Engaging Diverse Patients in Using an Online Patient Portal (California)

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Patient access to online patient portals has the potential to improve efficiency of care and enable patients to better manage their health. This is a particularly important strategy in chronic illness care, such as diabetes management, where 35 to 45 percent of diabetes patients are in poor control of their disease. Additionally, many patients with chronic illness need ongoing support and care coordination outside of office visits to improve disease management and reduce complications. Early evidence suggests that patient portal use could be linked to improved outcomes.

The goal of this project is to improve outcomes for patients with chronic conditions within real-life healthcare settings serving diverse patients by using a patient portal. The K99/R00 funding mechanism has two award phases. In the first phase, the research team examined portal use in relation to medication adherence, missed visits, and clinical diabetes control. In the next phase, they will conduct focus groups with racially and ethnically diverse patients to assess potential barriers to portal use.

The specific aims of the first phase were as follows:

  • Determine the impact of portal use on diabetes outcomes overall and within racial and ethnic groups. 
  • Determine barriers and facilitators to portal use among diabetes patients in a safety net setting. 

The second phase of the project will focus more broadly on chronic conditions. Using the findings from the first phase, the team will apply user-centered designed methodologies to develop a patient-focused interactive portal training for patients with chronic conditions. Next, the training will be evaluated by randomized trial comparing the following three conditions: 1) self-directed completion of the training; 2) support from a lay health worker to complete the training; and 3) usual care, consisting of a brochure about the portal and access to computers and kiosks to register for the portal. The trial will evaluate usability metrics, the primary outcomes of registration and portal use, health behavior outcomes, and patient perceptions of portal use.

The specific aims of the second phase are as follows:

  • Design an online training program to educate diverse patients about using a patient portal. 
  • Conduct a three-arm randomized pilot trial of the implementation of the online training program. 

This work has the potential to actively engage a broader and more representative group of patients in using patient portals and to improve health outcomes and reduce overall health disparities.

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