Disparities Limit the Effect and Benefit of a Web-Based Clinic Intake System

Abstract

With increasing value being placed on patient-centered care and the focus on efficiency and workflow in health care delivery, the authors have implemented a web-based system for demographic, medical history, and patient-reported outcomes data collection for every clinical visit at their specialty upper-extremity center. They evaluated initial success and disparities in use after 12 months. The authors evaluated questionnaire parameters from 2018 patients, focusing primarily on the new patient intake form. They analyzed form-completion time relative to appointment time and form-completion percentage at various times before the appointment. The authors grouped patients by age, sex, race, income, education, employment status, transportation access, self-reported pain, and quality-of-life scores. Waiting room time was evaluated. Of new patients, 94% used the web-based platform to complete the intake form. Of the 4898 completed forms, 69.7% were done more than 1 hour before appointment time, indicating that a personal device was used. When grouped by patient characteristics and controlling for all demographic factors, patients who were male, non-White, and older than 40 years; had lower family income; and had a high school education or less were significantly associated with later form completion. Of the 1136 patients for whom the authors had adequate waiting room time data, late form completion significantly increased odds of waiting more than 15 minutes to be placed into an examination room. These data indicate that the authors are reliably capturing important patient information before appointment time. This could improve clinical workflow and overall quality of care and also identify limits in access and online system use, providing opportunities to improve capture by developing targeted interventions for specific patient populations. [ Orthopedics . 2021;44(3):e434–e439.]

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

“…Remaining specialties included rheumatology [ 52 – 55 ] (n = 4, 14.3%), psychology/psychiatry [ 56 – 58 ] (n = 3, 10.7%), and one study each (3.6%) for neurology [ 37 ], geriatrics [ 59 ], trauma [ 60 ], home health care [ 61 ], and orthopedic hand surgery [ 62 ].…”

“…Overall concerns, needs, and preferences were abstracted from studies and detailed in Table 4 . Among the concerns were disparities in PRO completion among racial and ethnic minorities [ 11 , 38 , 50 , 62 ], Spanish-speaking patients [ 11 ], populations with low income/employment status and low educational or health literacy [ 62 ], and elderly or geriatric populations [ 11 , 38 , 62 ]. Needs among populations included additional help in completing surveys among patients with low income/education [ 55 ] and a suggestion for a tutorial video for ePRO use among elderly patients [ 59 ].…”

“…Primary care was the most common specialty represented (n = 10, 35.7%) [11,36,[38][39][40][41][42][43][44][45], followed by oncology (n = 4, 21.4%) [46][47][48][49][50][51], of which two studies were specific to breast oncology [46,47] and two studies were specific to urologic/radiation oncology [49,50]. Remaining specialties included rheumatology [52][53][54][55] (n = 4, 14.3%), psychology/psychiatry [56][57][58] (n = 3, 10.7%), and one study each (3.6%) for neurology [37], geriatrics [59], trauma [60], home health care [61], and orthopedic hand surgery [62].…”

“…Concerns: Non-Hispanic Black patients less likely than Hispanic, non-Hispanic White, and non-Hispanic Asian patients to be able to complete a touch-screen enabled computer-assisted self-interview [38] Non-Hispanic black patients more likely and Hispanic patients who preferred Spanish less likely to complete PROMs than Non-Hispanic White patients who speak English [11] Late responses to web-based PRO platform associated with racial/ethnic minorites [62] Black patients less likely than White patients to complete tablet-based PRO [50] Low income, limited health literacy, majority Black patients had more difficulty with PRO data retrieval than data completion within commercially available mobile apps on iPhones and Androids [42] Needs: n/a Preferences:…”

“…Late responses to web-based PRO platform associated with low income [62] Half of a low SES, low education population found PROs confusing [55] Low income, limited health literacy, majority Black patients had more difficulty with PRO data retrieval than data completion within commercially available mobile apps on iPhones and Androids [42] Needs: Half of a low SES, low education population wanted help completing surveys [55] Preferences: n/a Other: Low income patients had more favorable experiences with PROM collection than patients within the top 3 quartiles of income [37] PRO collection with EHR upload feasible in a low-resource clinical setting with a 25% Native American population [51] Interactive voice response symptom deemed feasible and improved symptom severity among majority unemployed African American and Latina patients [47] Populations with low educational or health literacy…”