Improving Provisioning of an Inpatient Portal: Perspectives from Nursing Staff

Gaughan, Alice; Walker, Daniel M.; Sova, Lindsey N.; Vink, Shonda; Moffatt-Bruce, Susan D.; McAlearney, Ann Scheck

doi:10.1055/s-0042-1743561

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…That said, we believe these experiences provide a valuable framework for technology distribution programs in other settings. 21 If our outcomes are reproducible, an investment in larger initiatives could be offset by the improvements in missed care opportunities and unnecessary lower-value acute care utilization (e.g., preventing emergency department visits). Lastly, we were unable to ascertain the usage patterns of the devices outside of direct clinical encounters.…”

Section: Discussionmentioning

confidence: 99%

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

et al. 2023

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Objective: The COVID-19 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to healthcare access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children’s hospital. Methods: Between October 2020-October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children’s hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a pre-intervention period (March 2020-October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics. Results: A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and Black, non-Hispanic (21.6%) and publicly insured (64.9%). Between the pre-intervention and intervention period, there was a significant increase in completed video- and phone-based virtual visits (75.3% vs. 79.1%, p=0.038). The proportion of video-based only visits increased from 82.9% to 88.9 %. p < 0.001). Families reported that the tablet improved the patient’s ability to receive medical care (93.7%) and was easy to use (93.9%). Conclusion: The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and healthcare experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.

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Section: Discussionmentioning

confidence: 99%

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

et al. 2023

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“…Similarly, our interventions did not purposefully incorporate approaches that may help advance health equity. For instance, bias, both implicit and explicit, has been noted as a barrier in patient portal uptake among Black individuals, 48 , 49 , 50 suggesting that it may be important to address this factor. Additionally, racial concordance of study staff delivering the touch intervention might improve patient trust and thereby differentially impact Black participants.…”

Section: Discussionmentioning

confidence: 99%

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Walker,

Hefner,

MacEwan

et al. 2024

JAMA Netw Open

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ImportanceDifferences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap.ObjectiveTo compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups.Design, Setting, and ParticipantsThis secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023.InterventionsA 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]).Main Outcomes and MeasuresPrimary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs.ResultsOf 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race.Conclusions and RelevanceIn this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity.Trial RegistrationClinicalTrials.gov Identifier: NCT02943109

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“…Third, our study followed the AMC's protocol for offering tablets in which nursing staff assessed a patient's ability to utilize a portal as part of the decision to offer the portal; this approach could have biased our sample toward patients who had higher perceived HLN. 31 As prior work has highlighted bias in perceptions of patients' ability to use the portal and provisioning of portals, 32 33 34 future work should take this potential bias into account and focus on the importance of asking all patients if they are interested in using a portal as well as consider how to systematically assess patients' capacities to use portals when evaluating overall use and impacts. This effort should extend to include non-English speakers and members of underrepresented groups.…”

Section: Discussionmentioning

confidence: 99%

Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use

et al. 2022

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Objectives The objective of this study is to investigate the relationships between health literacy and numeracy (HLN) and patient portal use, measured in inpatient and outpatient settings. Methods Using data collected as part of a pragmatic randomized controlled trial conducted across the inpatient population of a U.S.-based academic medical center, the present study evaluated the relationships between patients' perceptions of health literacy and their skills, interpreting medical information with metrics of engagement with patient portals. Results Self-reported levels of HLN for patients in the study sample (n = 654) were not significantly associated with inpatient portal use as measured by frequency of use or the number of different inpatient portal functions used. Use of the outpatient version of the portal over the course of 6 months following hospital discharge was also not associated with HLN. A subsequent assessment of patients after 6 months of portal use postdischarge (response rate 40%) did not reveal any differences with respect to portal use and health numeracy; however, a significant increase in self-reported levels of health literacy was found at this point. Conclusion While previous studies have suggested that low HLN might represent a barrier to inpatient portal adoption and might limit engagement with outpatient portals, we did not find these associations to hold. Our findings, however, suggest that the inpatient setting may be effective in facilitating technology acceptance. Specifically, the introduction of an inpatient portal made available on hospital-provided tablets may have practical implications and contribute to increased adoption of patient-facing health information technology tools.

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Improving Provisioning of an Inpatient Portal: Perspectives from Nursing Staff

Cited by 4 publications

References 28 publications

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use

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