Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study
Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study
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DOI：
10.2196/13146
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发表时间：
2019-10-07
影响因子：
7.4
通讯作者：
Mahoney, Kevin B.
中科院分区：
文献类型：
--
作者：
Huang, Jing;Chen, Yong;Mahoney, Kevin B.
背景：患者门户网站在现代医疗保健系统中经常用作参与和沟通工具。越来越多的关注这些沟通渠道的潜在价值，以改善健康outcome.Objective：本文旨在量化门户网站的使用对患者的预防性健康行为和慢性健康结果的影响。方法：我们进行了一项回顾性、观察性队列研究，2014年9月1日至2016年10月31日期间在宾夕法尼亚大学卫生系统（UPHS）接受治疗的50岁或以上的000例患者。数据来源于UPHS电子健康记录。我们调查了患者门户网站使用与患者的预防性健康行为或慢性健康结果之间的关联，使用基于倾向评分的新基数匹配方法和随后的自举方法来估计关联估计的方差，以控制混杂因素。患者水平特征在门户网站使用者（约占队列的59.32%（5932/10000））和非使用者之间存在显著差异。平均而言，用户更有可能是年轻人，（使用者63.46岁，非使用者66.08岁），白色（使用者72.77% [4317/5932] vs非使用者52.58% [2139/4068]），有商业保险（使用者60.99% [3618/5932] vs非使用者40.12% [1632/4068]），年收入较高（使用者74，172美元/年vs非使用者62，940美元/年）。即使在调整这些潜在的混杂因素，患者门户网站的使用有积极的和临床意义的影响，对患者的预防性健康行为，但不是慢性健康outcome.Conclusions：本文有助于了解患者门户网站的使用对健康结果的影响，是第一项研究，以确定一个有意义的亚组患者的健康行为，改善与门户网站的使用。这些发现可能会鼓励提供者促进门户网站的使用，以改善患者的预防性健康行为。
Background: Patient portals are frequently used in modern health care systems as an engagement and communication tool. An increased focus on the potential value of these communication channels to improve health outcomes is warranted.Objective: This paper aimed to quantify the impact of portal use on patients' preventive health behavior and chronic health outcomes.Methods: We conducted a retrospective, observational cohort study of 10,000 patients aged 50 years or older who were treated at the University of Pennsylvania Health System (UPHS) from September 1, 2014, to October 31, 2016. The data were sourced from the UPHS electronic health records. We investigated the association between patient portal use and patients' preventive health behaviors or chronic health outcomes, controlling for confounders using a novel cardinality matching approach based on propensity scoring and a subsequent bootstrapping method to estimate the variance of association estimates.Results: Patient-level characteristics differed substantially between portal users, comprising approximately 59.32% (5932/10000) of the cohort, and nonusers. On average, users were more likely to be younger (63.46 years for users vs 66.08 years for nonusers), white (72.77% [4317/5932] for users vs 52.58% [2139/4068] for nonusers), have commercial insurance (60.99% [3618/5932] for users vs 40.12% [1632/4068] for nonusers), and have higher annual incomes (US $74,172/year for users vs US $62,940/year for nonusers). Even after adjusting for these potential confounders, patient portal use had a positive and clinically meaningful impact on patients' preventive health behaviors but not on chronic health outcomes.Conclusions: This paper contributes to the understanding of the impact of patient portal use on health outcomes and is the first study to identify a meaningful subgroup of patients' health behaviors that improved with portal use. These findings may encourage providers to promote portal use to improve patients' preventive health behaviors.