Evidence Summary
Focused Bedside
Education May Improve Engagement of Hospitalized Patients with Their Patient
Portals
A Review of:
Greysen,
S.R., Harrison, J.D., Rareshide, C., Magan, Y., Seghal, N., Rosenthal,
J., Jacolbia, R., & Auerbach, A.D. (2018). A
randomized controlled trial to improve engagement of hospitalized patients with
their patient portals. Journal of the American Medical Informatics
Association, 25(12), 1626-1633. https://doi.org/10.1093/jamia/ocy125
Reviewed by:
Joanne M. Muellenbach
Library Director and Associate Professor
California Health Sciences University
Clovis, California, United States of America
Email: jmuellenbach@chsu.edu
Received: 6 Nov. 2019 Accepted: 15 Jan. 2020
2020 Muellenbach.
This is an Open Access article distributed under the terms of the Creative
Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly attributed, not used for commercial
purposes, and, if transformed, the resulting work is redistributed under the
same or similar license to this one.
DOI: 10.18438/eblip29671
Abstract
Objectives –
To study hospitalized patients who were provided with tablet computers and
the extent to which having access to these computers increased their patient
portal engagement during hospitalization and following their discharge.
Design – Prospective,
randomized controlled trial (RCT) within a larger, observational study of
patient engagement in discharge planning.
Setting – A large, academic medical centre in the
Western United States of America.
Subjects – Of a total of 250 potential subjects from a larger
observational study, 137 declined to participate in this one; of the remaining
113 subjects, 16 were unable to access the patient portal, leaving 97 adult (18
years of age or older) patients in the final group. All subjects (50
intervention and 47 control) were randomized but not blinded, had been admitted
to medical service, and spoke English. In addition, all participants were
supplied with tablet computers for one day during their inpatient stay and were
provided with limited assistance to the portal registration and login
process as needed. They were also required to have access to a tablet or home
computer when discharged.
Methods –
The intervention group participants received focused bedside structured education by trained research assistants
(RAs) who demonstrated portal key functions and explained the importance of
these functions for their upcoming transition to post-discharge care. Following
enrolment and consent, RAs administered a brief pre-study survey to assess
baseline technology use. Then, at the end of the observation day, the RAs
performed a debrief interview in which participants were asked to demonstrate
their ability to perform key portal tasks. The RAs recorded which tasks were
accomplished or if the RAs had provided assistance.
Patient demographics and clinical information were obtained from the Electronic
Health Record (EHR).
Main results –
Of the 97 patients who were enrolled in the RCT, 57% logged into their portals
at least once within seven days of their discharge. The mean number of logins
and specific portal tasks performed was higher for the intervention group than
for the control group. In addition, while in the hospital, the intervention
group was better able to log in and navigate the portal. Only one specific
portal task reached statistical significance—the use of the tab for viewing the
messaging interaction with the provider. The time needed to deliver the
intervention was brief—less than 15 minutes for 80% of participants. The
intervention group’s overall satisfaction with the bedside tablet to access the
portal was high.
Conclusion – Data analysis
revealed that the bedside tablet educational intervention succeeded in
increasing patient engagement in the use of the patient portal, both during
hospitalization and following discharge. As the interest and demand for patient
access to EHRs increases among patients, caregivers, and healthcare providers,
more rigorous studies will be needed to guide the implementation of patient
portals during and after hospitalization.
Commentary
This
is the first randomized clinical trial to test an intervention for increasing
patient engagement with their portals in hospital and post-discharge settings.
The study, through its strong design, provides a model for other studies of
patient portal use.
A
critical appraisal tool (Glynn, 2006) revealed the study’s strengths and
weaknesses. The authors received IRB approval and provided appendices outlining
the inclusion criteria, enrolment, and randomization details as well as other
details (the MyChart tutorial, post-study survey, and final questionnaire).
However, the study would have been stronger if it had included patients from
more than one hospital, as noted by the authors together with other study
limitations in the “Discussion” section (p. 1632). With regard to the training
provided by the RAs, the effect of the study not being blinded is unclear, as
is the effect of RAs being allowed to “tailor the depth of the explanations to
the needs of individual patients” (p. 1627). In future studies, a separate
“limitations” section might assist readers in considering study limitations.
Patient
demographics and clinical information were adequately summarized. However, when
logistic regression analysis was performed, it revealed that an area of
difference between the two groups was prior MyChart registration: 34
participants in the intervention group (68%) were previously registered versus
18 participants (38%) in the control group. Given this difference, the study
would have been more robust if it had randomized for previous MyChart
registration.
Future
studies might be enriched by incorporating a “teach to goal” approach for such
skills as effective use of inhalers for patients with respiratory conditions
and might investigate additional patient characteristics (acute care needs, use
of different devices, and age/income effects, for example). Several recent
studies have focused on how inpatient portals have furthered patient
empowerment. A qualitative, retrospective study (McAlearney,
2019), found early indications that inpatient portals “promoted independence,
reduced anxiety, informed families, and increased patient empowerment,
overall.” A randomized trial (Masterson, 2019) concluded that inpatient portals
resulted in a decreased 30-day readmission rate. A systematic review (Dendere, 2019) found some evidence that patient portals
benefited by discovering medical errors, improving medication adherence, and
enhancing patient-provider communication, and these predictors for portal use
could be used in future studies.
Clinical,
consumer health, or hospital-based librarians may wish to collaborate with
health providers in further studies in order to contribute to the development
of new evidence-based, consumer health resources that could be linked within
the patient portals and to understand how library resources might be integrated
into such portals. Medical librarians might also benefit from understanding the
degree of engagement for patients who receive consumer health educational
interventions using patient portals and might contribute to identifying
patients with the greatest need for portals, such as those with serious health
conditions.
References
Dendere, R., Slade, C.,
Burton-Jones, A., Sullivan, C., Staib, A., & Janda, M. (2019). Patient portals facilitating engagement
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McAlearney, A. S., Fareed,
N., Gaughan, A., MacEwan, S. R., Volney,
J., & Sieck, C. J. (2019). Empowering patients during hospitalization:
Perspectives on inpatient portal use. Applied Clinical Informatics, 10(01),
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