The State of Evidence in Patient Portals: Umbrella Review.
The State of Evidence in Patient Portals: Umbrella Review.
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DOI：
10.2196/23851
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发表时间：
2020-11-11
影响因子：
7.4
通讯作者：
Lau F
中科院分区：
文献类型：
--
作者：
Antonio MG;Petrovskaya O;Lau F
患者门户网站已成为公认的数字健康战略。迄今为止，对患者门户网站的研究增长迅速。然而，随着时间的推移，越来越多的关于门户网站可用性、使用、临床或健康行为和结局以及门户网站采用的证据得到了有限的评价。本文的目的是全面巩固目前状态的证据，患者门户网站使用伞式审查方法，介绍我们的方法来评估证据的定量和定性的研究结果，包括系统性综述，并提出了一个知识翻译工具，可用于通知所有阶段的患者门户网站采用。在本研究中，使用了乔安娜·布里格斯研究所伞式审查方法的修改版本。对多个数据库进行了系统性综述检索，重点关注患者门户网站，最终样本包括14篇综述。我们对系统评价中报告的定量、定性和混合方法的初步研究结果进行了元水平综合。我们根据临床采用元模型（CAMM）组织了伞式审查结果。投票计数，GRADE（推荐、评估、发展和评价的分级）和CERQual（定性研究审查证据的置信度）用于评估伞式审查证据。我们的知识翻译工具以证据图的形式总结了这些发现。该地图按CAMM类别组织，描述了影响门户采用和效果的以下因素：患者背景、患者的兴趣和满意度、门户设计、促进者和障碍、提供者的态度、服务利用率、行为效果、临床结果和患者报告的结果。该地图列出了在所包含的门户研究中认识到的理论和机制，同时确定了对业务模型和组织理论的需求，这些理论可以为门户采用的所有阶段提供信息。我们的GRADE和CERQual总体审查评价结果显示，大多数证据被评为中度至低度，这反映了门户网站研究中的方法学问题、研究数量不足或特定重点领域的混合结果。证据评级较高的2项发现是患者对使用门户网站进行交流的兴趣以及门户网站中简单显示信息的重要性。总括审查确定了40多个门户网站功能，所有系统性审查都提到通过安全信息和预约进行通信。我们的综述提供了一个元水平的综合，以了解已发表的系统性综述中患者门户网站的证据。对门户功能的不系统和可变的报告破坏了评估和比较门户效果的能力，并忽视了门户使用的具体背景。需要对社会、组织、政策和时间维度敏感的研究设计，以更好地理解利用所确定的因素来改善门户网站使用和效果的基本机制和背景。
Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.
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