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Danielle Day: The Utility of an Electronic Patient Portal in Improving Patient Engagement and Outcomes in Elderly Patients (Under the Direction of Sue Tolleson-Rinehart) Introduction: ED use for ambulatory sensitive conditions (ASCs) accounts for a third of annual ED visits. Addressing this issue has the potential to reduce costs, improve patient outcomes and prevent ED overcrowding. Electronic patient portals (EPPs) are widely implemented and can improve access to care. Since some older patients use the Internet less regularly than others, the utility of EPPs especially needs to be investigated in this population. The aim of this study was to identify whether the UNC EPP, My UNC Chart, is associated with emergency department visits for ASCs in geriatric patients. Methods: This was a survey study design of a cross sectional convenience sample from the waiting room of the Geriatrics Specialty Clinic at UNC performed in June 2017. The primary outcome was recent ED visit for an ASC. Secondary outcomes included ED visits and hospital admissions in the past year. The exposure variable was use of My UNC Chart, an online patient portal. Bivariate and multivariate analyses included important covariates and the outcomes of interest. Results: PCP contact type via My UNC Chart was statistically significantly associated with the primary outcome (R:-0.5, CI: -0.99, -0.01). The additional covariates investigated in the bivariate analysis included whether, how often, and via what kind of device patients used My UNC Chart. I also measured opinions about My UNC Chart (helpfulness, enjoyability, assistance with managing care), patients' general health status, and change in that status over the past month and past year. I created a general technology use score, and asked participants about their most recent ED visit, primary care provider contact before ED visit, and, finally, their sex, race, age. and education level. I found no significant associations between My UNC Chart use and the secondary outcomes of frequency of ED visits and hospitalizations in the past year. The multivariate analysis also failed to produce significant relationships. I did not find a correlation between the technology use score and use of My UNC Chart. Conclusion: My UNC Chart use did not predict lower numbers of recent ED visit for ASCs, ED visit frequency in the past year, or hospitalizations in the past year in this study. Contact with PCPs via My UNC Chart before recent ED visits was associated with increased use of the ED for ambulatory sensitive conditions, although these data are difficult to interpret. Future research should focus on understanding these relationships in larger, more geographically diverse elderly populations. |
