Date Presented 04/7/21
Participants will identify patient characteristics associated with decreased participation in health management using electronic health technologies, particularly patient portals. Results of a cross-sectional study of patient portal adoption among 154,189 patients at a large, urban U.S. health care system will be presented. Implications for OT practice with the older adult population will be emphasized and proposed as a prime area of opportunity.
Primary Author and Speaker: An T. Nguyen
Additional Authors and Speakers: Breanna Carter, Molly Cutler
BACKGROUND: Healthcare systems are increasingly deploying electronic health (eHealth) technologies, such as mobile health applications, telehealth, and patient portals, as interventions to enhance patient engagement in personal health management. The Occupational Therapy Practice Framework (3rd Edition) includes participation in health management as instrumental activities of daily living within the scope of occupational therapy practice (AOTA, 2017). To guide occupational therapy practitioners to assume expanded roles in assisting individuals, groups, and populations to improve participation in eHealth-enabled health management, a better understanding of patient-level risk factors for decreased engagement with eHealth technologies is needed.
OBJECTIVE: To identify patient characteristics associated with decreased participation in health management enabled by a large healthcare system's electronic patient portal.
DESIGN: A cross-sectional analysis of patient data at a large, urban U.S. healthcare system between August 1, 2017 and July 31, 2019.
METHODS: Data were retrieved from the electronic health record and patient portal server logs. Inclusion criteria included patient who: (1) were age 18 years and over; (2) had a primary care provider within the healthcare system under study; (3) had at least two outpatient visits during the study period; and (4) lived in Los Angeles County. Exclusion criteria included patients who: (1) were labelled as employees, students/trainees, or volunteers within the healthcare system under study; and (2) were deceased. Statistical analyses included descriptive statistics and estimation of a multivariate logistic regression model to test associations between patient portal adoption and patient characteristics, including socio-demographics, healthcare utilization, and 23 comorbid conditions. Comorbidities were defined by previously validated ICD-10 code groups (Quan et al., 2005). A socioeconomic index, called the SocioNeeds Index, was used as a proxy for neighborhood socioeconomic status by mapping 5-digit zip codes to index values (Conduent Health Communities Institute, 2019). Missing data were handled using multiple imputation.
RESULTS: In total, 154,189 patients were included in the study. Adjusted odds ratios (OR) of patient portal adoption indicated that patients less likely to participate in health management using the patient portal were older (age 45 years and above); had public health insurance (Medicare or Medicaid); had lower socioeconomic status; and were more likely to have age-related comorbidities, including cerebrovascular disease (OR = 0.860, 95% confidence interval (CI) [0.797-0.927], p < .0001), peripheral vascular disease (OR = 0.813, 95% CI [0.754-0.876], p < 0.001), congestive heart failure (OR = 0.712, 95% CI [0.625-0.778], p < .0001), dementia (OR = 0.797, 95% CI [0.708-0.897], p < .0001), diabetes (OR = 0.760, 95% CI [0.692-0.834], p < .0001), kidney disease (OR = 0.706, 95% CI [0.651-0.765], p < .0001), and metastatic cancer (OR = 0.492, 95% CI [0.403-0.530], p < .0001).
CONCLUSION: Findings of this study suggest that the older adult population is at increased risk for decreased participation in health management using eHealth technologies. In particular, older adults with public health insurance, lower socioeconomic status, and age-related comorbidities are at higher risk for non-engagement. Findings suggest opportunities for occupational therapy to address participation in using eHealth technologies for health management among the older adult population.
IMPACT STATEMENT: This study suggests an opportunity for expanding the role of occupational therapy to improve older adults' participation in using eHealth technologies for health management.
References
American Occupational Therapy Association [AOTA] (2017). Occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy, 68(Supplement_1), S1-S48. https://doi.org/10.5014/ajot.2014.682006
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J. C., Saunders, L. D., Beck, C. A., Feasby, T. E., & Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43(11), 1130-1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83
Conduent Healthy Communities Institute (2019). SocioNeeds Index. Retrieved from https://www.thinkhealthla.org/index.php?module=indicators&controller=index&action=socioneeds
