J. Med. Internet Res. - Impact of health portal enrollment with email reminders on adherence to clinic appointments: a pilot study.

Tópicos

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Resumo

CKGROUND: Internet portal technologies that provide access to portions of electronic health records have the potential to revolutionize patients' involvement in their care. However, relatively few descriptions of the demographic characteristics of portal enrollees or of the effects of portal technology on quality outcomes exist. This study examined data from patients who attended one of seven Duke Medicine clinics and who were offered the option of enrolling in and using the Duke Medicine HealthView portal (HVP). The HVP allows patients to manage details of their appointment scheduling and provides automated email appointment reminders in addition to the telephone and mail reminders that all patients receive.OBJECTIVE: Our objective was to test whether portal enrollment with an email reminder functionality is significantly related to decreases in rates of appointment "no-shows," which are known to impair clinic operational efficiency.METHODS: Appointment activity during a 1-year period was examined for all patients attending one of seven Duke Medicine clinics. Patients were categorized as portal enrollees or as nonusers either by their status at time of appointment or at the end of the 1-year period. Demographic characteristics and no-show rates among these groups were compared. A binomial logistic regression model was constructed to measure the adjusted impact of HVP enrollment on no-show rates, given confounding factors. To demonstrate the effect of HVP use over time, monthly no-show rates were calculated for patient appointment keeping and contrasted between preportal and postportal deployment periods.RESULTS: Across seven clinics, 58,942 patients, 15.7% (9239/58,942) of whom were portal enrollees, scheduled 198,199 appointments with an overall no-show rate of 9.9% (19,668/198,199). We found that HVP enrollees were significantly more likely to be female, white, and privately insured compared with nonusers. Bivariate no-show rate differences between portal enrollment groups varied widely according to patient- and appointment-level attributes. Large reductions in no-show rates were seen among historically disadvantaged groups: Medicaid holders (OR = 2.04 for nonuser/enrollee, 5.6% difference, P < .001), uninsured patients (OR = 2.60, 12.8% difference, P < .001), and black patients (OR = 2.13, 8.0% difference, P < .001). After fitting a binomial logistic regression model for the outcome of appointment arrival, the adjusted odds of arrival increased 39.0% for portal enrollees relative to nonusers (OR = 1.39, 95% CI 1.22 - 1.57, P < .001). Analysis of monthly no-show rates over 2 years demonstrated that patients who registered for portal access and received three reminders of upcoming appointments (email, phone, and mail) had a 2.0% no-show rate reduction (P < .001), whereas patients who did not enroll and only received traditional phone and mail reminders saw no such reduction (P < .09).CONCLUSIONS: Monthly no-show rates across all seven Duke Medicine clinics were significantly reduced among patients who registered for portal use, suggesting that in combination with an email reminder feature, this technology may have an important and beneficial effect on clinic operations.

Resumo Limpo

ckground internet portal technolog provid access portion electron health record potenti revolution patient involv care howev relat descript demograph characterist portal enrolle effect portal technolog qualiti outcom exist studi examin data patient attend one seven duke medicin clinic offer option enrol use duke medicin healthview portal hvp hvp allow patient manag detail appoint schedul provid autom email appoint remind addit telephon mail remind patient receiveobject object test whether portal enrol email remind function signific relat decreas rate appoint noshow known impair clinic oper efficiencymethod appoint activ year period examin patient attend one seven duke medicin clinic patient categor portal enrolle nonus either status time appoint end year period demograph characterist noshow rate among group compar binomi logist regress model construct measur adjust impact hvp enrol noshow rate given confound factor demonstr effect hvp use time month noshow rate calcul patient appoint keep contrast preport postport deploy periodsresult across seven clinic patient portal enrolle schedul appoint overal noshow rate found hvp enrolle signific like femal white privat insur compar nonus bivari noshow rate differ portal enrol group vari wide accord patient appointmentlevel attribut larg reduct noshow rate seen among histor disadvantag group medicaid holder nonuserenrolle differ p uninsur patient differ p black patient differ p fit binomi logist regress model outcom appoint arriv adjust odd arriv increas portal enrolle relat nonus ci p analysi month noshow rate year demonstr patient regist portal access receiv three remind upcom appoint email phone mail noshow rate reduct p wherea patient enrol receiv tradit phone mail remind saw reduct p conclus month noshow rate across seven duke medicin clinic signific reduc among patient regist portal use suggest combin email remind featur technolog may import benefici effect clinic oper

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