News Release 

Electronic portals may help patients with multiple complex conditions

Patients managing their health via the portal had fewer emergency room visits, hospitalizations

PLOS

Access to a patient portal can increase engagement in outpatient visits and reduce emergency room visits and hospitalizations in patients with multiple chronic diseases, according to a study published June 19, 2019 in the open-access journal PLOS ONE by Mary Reed (DrPH) of Kaiser Permanente, USA, and colleagues.

An increasing number of patients in the United States are living with multiple complex chronic conditions, including diabetes, asthma, congestive artery disease, congestive heart failure and hypertension. Electronic patient portals offer patients the ability to manage several aspects of their healthcare--by checking lab results, contacting providers or refilling medications, for instance. Previous studies have found improvements in healthcare associated with some portal components.

In the new study, researchers retrospectively examined the records of 165,447 patients with diabetes enrolled in the integrated delivery system of Kaiser Permanente Northern California. 22.6% of the patients had diabetes only, while the other 77.4% had diabetes plus one or more other conditions. For the study, researchers focused on comparing patients' use of health services before and after portal access.

During the study period, 22.3% of all patients registered to use the patient portal. After accounting for patient characteristics and clinical needs, the researchers found that access to the portal was associated with more outpatient office visits (170 more visits per 1,000 patients per month, p<0.05): patients who used the portal averaged 949 office visits per 1,000 patients per month, while patients who didn't use the portal averaged 779 visits. In patients with multiple complex chronic conditions, this was accompanied by fewer emergency department visits (3.9 fewer per 1,000 patients per month, p<0.05), with patients using the portal averaging 48.5 emergency department visits per 1,000 patients per month, and patients not using the portal averaging 52.4, as well as fewer preventable hospital stays (0.8 fewer per 1,000 patients per month, p<0.05), with patients using the portal averaging 7.3 hospital stays per 1,000 patients per month, while patients not using the portal averaged 8.1 stays.

The study results may not be generalizable to all settings, and there may be patient characteristics associated with using or not using the portal which were not accounted for. However, the authors believe that the portal might help patients to engage in outpatient office visits, preventing serious health events arising down the line.

Reed adds: "We found a promising pattern of portal-related impacts on patient outcomes - that patients using the portal were more likely to visit their doctors' offices but less likely to end up in the emergency room or with a hospital stay, and these patterns are more pronounced in patients that were juggling multiple chronic conditions. The patient portal offers patients a tool to manage their health care more proactively and this seems to have kept them from needing emergency care or more serious health events."

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Citation: Reed ME, Huang J, Brand RJ, Neugebauer R, Graetz I, Hsu J, et al. (2019) Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal. PLoS ONE 14(6): e0217636. https://doi.org/10.1371/journal.pone.0217636

Funding: This study was supported by funding from the Patient Centered Outcomes Research Institute (IH-12-11-4925) to all authors. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of this manuscript.

Competing Interests: The authors have declared that no competing interests exist.

In your coverage please use this URL to provide access to the freely available article in PLOS ONE: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217636

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