| Popis: |
Outpatient portal technology (OPP) can improve patient engagement. For pregnant women, this high level of engagement could have important implications for maternal and infant outcomes. There is a dearth in studies that characterize OPP use among pregnant women. Our academic medical center (AMC) implemented a system-wide OPP in 2011. The OPP includes functions that allow patients to access their personal health information (PHI), view and schedule appointments, and message their providers. Our study is among the few studies that characterizes OPP use in a historically understudied patient population. We built upon existing research using OPP server-side log files by executing a hierarchical clustering algorithm to group 7,663 pregnant women based on the proportion of use for each OPP function. We calculated proportions of use for each OPP function a woman engaged with and used these proportions as inputs for our cluster analysis. Women who visited a Maternal Fetal Medicine (MFM) provider for pregnancy were regarded as having high pregnancy-related risk, while those who only visited an Obstetrics and Gynecology (OB/GYN) provider were considered as having normal pregnancy-related risks. Post-hoc analyses were performed using one-way ANOVA to further assess OPP use on key encounter characteristics. Use of the following OPP functions was examined within the cluster analysis: Visits (manage appointments), MyRecord (access PHI), Messaging (send/receive messages), and Billing (view bills, insurance information). Our study sample was predominantly represented by non-Hispanic white women between the ages of 25 and 34. The most frequently used functions at the patient level were MyRecord, Visits, Messaging and Billing, with frequency of use similar between pregnancy risk groups. Median OPP function use plateaued by the third trimester for each pregnancy risk group, with significantly more use among women with a high-risk pregnancy compared to those with a normal pregnancy. Four distinct clusters were identified among all pregnant women based on our clustering stopping rules. The “Average Users” (AUs) cluster consisted of women who primarily used the MyRecord (47%) and Visits (23%) functions. The “Schedulers” (SCs) focused on using the Visits (67%) functions. The “Intense Digital Engagers” (IDEs) primarily used the Messaging (41%) and MyRecord (33%) functions. Finally, the “Prepared Engagers” (PEs) used both the Visits (47%) and MyRecord functions (32%). The same clusters were seen among high-risk pregnancies, while SCs were absent among those with a normal pregnancy. Post-hoc analyses revealed that the IDEs cluster and MyRecord-oriented clusters engaged with the OPP less over time, while SCs engaged with the OPP the most. Movement between clusters over time, assessed using a Sankey diagram, was common, though there were women who remained in the same clusters throughout the duration of a pregnancy. Our identification of distinct cluster groups of OPP users among pregnant women underscores the importance of avoiding the use of generalizations when describing how such patients might engage with patient-facing technologies such as an OPP. These results can be used to improve user experience and training with OPP functions, and may educate OB/GYN and MFM providers on patient engagement with the OPP. |
