 36 hours. Electronic portals streamline patient-provider communication and increase transparency; however, we should consider that the task of delivering bad news was never meant for computers.

LIVING WITH HEART FAILURE AND MULTIMORBIDITY: SEX-BASED DIFFERENCES IN DISEASE BURDEN

Abstract Heart failure (HF) is one of the leading causes of hospitalization and discharge diagnosis. People with HF present an average of six co-morbid conditions and are mostly older women. Comorbidity or multimorbidity in HF, increases the risk for poor health outcomes, significantly affecting the progression, severity, and complexity of management and care outcomes. This study aimed to examine the sex differences in disease burden among individuals living with multimorbidity. The study is an ongoing cohort study collecting socio-demographic, clinical, and outcome data at baseline, 30 days, and 1-year follow-up. Adults aged 50 years and older living with HF and multimorbidity, defined as the presence of HF and one more chronic condition identified as a common list of comorbidities were recruited using an electronic patient portal. Disease burden data were collected using a modified disease burden impact scale consisting of comorbid conditions included in the eligibility criteria. A preliminary analysis of 406 participants (mean [SD] age = 69.6[9.7] years; 49% female) at baseline found that females (67.7 [9.2] years) were significantly younger than males (71.6 [9.9] years) and females (28.1 [15.2]) had significantly higher disease burden scores compared to males (22.0 [13.6]). An adjusted analysis found females had 3 times higher disease burden scores than males (beta=3.32; 95% confidence interval [CI] = 0.44-6.20, p= 0.024), after controlling for sociodemographic characteristics, social support, resilience, and quality of life. Effective multimorbidity management program requires consideration of both sex and gender-based differences, particularly among older women.

“CAREGIVING IS TEAMWORK...” INFORMATION SHARING IN HOME CARE FOR OLDER ADULTS WITH DISABILITIES IN THE COMMUNITY

Abstract Direct care workers provide assistance with daily activities to persons with disabilities. Direct care workers are well positioned to recognize and share information about care gaps and changes in function and behaviors but are often viewed as unskilled and excluded from interdisciplinary care team interactions. We conducted 11 semi-structured interviews with administrators (n=5), nurses (n=3), and direct care workers (n=3) from home care agencies (“residential service agencies” in Maryland) to understand information sharing between direct care workers, family caregivers, and clinicians in home care delivery for older adults with disabilities, including those living with dementia. Thematic analysis was completed by the research team. Leveraging Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, a human factors framework, respondents highlighted aspects of information sharing across (1) work systems, (2) processes, and (3) dementia-related adaptations. Work system characteristics relevant to information sharing included the utilization of electronic management systems and patient portals to communicate within agencies and with clinicians and using multiple methods to gather information about client goals and preferences (e.g., assessments, client profiles). Process characteristics include collaborations between families and residential service agency staff to deliver optimal care. Direct care workers did not report differences in coordinating care for persons living with dementia, however they reported dementia-related adaptations like an increased need to establishing and sustaining strong relationships with family members and communicating with clinicians during medical visits. Findings highlight the care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.

Patients involvement in the discharge process from hospital to home: A patient's journey.

The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients. A multiple case study with a phenomenological approach. Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre. Eight themes were identified within three phases of the transfer process. The Sign-up phase contained two themes: 'organizing follow-up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'. Patient participation in the transition process from the hospital to follow-up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals. Patient and family involvement has the potential to improve transition of care and techniques for shared decision-making can be applied to a greater extent. This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process. COREQ guidelines for qualitative reporting. No patient or public contribution. This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process. This paper gives direction how to improve patient participation during the discharge process from hospital to follow-up care.

The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System.

To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.

Contemporary Trends in Reviewing Test Results Through the Electronic Patient Portal Among Patients With Cancer

This cohort study among patients with cancer examines changes in the time from posting of test results in the electronic health record to patient viewing in the patient portal before and after implementation of the 21st Century Cures Act.

Reducing Preventable Bleeding Visits and Institutional Factor Costs for Patients with Bleeding Disorders with a Prospective Quality Improvement Project

Providing optimal care to patients with bleeding disorders requires specialized physician, laboratory, pharmacy, nursing, and institutional resources best achieved at Hemophilia Treatment Centers (HTCs). Current systems for managing the care of a resource intensive patient population may be suboptimal. We observed frequent bleeding related hospitalizations and emergency room (ER) visits in patients with bleeding disorders treated at our HTC that could have been potentially prevented by changes in outpatient care delivery. We initiated a prospective quality improvement (QI) project to improve care delivery and to reduce preventable bleeding related hospitalizations and ER visits for adult patients treated at our HTC. The interventions targeted patient-level and systems-level factors contributing to preventable visits, and barriers to care in our patient population. We compared preventable bleeding related hospitalizations and ER visits, institutional factor cost, use of prophylaxis in severe hemophilia, primary care physician attainment, and patient electronic portal enrollment before and after the QI intervention. In our population of adult patients with bleeding disorders (N=88), the intervention significantly reduced the primary outcome of preventable bleeding hospitalization or ER visit (P=0.0082, Figure), and reduced such visits by 85.4%, meeting the pre-specified criteria for success. Institutional factor acquisition costs to treat preventable bleeding were reduced by 94.5%, from $11,800 to $640 per patient per year; a projected savings of $982,088 yearly. Use of factor prophylaxis in patients with severe hemophilia increased from 58.8% to 100%, attainment of a primary care physician increased from 69.4% to 86.4%, and use of the electronic patient portal increased from 53.2% to 83%; all secondary outcomes met pre-specified criteria of success and were statistically significant. HTC clinic visit attendance was low at 55.2%. The majority of patients (71.6%) had at least one outpatient urgent episode (mean 0.72 episode per year), and 93% had non-urgent management (mean 9.3 episodes per year) occurring outside of a clinic visit. These data demonstrate that concerted outpatient management of patients with bleeding disorders with a quality improvement framework can reduce preventable hospitalization and ER visits. Decreased inpatient utilization resulted in substantial reductions in factor costs at the health system level. The clinical effort required to achieve these results was substantial, and required frequent provider engagement outside of regular clinic visits. The HTC can improve patient outcomes and reduce institutional costs from preventable bleeding episodes by supporting a collaborative quality improvement process led by physician, nursing, and laboratory coagulation experts.

Abstract 12350: The Impact of an Electronic Best Practice Advisory on Patients’ Physical Activity and Cardiovascular Risk Profile

Background: Regular physical activity (PA) is one of eight components of cardiovascular health and it is associated with numerous benefits including a lower risk of CVD. Promoting PA to sedentary patients in primary care can result in significant improvements in PA. The aims of this study were to implement a PA counseling intervention using an electronic best practice advisory (BPA), in a preventive cardiology clinic, and to assess changes in PA and CVD risk factors in a sample of patients enrolled in 12 weeks of PA monitoring. Methods: Patients were assessed with the 3-question (days/minutes/intensity) physical activity vital sign (PAVS) via their electronic patient portal prior to an office visit. Those who self-reported less than 50% of current PA recommendations prompted a BPA to their cardiologist to counsel them on improving their PA. Patients were then offered participation in remote patient monitoring wearing a Fitbit for 12 weeks. Blood pressure, waist circumference, lipids, BMI, PA (using the PAVS and Fitbit step-counts) and the six-minute walk test (for cardiorespiratory fitness) were measured at baseline and 12 weeks. Paired t -tests assessed for changes in these CVD risk factors from baseline to 12 weeks. We calculated the percent of participants who achieved a clinically important difference of 25 meters in the six-minute walk test. Results: The enrolled sample (n=59) were primarily female (51%), White adults (76%) with a mean age of 61.13±11.6 years. There was significant improvement in moderate-to-vigorous PA as self-reported by the PAVS (43±86 vs. 114±157, p=.005). There was no significant difference between week 2 step counts (baseline) and week 12 (p=.07). There was significant improvement in the distance covered (in meters) during the six-minute walk test (469±108 vs. 494±132, p=.0034) and 23 participants (42%) improved at least 25 meters. There were also significant differences in total cholesterol (163±51 mg/dl at baseline vs. 148±45mg/dl at 12 weeks; p=.0.02). No other improvements in CVD risk factors were noted. Conclusion: Patients who reported low PA and triggered a BPA for PA counseling had improvements in some, but not all, CVD risk factors. Additional counseling may be needed to improve and maintain PA levels in patients at risk of CVD.

Examining how information presentation methods and a chatbot impact the use and effectiveness of electronic health record patient portals: An exploratory study

ObjectivesExamining information presentation strategies that may facilitate patient education through patient portals is important for effective health education. MethodsA randomized exploratory study evaluated information presentation (text or videos) and a chatbot in patient education and examined several performance and outcome variables (e.g., search duration, Decisional Conflict Scale, and eye-tracking measures), along with a simple descriptive qualitative content analysis of the transcript of chatbot. ResultsOf the 92 participants, those within the text conditions (n = 46, p < 0.001), had chatbot experiences (B =−74.85, p = 0.046), knew someone with IBD (B =−98.66, p = 0.039), and preferred to engage in medical decision-making (B =102.32, p = 0.006) were more efficient in information-searching. Participants with videos spent longer in information-searching (mean=666.5 (SD=171.6) VS 480.3 (SD=159.5) seconds, p < 0.001) but felt more informed (mean score=18.8 (SD=17.6) VS 27.4 (SD=18.9), p = 0.027). The participants’ average eye fixation duration with videos was significantly higher (mean= 473.8 ms, SD=52.9, p < 0.001). ConclusionsParticipants in video conditions were less efficient but more effective in information seeking. Exploring the trade-offs between efficiency and effectiveness for user interface designs is important to appropriately deliver education within patient portals. Practice implicationsThis study suggests that user interface designs and chatbots impact health information’s efficiency and effectiveness.

Barriers to engagement of patients in medication reconciliation.

362 Background: Medication reconciliation (MedRec) is a process where a detailed medication list is compiled and reviewed with an appropriate health care professional for completeness and drug-drug interactions, then communicated across all of the patient’s healthcare teams. While effective MedRec can minimize the risk of adverse events, uptake in outpatient oncology can be poor. Engagement of patients and caregivers in collection of medication lists through patient portals has been suggested as a potential change idea to improve uptake. To understand barriers and facilitators of patient engagement in the MedRec process through an electronic patient portal we undertook semi structured interviews in a comprehensive cancer center in Ontario, Canada. Methods: Patients in outpatient oncology clinics and chemo-daycare waiting areas were approached to participate in interviews; as we wished to understand barriers both users and non-users of the medication list feature of the patient portal were eligible to participate. Participant recruitment continued until saturation of data was reached. Interviews were carried out virtually following a semi-structured guide between 08/2022 and 12/2022. Interviews were recorded and transcribed verbatim; thematic coding was completed in NVIVO by two members of the study team. Results: A total of 10 patients participated in interviews; participants ranged in age between 30 to 89 years, and all completed post-secondary education. Patients’ emphasized issues with provider/care team communication expressing it was unclear why they were asked to enter medications and did not know if anyone was reviewing the medications entered. Additionally, patients had a fear of inputting erroneous medications resulting in their overall avoidance to use the portal. Portal features such as the use of generic vs trade name medications created lack of clarity for patients when entering medications into the system. Presently, the language is limited to English which may reduce the number of users. Accessibility issues such as font size and overall layout, especially on mobile devices were noteworthy during interviews. Patients recommended the addition of the following features: refill information including requests, medication reminder features via text/email and linkable medication information. Conclusions: Our findings indicate that although patients are using the portal to upload their medication lists, there are technical and systemic improvements that can be made to increase patient usage. In addition to updates to the patient portal to create added value to patients, and improve comprehension and accessibility, patient education is needed to raise awareness of the importance of MedRec and their role in the process and improve buy in.

Pilot implementation study of a default genetic referral process for patients with young-onset colorectal cancer.

429 Background: Young-onset colorectal cancer (yCRC) diagnosed under age 50 is increasing at alarming rates, with &gt;75% of young-onset cases occurring in patients between 40-49 years old. Although national guidelines recommend germline genetic risk evaluations for all patients with yCRC, multiple studies have shown suboptimal rates of guideline-recommended genetic evaluations. Methods: We conducted a pilot implementation study of a default genetic referral process for patients diagnosed with CRC between ages 40-49 from 1/2019-4/2022 at five hospitals in an academic health system. Patients previously referred to genetics were analyzed as a historical comparator cohort. In the intervention cohort, a research coordinator notified patients and their oncologists of their eligibility for a default genetic referral via an electronic patient portal message or telephone call, after which all patients who did not opt out within two weeks were referred for genetic counseling, testing, and result disclosure as per usual care. The primary outcome was feasibility, defined as a ≥60% referral rate; secondary outcomes included the proportion of genetic referrals that were scheduled, completed, and resulted in testing within three months of referral. Semi-structured exit interviews were conducted with a subset of patients and oncologists to assess attitudes toward the default genetic referral process. Results: We identified 128 patients with yCRC; 75 (59%) had previously been referred to genetics and were assigned to the historical cohort. There were no significant differences in sex, race, or ethnicity between the historical and intervention cohorts. All 10 patients with mismatch repair deficient tumors had previously been referred to genetics. Of the 53 patients in the intervention cohort, 49 (92%) were referred to genetics after one oncologist opted out on behalf of an international patient due to financial concerns and three patients requested to discuss with their oncologist before being referred. Of the patients who were referred, 38 (78%) were scheduled, 22 (45%) completed genetic counseling, and 13 (27%) underwent testing within three months of referral. Reasons for failing to complete the germline genetic risk evaluation process included lack of interest, competing priorities, communication/scheduling challenges, and failure to return saliva-based genetic testing kits. In exit interviews with 10 patients who completed testing and 10 oncologists, participants reported finding the default genetic referral process to be acceptable and feasible to implement. Conclusions: A default genetic referral process is feasible and results in a high referral rate for patients with yCRC, but subsequent scheduling, evaluation, and testing rates remain suboptimal. Multilevel implementation strategies are needed to address the patient, clinician, and system barriers identified in this study. Clinical trial information: NCT05018156 .

Is there an outcome benefit? Patient engagement technology in addition to the electronic medical record patient portal following elective colorectal surgery.

Patient engagement technologies (PET) are an area of growing innovation and investment, but whether PET use in the setting of electronic medical record (EMR) supported patient portals are associated with improved outcomes is unknown.Therefore, we assessed PET and EMR activation among patients undergoing elective colorectal surgery on an enhanced recovery pathway. We identified adults undergoing elective colorectal surgery between 1/2017 and 7/2021. EMR activations were assessed and patients were considered PET users if they used a proprietary PET application. Multivariable logistic regression was used to identify factors associated with PET use and determine whether the level of engagement (percentage of messages read by the patient) was associated with 30-day outcomes. 484 patients (53.5% PET users, 81.6% with an activated EMR patient portal, 30.8% ≥ 70years of age) were included. PET users were younger, more likely to have their EMR portal activated and had decreased odds of prolonged length of stay [odds ratio (OR) 0.5, 95% confidence interval (CI) 0.4-0.8]. Among patients ≥ 70years, PET users had reduced odds of readmissions (OR 0.2, 95% CI 0.1-0.9) compared to PET non-users. The most engaged PET users had decreased morbidity (OR 0.2, 95% CI 0.1-0.8) and readmissions (OR 0.3, 95% CI 0.1-0.8) compared to the least engaged PET users. When controlling for EMR activation, patients who use PET, specifically those with higher levels of engagement or aged ≥ 70, have improved outcomes following elective colorectal surgery. Interventions aimed at increasing the adoption of PET among older adults may be warranted.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians.

Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. This study aimed to survey nurse and physician readiness to adopt these tools. An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.

“Caregiving is teamwork…” Information sharing in home care for older adults with disabilities living in the community

AimWe examined information sharing between direct care workers, family caregivers, and clinicians involved in the care of older adults with disabilities. MethodsSemi-structured interviews with N = 11 representatives of home care agencies (“residential service agencies” in Maryland). ResultsWork system and process characteristics relevant to information sharing included: (1) using electronic management systems and patient portals to communicate within agencies and with clinicians, (2) implementing tools to gather information about client goals, preferences, and routines, and (3) relying on family members for information about clients’ needs. Participants did not report differences in dementia-related care coordination; however, dementia-related adaptations involved additional considerations for navigating relationships with family and standardizing processes to communicate with clinicians. ConclusionFindings highlight care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.

Human Factors Engineering and Usability as Key Drivers for Design of Device Suited for Urine Filtration and Enrichment

Evidence-based practices (EBPs) are not always straightforward to implement in a design process, as impacts can be difficult to assess in practice and appropriate methods are not yet established. User-centered design (UCD) offers opportunities to improve implementation of EBPs. UCD refers to the use of rigorous and validated engineering tools to design technology interfaces focused on user goals, such as device safety, effectiveness, efficiency, and user satisfaction. UCD has the potential to improve six core elements of patient-centered care: (i) education and shared knowledge, (ii) free flow of information, (iii) patient engagement, (iv) teamwork, (v) attention to non-medical aspects of care, and (vi) respect for patient preferences. Technological advances in medicine over the past few decades have provided patients with a variety of inventions, such as electronic health record patient portals, home-based medical devices, and smartphone apps. Effective application of UCD principles results in patient-centered inventions that are more likely to ease patients’ treatment burden, improve their care experience, increase patient engagement, and enable patients to become more self-sufficient. Here, the URICH device design process is used as case-example to demonstrate the inclusion of usability testing and all users as early as possible in the product design and development process.

Identifying patients at risk for hereditary myeloid malignancy syndromes incorporating a novel, self-administered questionnaire to an initial screening platform.

Four to 10% of cases of myeloid malignancies are inherited. We report our experience on hereditary myeloid malignancy syndromes (HMMS) incorporating a novel questionnaire in the screening platform for patients with myeloid malignancies and aplastic anemia. The questionnaire was sent via electronic patient portal prior to clinic visits. Patients screened positive based on responses to questionnaire items, presence of suspicion disease characteristics (young age, family history, monosomy 7 etc.) and/or presence of signs of HMMS. Those deemed at-risk based on questionnaire responses, clinical features and/or somatic mutation profile were offered germline testing. A total of 408 patients were screened, 141 (35%) were deemed at-risk. Fifty-four (38%) of at-risk patients were seen in the genetics clinic. Forty-one (76%) of the patients seen agreed to germline testing and 13 declined due to cost or personal decision. Twenty pathogenic (P)/likely-pathogenic (LP) germline mutations were identified in 16 (39%) of the tested patients. Five patients also had a variant of uncertain significance (VUS) and an additional 13 had at least 1 VUS without P/LP mutations (total 29 VUS's were found in 18 (44%) of tested patients). The median age of diagnosis for patients with P/LP mutations was 56 years versus 66 years in the entire cohort. Incorporating an electronic questionnaire is an effective screening method for HMMS. Many patients declined testing due to cost. These results highlight the importance of germline testing in patients with myeloid malignancies, further research in HMMS, and coverage by healthcare plans.

Screening Infants Through Adolescents for Social/Emotional/Behavioral Problems in a Pediatric Network.

To assess changes in screening completion in a diverse, 7-clinic network after making annual screening for social/emotional/behavioral (SEB) problems the standard of care for all infant through late adolescent-aged patients and rolling out a fully automated screening system tied to the electronic medical record and patient portal. In 2017, the Massachusetts General Hospital made SEB screening using the age-appropriate version of the Pediatric Symptom Checklist the standard of care in its pediatric clinics for all patients aged 2.0 months to 17.9 years. Billing records identified all well-child visits between January 1, 2016 and December 31, 2019. For each visit, claims were searched for billing for an SEB screen and the electronic data warehouse was queried for an electronically administered screen. A random sample of charts was reviewed for other evidence of screening. Chi-square analyses and generalized estimating equations assessed differences in screening over time and across demographic groups. Screening completion (billing and/or electronic) significantly increased from 2016 (37.2%) through 2019 (2017 [46.2%] vs 2018 [66.8%] vs 2019 [70.9%]; χ2 (3) =112652.33, P < .001), with an even higher prevalence found after chart reviews. Most clinics achieved screening levels above 90% by the end of 2019. Differences among demographic groups were small and dependent on whether data were aggregated at the clinic or system level. Following adoption of a best-practice policy and implementation of an electronic system, SEB screening increased in all age groups and clinics. Findings demonstrate that the AAP recommendation for routine psychosocial assessment is feasible and sustainable.

The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic.

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Feasibility and acceptability of implementing electronic patient reported outcomes (ePRO) collection in Zambia: Findings from a patient needs assessment.

12115 Background: Studies in high-income countries have shown that systematic, remote and electronic collection of patient-reported outcomes (ePROs) during chemotherapy, with provider intervention if symptoms worsen, is associated with fewer symptoms, better quality of life (QOL), and improved survival. It is unknown whether similar ePRO interventions, often using electronic medical record patient portals or mobile devices, can improve outcomes for cancer patients in low- and middle-income countries (LMICs). In sub-Saharan Africa (SSA), cervical cancer (CC) is the second most common cancer and most common cause of cancer deaths in women. As most patients are diagnosed with locally advanced disease, chemoradiotherapy is standard care; many have severe comorbidities such as HIV. Due to patients’ increased risk for high symptom burden, remote monitoring of ePROs during CC treatment may improve outcomes. We evaluated the feasibility and acceptability of ePRO collection in CC patients from SSA. Methods: Patients were recruited from a prospective cohort study of women with newly diagnosed CC at the Cancer Diseases Hospital in Lusaka, Zambia from June 2022 through January 2023. Patients completed an in-person interview regarding mobile technology usage comprising questions adapted from the 2019 Pew Report on Mobile Connectivity in Emerging Economies and the 2019 Global System for Mobile Communication Association Mobile Gender Gap Report. Questions were translated into 4 primary Zambian languages (Tonga, Nyanga, Lozi and Bemba). Results: Respondents’ (n = 100) mean age was 49.6 years (range, 29-75, SD 9.2), 55% were diagnosed with stage III-IV disease and 59% were HIV+. Most (70%) completed only primary school or no school, 29% reported not being able to read at all and 29% could read only parts of a sentence. Most personally owned a mobile phone (90%) and 8% reported using a phone that belonged to another person. Most used phones to make or receive calls (98%), for banking/mobile money (92%), and text messaging (67%). Of the 26% who owned a smartphone, only half connected to the internet by phone more than once weekly. Nearly all indicated willingness to use a phone to self-report CC-related symptoms if compensated for costs (98%), with 97% preferring to do so via a phone call and fewer via text message (43%) or mobile app (17%). Most (71%) were able to charge phones at home using electricity or solar power and 18% traveled more than 30 minutes to charge phones. Conclusions: Nearly all patients owned or had access to mobile phones and expressed willingness to self-report CC symptoms via phone. Findings support the feasibility and acceptability of ePRO collection and provide contextual data to guide implementation in LMICs, including consideration of telecommunications infrastructure and literacy, low internet use, and ePRO reporting preferences (i.e., calls vs text).