An Analysis of Patient Portal Enrollment During Transitions of Care

From the 2022 HVPA National Conference

Mahip Grewal BA (NYU Grossman School of Medicine), Jamie Schlacter BS (NYU Grossman School of Medicine), Michael Martinez BS, Kevin Eaton MD

Background

The recent passage of the 21st Century Cures Act “open notes” mandate underscores the central role of patient portals in the healthcare system. Moreover, the use of patient portals such as MyChart has been associated with improved patient engagement, safety, and health outcomes. However, in previous studies of both inpatient and outpatient settings, significant disparities in patient portal utilization have been demonstrated with respect to race, age, and socioeconomic status.

Objective

At our institution, we sought to investigate the role of the MyChart patient portal during transitions of care from the inpatient to outpatient setting. Specifically, we aimed to characterize the patient demographics associated with MyChart status at discharge and to investigate relationships between MyChart status at discharge, readmissions, and completion of outpatient follow-up visits.

Methods

A retrospective analysis of patients (n = 1195) discharged from a general medicine inpatient unit between November 1, 2020 and October, 1 2021 was performed. The primary variables assessed were age, sex, self-identified race, primary language, MyChart status at discharge, follow-up outpatient visit completion, and readmission within 30 days. Of note, patients with an inactive or pending status, along with those who declined MyChart, were combined in a single non-active MyChart status category. Pearson’s Chi Square and Fisher’s Exact Test were employed for univariate analyses, and multivariate analyses were conducted using logistic regressions.

Results

MyChart status differed significantly according to self-identified race (P < 0.001) and age (P < 0.005), whereas MyChart status was not significantly associated with language. 63% of Black patients had an active MyChart status upon discharge, the lowest proportion among all racial groups. In comparison, 77% of White patients had an active MyChart. A multivariate logistic regression for MyChart status including age, gender, and race revealed that age (P < 0.05), White race (P < 0.001), and Asian race (P < 0.001) were significantly associated with an active MyChart status. Multivariate regression analysis of 30-day readmission based on age and MyChart status at discharge revealed only age as a significant risk factor (P < 0.05). The proportion of patients who attended an outpatient visit after discharge was significantly greater among patients with an active MyChart status than patients with a non-active MyChart status (P < 0.0001). Outpatient visit completion was also statistically different according to race (P < 0.01) and age groups (P < 0.0005).

Conclusions

Our analysis revealed significant differences in MyChart status at discharge based on age and race. These differences may be related to disparities in post-discharge outpatient visit completion, negatively impacting patient outcomes.

Clinical Implications

Given the demonstrated benefits of patient portal utilization with regards to patient satisfaction and health outcomes, along with our finding that an active MyChart status at discharge is associated with outpatient follow-up, further research is warranted to determine how to better engage older and minority patients with patient portals to promote more equitable transitions of care.

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