Portal Messages Research Articles

A retrospective review of unreimbursed medical care provided through electronic patient portals in dermatologic surgery

To the Editor: Patient portals, based on electronic medical records, allow patients to view medical records and securely message their practitioners. Direct messaging between patients and health care teams improves patient satisfaction.1 However, the number of patient-initiated messages has increased over time in dermatology and other fields.2,3 Although the increasing workload can be optimized, it cannot be eradicated.4 Patient portal messaging will likely increase further with the implementation of the 21st Century Cures Act, which allows patients immediate access to their health records.

A retrospective cohort study of clinical factors, visit patterns, and demographic factors associated with use of remote communications in patients with headache.

To identify the characteristics associated with high utilization of remote communications (RCs) in patients with headache. Patients with headache frequently communicate with their providers using secure portal messaging and telephone calls. However, clinical and demographic factors as well as visit patterns associated with RC utilization remain poorly characterized. We retrospectively analyzed data from patients with headache who were evaluated in the ambulatory neurology faculty practice at the Icahn School of Medicine at Mount Sinai in New York between January 1 and June 30, 2019. We extracted clinical and demographic characteristics, total office visits, secure MyChart portal messages, and telephone encounters from our institutional data warehouse. We defined high RC and MyChart utilization as the top tertile of RC and MyChart message volume, respectively, and assessed the relationship between patient characteristics and high RC (primary outcome), as well as high MyChart utilization (secondary outcome). We characterized the relationship between clinicodemographic characteristics and the ratio of MyChart messages to total RCs (secondary outcome). We identified 1390 patients, of whom 477 (34.3%) were high RC utilizers and 321 (23.1%) were high MyChart utilizers. High RC utilizers generated 3306/3921 (84.3%) RCs. The presence of chronic headache (aOR 2.31, 95% CI 1.75-3.03, p<0.0001), cluster headache (aOR 18.3, 95% CI 5.0-71.7, p=0.001), and migraine (aOR 3.82, 95% CI 1.93-9.3, p=0.011) was associated with high RC utilization. Patients ≥65years of age were less likely to engage in MyChart messaging as a proportion of RC (191/680, 28.1%) compared with patients 18-30years of age (243/620, 39.2%, p=0.049) and 30-64years of age (1172/2721, 43.1%, p<0.0001). A minority of patients with headache (477/1390; 34.3%) generated the majority (3306/3921; 84.3%) of RCs. Our findings should be validated in external patient cohorts with the objective of developing strategies to optimize RC utilization.

Optimizing the Radiation Oncology Nursing Care Model Within an Academic Practice Setting

<h3>Purpose/Objective(s)</h3> Registered nurses (RN) can provide patients with the necessary support to successfully complete radiation treatment, including coordination of care, education, and toxicity management. Optimal nursing support can also improve the efficiency of the provider. Within an academic radiation oncology facility, we found that RNs were underutilized, performing mainly secretarial or medical assistant level tasks. The purpose of this study was to identify opportunities for process improvement in the nursing care model with the intent to improve nursing job satisfaction, provider satisfaction and patient satisfaction. <h3>Materials/Methods</h3> A job satisfaction survey was designed to determine RN satisfaction with the tasks that they are assigned and their overall satisfaction of their job duties. A provider satisfaction survey was designed for physicians and nurse practitioners to determine their satisfaction in providing high quality care for their patients. Surveys were sent to the nursing and provider teams in August 2020, to determine initial state and 6 months later in February 2021. Survey data was collected anonymously. In the 6 months between surveys, the RN teams began formal clinic prep, to understand and prepare for new patients/follow up patients for the week and catch any issues that would cause delays during the patient visit, RNs were encouraged to attend the new patient consultation visits to anticipate care coordination issues, and RNs were encouraged to be proactive in answering portal messages from patients rather than sending them directly to the provider. <h3>Results</h3> The nursing survey was a 5-point rating scale (1 worst-5 best): job duties match knowledge and skills: 3.8, job responsibilities match strengths: 3.2, ability to advocate for patients: 4.4, providers communicate well: 3.0, nursing staff works as a team: 3.4 and enjoy working in this department: 4.3. At 6 months follow up, job duties match knowledge and skills: 4.2, job responsibilities match strengths: 4.3, ability to advocate for patients: 4.6, providers communicate well: 3.5, nursing staff works as a team: 3.9 and enjoy working in this department: 4.5. The provider survey consisted of the following: 67% of providers knew who their primary nurse was, 100% understood the nurse's primary responsibilities, ability to advocate for your patients scored 4.2/5, 56% felt like they had appropriate nursing support, and nurses communicate well scored 3.1/5. At 6 months follow up, 88% of providers knew who their primary nurse was, ability to advocate for your patients scored 4.6/5, appropriate nursing support 4.0/5, and nurses communicate well 4.1/5 <h3>Conclusion</h3> Optimizing nursing care delivery within the academic practice setting is feasible and led to improved nurse and provider satisfaction. The interventions studied here are low in cost and easily implemented. This work is ongoing to further improve the nursing care model in radiation oncology clinics.

Ensuring Adolescent Patient Portal Confidentiality in the Age of the Cures Act Final Rule

PurposeManaging confidential adolescent health information in patient portals presents unique challenges. Adolescent patients and guardians electronically access medical records and communicate with providers via portals. In confidential matters like sexual health, ensuring confidentiality is crucial. A key aspect of confidential portals is ensuring that the account is registered to and utilized by the intended user. Inappropriately registered or guardian-accessed adolescent portal accounts may lead to confidentiality breaches. MethodsWe used a quality improvement framework to develop screening methodologies to flag guardian-accessible accounts. Accounts of patients aged 12–17 were flagged via manual review of account emails and natural language processing of portal messages. We implemented a reconciliation program to correct affected accounts’ registered email. Clinics were notified about sign-up errors and educated on sign-up workflow. An electronic alert was created to check the adolescent’s email prior to account activation. ResultsAfter initial screening, 2,307 of 3,701 (62%) adolescent accounts were flagged as registered with a guardian’s email. Those accounts were notified to resolve their logins. After five notifications over 8 weeks, 266 of 2,307 accounts (12%) were corrected; the remaining 2,041 (88%) were deactivated. ConclusionsThe finding that 62% of adolescent portal accounts were used/accessed by guardians has significant confidentiality implications. In the context of the Cures Act Final Rule and increased information sharing, our institution’s experience with ensuring appropriate access to adolescent portal accounts is necessary, timely, and relevant. This study highlights ways to improve patient portal confidentiality and prompts institutions caring for adolescents to review their systems and processes.

S3268 Development and Implementation of EGID Partners: A Global, Online, Patient-Centric Research Platform

Introduction: Eosinophilic GI diseases (EGIDs) include eosinophilic esophagitis (EoE), gastritis (EG), gastroenteritis (EGE), and colitis (EC) and represent a substantial burden to patients and caregivers. We aimed to develop and implement a global, online, patient-centric research platform to provide a foundation for studies of EGIDs. Methods: Patient advocacy groups (PAGs) and EGID researchers collaborated to design EGID Partners (egidpartners.org) and enroll both cases and controls. The overall structure included baseline surveys followed by updates every 6 months. At follow-up, new surveys could also be deployed. There were 8 possible pathways: EoE adults (≥18 years); non-EoE EGID adults; adults with both EoE and EGID; non-EGID adult controls; and these same groups but for caregivers of children < 18 years of age. Recruitment is rolling, with baseline surveys including demographics, disease and medical history, treatment history, and validated patient-reported outcomes (PROs) for symptoms and quality of life. Baseline surveys also included assessment of early life exposures and patient-level costs, health utilization, and burden of disease. A multifaceted recruitment plan was instituted with informational emails and social media campaigns from PAGs, directed messages to EGID patients through medical record patient portals, webinars, and by publicizing the platform among physicians and at meetings. Results: EGID Partners was launched in October, 2020 (Fig. 1A). To date, 360 subjects (Partners) have joined, including 330 cases and 30 controls; 290 were adults and 70 were caregivers. There were 256 with EoE, 7 with EG, 14 with EGE, 5 with EC, and 78 with overlapping EGIDs (38 of whom had esophageal involvement). Partners have joined from 14 countries, with most from the US (295, from 36 states) and Australia (35). Recruitment increased steadily, but with notable spikes after webinars and patient portal messages (Fig. 1B). Six months after launch, a new follow-up survey was deployed to assess selected non-GI symptoms in EGID patients. Conclusion: We successfully developed and implemented EGID Partners, a patient-centric, online research platform. Despite the rarity of these diseases, patients from around the world and across all EGID types were recruited within a short period of time. The goal is for EGID Partners to expand into a patient-powered research network, with future research informed by patient, PAG, and researcher input.Figure 1.: Development and recruitment for EGID Partners. The home page (A) and recruitment trends (B) are displayed.

Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians

Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality. To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals. A cross-sectional study to estimate the prevalence of guardian access to adolescent patient portal accounts was conducted at 3 academic children's hospitals. Adolescent patients (aged 13-18 years) with access to their patient portal account with at least 1 outbound message from their portal during the study period were included. A rule-based natural language processing algorithm was used to analyze all portal messages from June 1, 2014, to February 28, 2020, and identify any message sent by guardians. The sensitivity and specificity of the algorithm at each institution was estimated through manual review of a stratified subsample of patient accounts. The overall proportion of accounts with guardian access was estimated after correcting for the sensitivity and specificity of the natural language processing algorithm. Use of patient portal. Percentage of adolescent portal accounts indicating guardian access. A total of 3429 eligible adolescent accounts containing 25 642 messages across 3 institutions were analyzed. A total of 1797 adolescents (52%) were female and mean (SD) age was 15.6 (1.6) years. The percentage of adolescent portal accounts with apparent guardian access ranged from 52% to 57% across the 3 institutions. After correcting for the sensitivity and specificity of the algorithm based on manual review of 200 accounts per institution, an estimated 64% (95% CI, 59%-69%) to 76% (95% CI, 73%-88%) of accounts with outbound messages were accessed by guardians across the 3 institutions. In this study, more than half of adolescent accounts with outbound messages were estimated to have been accessed by guardians at least once. These findings have implications for health systems intending to rely on separate adolescent accounts to protect adolescent confidentiality.

Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer

BackgroundPatient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center.MethodsWe conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care.ResultsOf 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool’s ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5–6 portal messages.ConclusionsWeb-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.

Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey.

BackgroundPatient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients’ needs increase, whereas available resources, specifically access to care, become limited.ObjectiveThis study aims to examine patients’ health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts.MethodsWe explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients’ immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts.ResultsOut of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey–related injuries), mental health, technical difficulties, and provider constraints.ConclusionsThe patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.

Utilization Patterns of a Clinic‐Based Food Referral Program: Findings from the Mid‐Ohio Farmacy

Research ObjectiveEvidence suggests that clinic‐based food referral programs (FRP) offer health benefits to food insecure patients, yet little attention has been paid to understanding patient utilization of such programs. Our study addresses this gap by reporting on the patient characteristics associated with uptake and utilization of a FRP—the Mid‐Ohio Farmacy (MOF). The MOF is a partnership between a Midwestern regional foodbank and local healthcare providers, including a large, academic medical center (AMC). The MOF uses a variation on food vouchers: an electronic referral from a patient's primary care provider to one of 14 partner food pantries in the metropolitan area. Referred patients who visit a participating pantry are eligible to receive fresh produce once weekly.Study DesignThis observational study leverages data from two AMC family medicine clinics offering the MOF referral from September 2019 to November 2020. Using multivariable logistic regression, we examined the association between filling a MOF referral (i.e., pantry visitor vs. non‐visitor) and patient demographic and clinical characteristics. Patients and their pantry visits were characterized based on their pre‐referral utilization (i.e., new or existing patrons; pre‐ or post‐referral pantry visit) to assess patterns of pantry utilization.Population StudiedAMC patients 18 years or older who screened positive for food insecurity and had an eligible chronic condition. Eligible conditions included a diagnosis of diabetes with hemoglobin A1c (HbA1C) &gt;9%, obesity (BMI ≥ 30 kg/m2), or hypertension; uncontrolled diabetes defined as a HbA1C &gt; 9% with or without a diabetes diagnosis; or uncontrolled hypertension defined as blood pressure &gt; 140/90 with a hypertension diagnosis.Principal FindingsIn total, 51% (164/322) of patients who received a MOF referral visited a pantry at least once during the study period. Three factors were associated with an increased likelihood of filling a MOF referral: a 1‐year increase in age (0.7%; p &lt; 0.01); diabetes diagnosis (11%; p &lt; 0.05); and pantry visits prior to referral (36%; p &lt; 0.001). Patients with uncontrolled hypertension were 19% (p &lt; 0.001) less likely to visit a pantry following their referral. Relative to new visitors, existing visitors had a greater total number of visits following referral, shorter days to their first visit following referral, and travelled shorter distances. Existing visitors had more total pantry visits and more produce‐specific visits in the 90‐days following their referral relative to the 90‐days prior to their referral.ConclusionsOur results suggest that while the MOF can connect patients to food resources, further attention may be needed to encourage its use among patients who have not previously accessed pantries.Implications for Policy or PracticeChanges to the MOF program may be necessary such as adding one additional question to the food insecurity screening process (e.g., “Have you used a food pantry in the last year?”), so that potential first‐time users could be targeted for resources (e.g., transportation support such as Lyft credits or bus passes) to address barriers to pantry use. Additionally, reminding patients about the opportunity to visit the pantry, for instance through text message reminders or secure health portal messages, could help encourage patients to use this community resource.Primary Funding SourceCrisafi‐Monte Foundation.

When no news is bad news: Improving diagnostic testing communication through patient engagement

Importance Up to 17% of diagnostic test results are missed, lost or ignored despite conventional fixes such as electronic physician reminders – naïvely, patients assume: ‘No-News-is-Good-News’. These lapses can result in poor outcomes, complications, and even death. In response, Centers for Medicare and Medicaid Services (CMS)-led physician quality reporting system measure#265 emphasizes prevention. This study aims to improve the timely review of results through increasing patient engagement. Design and Participants Ninety patients undergoing diagnostic testing were included in this Internal Review Board (IRB)-approved study. Two groups, group-A (patients with medical chart access through our EHR, n = 40); and group-B (controls, n = 50) were included. Group-A was reminded via written AVS and EHR portal messages to ask about their test results at their next appointment. Controls were sent no reminders, mimicking the status- quo. Main Outcomes At subsequent visits whether patients ‘asked’ or ‘did not ask’ about their results was recorded and analyzed. Study group participants were also surveyed on their preferences for reminder communication. Results Patients that were sent reminders were up to twenty times more likely to ask their provider regarding their test results than the control group ( p &lt; 0.0001). Eighty-one percent indicated that the reminders were helpful with 90% indicating they were ‘necessary’. Neither gender nor age seemed predictive factors of patient engagement. Conclusions and Relevance This pilot study demonstrates that engaging patients in their own care through already-existing tools (AVS, EHR portal messages) improves patient-physician communication, and could lead to lower rates of missed diagnostic tests.

Improving Efficiency and Quality of Patient Portal Messaging in an Academic Dermatologic Surgery Clinic.

Improving Efficiency and Quality of Patient Portal Messaging in an Academic Dermatologic Surgery Clinic.

Impact of Patient Portal Messaging Reminders with Self-Scheduling Option on Influenza Vaccination Rates: a Prospective, Randomized Trial.

BackgroundPatient portal messages have been used in a variety of ways to facilitate improved communication between provider and patient. These platforms have shown promise in many ways for improving various health outcomes and overall communication between patient and provider.ObjectiveAssess the impact of automated portal reminder messages and self-scheduling options on increasing rates of annual influenza vaccination.DesignThis is a prospective, randomized, controlled study.ParticipantsAll patients who receive their primary care through an ambulatory primary care clinic at a large, multidisciplinary, academic health center.InterventionsOne group of patients received a portal message reminder to undergo influenza vaccination. A second group received the same message with instructions to self-schedule the vaccination appointment. A third group received no portal message (control).Main MeasuresRates of influenza vaccination in each group for previously unvaccinated patients in the 2019−2020 influenza season.Key ResultsFor the group receiving the message with self-scheduling option (n=5408), the in-study vaccination rate was significantly greater than the group receiving no message (n=5621) (15.7% vs. 13.5%; p=0.002). For the group receiving a message alone (without self-scheduling) (n=5699), the in-study vaccination rate was significantly greater than the group receiving no message (15.1% vs. 13.5%; p=0.01). There was no significant difference in vaccination rate between the two intervention groups receiving messages (15.7% vs. 15.1%; p=0.549).ConclusionsPortal messaging reminders increase annual influenza vaccination rates, but the addition of a self-scheduling option did not further increase rates.Key Wordsvaccination patient portal messaging influenza

849-P: Outreach Method Predicts Patient Engagement during Sustained Care Disruption

The COVID-19 pandemic has caused sustained disruptions in access to usual diabetes care. In response to the high number of cancelations, an academic, urban diabetes program transitioned to virtual visits and launched an initiative to provide outreach to patients who canceled an appointment between Mar 16 and Jun 19, 2020. Members of the diabetes team used a standardized approach to prevent delayed care or disengagement. Method of contact was defined as Reached (two-way communication between clinician and patient by phone or EHR portal message), Message Left (e.g., voicemail) and No Contact. Engagement was defined as booking a follow up appointment and keeping the appointment. A total of 787 patients were determined to have canceled visits due to the pandemic. Mean (SD) age was 61.7 yrs (14.2), 53.7% female, 67.3% white, baseline A1c 7.96% (1.81). Of the 648 visits booked, 519 (80%) were kept. Patients who were reached were more likely to book (OR = 2.43, p&amp;lt;0.001) and keep an appointment (OR = 2.39, p&amp;lt;0.001) compared to no contact or message left. Older age was a significant predictor of booking (OR = 1.014 for each year older, p=0.037). Patients on insulin were more likely to keep their appointment (OR = 1.70, p=0.008), while patients with higher HbA1c were less likely to (OR = 0.87 for each 1.0% increase in HbA1c, p=0.011). These findings suggest that for systems designed to optimize engagement during care disruption, one-way communication is no better than no contact, and two-way communication increases the likelihood that patients will maintain access to care. In addition, while higher risk patients (e.g., older age or on insulin) may be more incentivized to stay engaged, targeted outreach may be needed for those with chronic poor glycemic control. Disclosure G. Cromwell: None. M. Hudson: None. C. K. Mckitrick: None. M. Donahue: None. C. M. Smith: None. K. M. Fowler: None. K. L. Del valle: None. D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. M. E. Mcdonnell: Stock/Shareholder; Spouse/Partner; Abbott Diabetes.

P356 A comparison of innovative strategies to promote engagement with an IBD patient portal

Abstract Background Patient portals are available on most major electronic health record (EHR) platforms and present many opportunities to improve patient engagement with services, the quality of data captured and therefore healthcare outcomes and patient satisfaction. Our centre looks after 5100 patients with IBD. We recently adopted the EPIC Systems patient portal MyChart which allows patients to view results, letters and complete patient reported outcomes (PRO). At baseline, few patients were registered for this platform. Our aim was to compare patient engagement with MyChart using a low and higher cost approach and to evaluate patient satisfaction with the platform. Methods 160 consecutive patients were invited to join MyChart between September and October 2020. The low-intensity intervention group were invited to join MyChart via a standardised email without further communication. Newly registered patients and active patients were sent a portal message with disease-specific PRO questionnaire 7 days prior to clinic (HBI, SCCAI and IBD Control). Patients in the high-intensity intervention group received a telephone reminder to encourage completion at each step, which took on average 2 minutes, in addition to email. Engagement with the platform was measured prospectively. After clinic a patient-experience questionnaire was sent to all patients who signed up to the platform. Results 72 patients were included in the low intensity group and 88 in the high intensity group. At baseline only 33% patients were already signed up to MyChart. Significantly more patients newly registered with the patient portal following the high intensity intervention compared to the low (75% vs. 30%, p &amp;lt;0.0001). Overall, patients in the high intensity group were significantly more likely to complete the PRO compared to the low (53% vs. 28%, p=0.002). Patients already registered were 5 times more likely to complete the PRO in the high intensity group compared to low (p=0.017). Platform engagement was not significantly impacted by gender or ethnicity. There was a trend toward lower engagement in patients over 65. 63 patients provided feedback. 87% found MyChart easy to use and 94% said they would complete the PRO questionnaires again. Conclusion In our patient cohort, a higher intensity strategy significantly increased patient registration and engagement with a new patient portal at a minimal cost of time and resource. Healthcare providers can facilitate patient engagement with patient portals and overcome barriers to adoption to unlock transformative opportunities for better quality IBD care, disease monitoring and population-based research.

Patient Recruitment Into a Multicenter Clinical Cohort Linking Electronic Health Records From 5 Health Systems: Cross-sectional Analysis

BackgroundThere is growing interest in identifying and recruiting research participants from health systems using electronic health records (EHRs). However, few studies have described the practical aspects of the recruitment process or compared electronic recruitment methods to in-person recruitment, particularly across health systems.ObjectiveThe objective of this study was to describe the steps and efficiency of the recruitment process and participant characteristics by recruitment strategy.MethodsEHR-based eligibility criteria included being an adult patient engaged in outpatient primary or bariatric surgery care at one of 5 health systems in the PaTH Clinical Research Network and having ≥2 weight measurements and 1 height measurement recorded in their EHR within the last 5 years. Recruitment strategies varied by site and included one or more of the following methods: (1) in-person recruitment by study staff from clinical sites, (2) US postal mail recruitment letters, (3) secure email, and (4) direct EHR recruitment through secure patient web portals. We used descriptive statistics to evaluate participant characteristics and proportion of patients recruited (ie, efficiency) by modality.ResultsThe total number of eligible patients from the 5 health systems was 5,051,187. Of these, 40,048 (0.8%) were invited to enter an EHR-based cohort study and 1085 were enrolled. Recruitment efficiency was highest for in-person recruitment (33.5%), followed by electronic messaging (2.9%), including email (2.9%) and EHR patient portal messages (2.9%). Overall, 779 (65.7%) patients were enrolled through electronic messaging, which also showed greater rates of recruitment of Black patients compared with the other strategies.ConclusionsWe recruited a total of 1085 patients from primary care and bariatric surgery settings using 4 recruitment strategies. The recruitment efficiency was 2.9% for email and EHR patient portals, with the majority of participants recruited electronically. This study can inform the design of future research studies using EHR-based recruitment.

Abstract MP36: The Development Of A Centralized Recruitment Process For Covid-19 Research: Hopkins Opportunity For Participant Engagement Registry

Introduction: The COVID-19 pandemic has required urgent scientific response to investigate the disease, its prevention and treatment and interactions with cardiovascular conditions. Consequently, a centralized workflow was needed to effectively recruit, screen and connect volunteers to COVID-19 research opportunities. Objective: To create a centralized registry to match eligible and interested volunteers ≥18 years with COVID-19 outpatient research studies at an academic health system. Methods: Key stakeholders, including researchers and participant advocates, collaborated to build the Hopkins Opportunity for Participant Engagement (HOPE) Registry in English and Spanish. REDCap, a secure web-based application, served as the Registry platform. Study teams recruiting for outpatient studies were invited to present their studies through the Registry. Study volunteers were recruited using multiple methods, including patient portal messages, email, social media, and online advertisement. The Registry included COVID testing results and participant survey of demographic and COVID-19 related questions. Branching logic was used to pre-screen and present participating studies for which the person was eligible. The individual then selected which studies, if any, they were interested in. Study teams received an automatic notification and reached out directly to individuals expressing interest in their study ( Figure ). Results: The HOPE Registry includes 7 studies and has enrolled 4186 people. Over half (55%) were &gt;55 years and the majority were female (64%). Racial/ethnic groups represented were Whites (80%), Black s (9%), Asians (4.7%), Hispanics (5%), and American Indian (0.3%). Participants were interested in: 29%, treatment study; 37%, vaccine study; and 66%, donating plasma. Within 10 weeks, 585 persons were matched with an actively recruiting study. Conclusions: The ongoing HOPE registry has shown promise in engaging individuals with COVID-19 research and improving research recruitment workflow.

A randomized controlled trial to evaluate the use of a web-based application to manage medications during in vitro fertilization

To evaluate the use of a web-based application that assists in medication management during invitro fertilization (IVF) treatment. Multicenter randomized controlled trial. University hospitals. Women undergoing IVF. Subjects were recruited to assess quality of life during IVF and were randomly assigned to use either the OnTrack application to assist with medication management or conventional medication management. Surveys were administered at four time points. Medication surplus, incidence of medication errors, amount of patient-initiated communication, and patient satisfaction. A total of 153 women participated. The average number of portal messages and telephone calls was similar between groups. Twelve patients in the control group (12/69, 17.4%) and 8 patients in the case group (8/72, 11.1%) made medication errors. There were similar amounts of medication surplus in the two groups. The estimated cost of medication waste was $2,578 ± $2,056 in the control group and $2,554 ± $1,855 in the case group. Patient satisfaction was similar between the two groups. Use of a web-based application did not decrease medication errors, medication surplus, or patient-initiated messages. Many patients had a medication surplus, which can be an area of cost reduction during IVF. Clinicaltrials.gov NCT03383848.

Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial

ObjectiveTo evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965.DesignPragmatic...

Detecting and Assessing Suicide Ideation During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic prompted a rapid shift to virtual (video and telephone) delivery of mental health care, disrupting established processes for identifying people at increased risk of suicidal behavior.MethodsFollowing the shift to virtual care, Kaiser Permanente Washington implemented a series of workflow changes to administer standard screening and monitoring questionnaires at virtual visits and to complete structured suicide risk assessments for patients reporting frequent suicidal ideation. These new workflows included automated distribution of questionnaires via the electronic health record (EHR) patient portal and automated alerts to clinicians regarding indicators of high risk.ResultsIn March 2020, in-person mental health visits were rapidly and completely replaced by video and telephone visits. The proportion of mental health visits with completed screening and monitoring questionnaires fell from approximately 80% in early 2020 to approximately 30% in late March, then gradually recovered to approximately 60% by the end of 2020. Among patients reporting frequent suicidal ideation on monitoring questionnaires, the proportion with a recorded suicide risk assessment fell from over 90% in early 2020 to approximately 40% in late March, then gradually recovered to nearly 100% by the end of 2020.ConclusionUse of EHR patient portal messaging capabilities can facilitate systematic identification and assessment of suicide risk for patients receiving mental health care by telephone or video visit.

Limited English Proficiency and Disparities in Health Care Engagement Among Patients With Breast Cancer.

Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal. Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group. Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77). We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.