scholarly journals Quantifying Patient Portal Use: Systematic Review of Utilization Metrics

10.2196/23493 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e23493
Author(s):  
Lauren L Beal ◽  
Jacob M Kolman ◽  
Stephen L Jones ◽  
Aroub Khleif ◽  
Terri Menser

Background Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction. Portal studies have also connected portal use, as well as the nature of users’ interactions with portals, and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the United States have encouraged uptake of health information technology, including patient portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. No known review has systematically assessed the measurements used to investigate patient portal utilization. Objective The objective of this study was to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. Methods Original studies with quantifiable metrics of portal use published in English between 2014 and the search date of October 17, 2018, were obtained from PubMed using the Medical Subject Heading term “Patient Portals” and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by the retrieval of works cited in systematic reviews (based on title screening of all citations). An additional search round included broader keywords identified during the full-text review of the first round. Second round results were screened at abstract level for inclusion and confirmed by at least two raters. Included studies were analyzed for metrics related to basic use/adoption, frequency of use, duration metrics, intensity of use, and stratification of users into “super user” or high utilizers. Additional categories related to provider (including care team/administrative) use of the portal were identified inductively. Additional analyses included metrics aligned with meaningful use stage 2 (MU-2) categories employed by the US Centers for Medicare and Medicaid Services and the association between the number of portal metrics examined and the number of citations and the journal impact factor. Results Of 315 distinct search results, 87 met the inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three (26 studies, 30%) or four (23 studies, 26%) metrics. Nine studies (10%) only reported the patient use/adoption metric and only one study (1%) reported all six metrics. Of the US-based studies (n=76), 18 (24%) were explicitly motivated by MU-2 compliance; 40 studies (53%) at least mentioned these incentives, but only 6 studies (8%) presented metrics from which compliance rates could be inferred. Finally, the number of metrics examined was not associated with either the number of citations or the publishing journal’s impact factor. Conclusions Portal utilization measures in the research literature can fall below established standards for “meaningful” or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.

2020 ◽  
Author(s):  
Lauren L Beal ◽  
Jacob M Kolman ◽  
Stephen L Jones ◽  
Aroub Khleif ◽  
Terri Menser

BACKGROUND Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction; portal studies have also connected portal use as well as the nature of users’ interactions with portals and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the USA have encouraged uptake of health information technology, including portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. OBJECTIVE No review has systematically assessed the measurements used to investigate patient portal utilization. Therefore, the objective of this study is to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. METHODS Original studies with quantifiable metrics of portal use, available in English between 2014 and the search date of October 17, 2018, were obtained from PubMed, using the Medical Subject Heading term “patient portals” and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by retrieval of works cited in systematic reviews (based on title screening). An additional search round included broader keywords. Studies were screened at abstract-level for inclusion, confirmed by at least two raters. Included studies were analyzed for metrics related to basic use / adoption; frequency of use; duration metrics; intensity; and stratification of users into “super user” or high-utilization types. Additional categories related to provider (including care team / administrative) use of the portal were identified inductively. Analysis of whether metrics aligned with Meaningful Use Stage 2 categories (MU-2) employed by the US Centers for Medicare and Medicaid Services was also conducted. RESULTS Of 315 distinct search results, 87 met inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three types (27 studies, 31.03%) or four types (22, 25.29%) of metrics. Nine studies (10.34%) only reported the patient use / adoption metric, and only one study (1.15%) reported all six. Of the U.S.-based studies (76), 18 were explicitly motivated by MU-2 compliance; 40 (52.63%) at least mentioned these incentives, but only 6 (7.89%) presented metrics from which compliance rates could be inferred. CONCLUSIONS Portal utilization measures in the research literature can fall below established standards for “meaningful” or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.


BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016298 ◽  
Author(s):  
Janaka Lagoo ◽  
Steven R Lopushinsky ◽  
Alex B Haynes ◽  
Paul Bain ◽  
Helene Flageole ◽  
...  

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.


2019 ◽  
Author(s):  
Hae-Ra Han ◽  
Kelly T Gleason ◽  
Chun-An Sun ◽  
Hailey N Miller ◽  
Soo Jin Kang ◽  
...  

BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient’s condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.


CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S11-S12
Author(s):  
A. Suleman ◽  
J. Krakovsky ◽  
P. Joo

Introduction: It is typical to look for UTI in delirious elderly patients, despite a high prevalence of asymptomatic bacteriuria (ASB) in this population. A common presentation of infection is delirium, which often has a non-specific and multifactorial etiology. Therefore, when bacteriuria is present with delirium in the absence of urinary symptoms, physicians prescribe antibiotics for the suspected UTI-induced delirium. We set to determine whether antibiotic treatment in the elderly presenting with delirium in the presence of ASB resulted in resolution of delirium. Methods: Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Abstracts were independently reviewed by two authors for decision to include for full-text review. Inclusion criteria included female gender, >65 years of age, presenting in an acute care setting with delirium and ASB. The primary outcome was resolution of delirium. The secondary outcomes were mortality, frequency of side effects from antibiotics, length of hospital stay and readmission for delirium. Results: 930 abstracts published from 1946-2017 were screened, and 42 were included for full text review. No studies were eligible for inclusion in the systematic review, as none addressed the primary outcome. One study addressed the outcomes of poor functional recovery after delirium and the rate of improvement of delirium symptoms after presentation of delirium with ASB. Conclusion: Even though current guidelines recommend against treatment of ASB, no guideline states whether ASB should be treated in elderly patients with delirium. Little evidence exists to elucidate whether treating delirious patients with ASB results in improvement in outcomes. Future studies should focus on demonstrating the relationship between resolution of delirium with antibiotic treatment. This will clarify whether delirium is a true symptom of ASB and whether treatment results in faster resolution of delirium.


2020 ◽  
Vol 45 (8) ◽  
pp. 645-655
Author(s):  
Johnny Wei Bai ◽  
Dong An ◽  
Anahi Perlas ◽  
Vincent Chan

Local anesthetics (LAs) are commonly infiltrated into surgical wounds for postsurgical analgesia. While many adjuncts to LA agents have been studied, it is unclear which adjuncts are most effective for co-infiltration to improve and prolong analgesia. We performed a systematic review on adjuncts (excluding epinephrine) to local infiltrative anesthesia to determine their analgesic efficacy and opioid-sparing properties. Multiple databases were searched up to December 2019 for randomized controlled trials (RCTs) and two reviewers independently performed title/abstract screening and full-text review. Inclusion criteria were (1) adult surgical patients and (2) adjunct and LA agents infiltration into the surgical wound or subcutaneous tissue for postoperative analgesia. To focus on wound infiltration, studies on intra-articular, peri-tonsillar, or fascial plane infiltration were excluded. The primary outcome was reduction in postoperative opioid requirement. Secondary outcomes were time-to-first analgesic use, postoperative pain score, and any reported adverse effects. We screened 6670 citations, reviewed 126 full-text articles, and included 89 RCTs. Adjuncts included opioids, non-steroidal anti-inflammatory drugs, steroids, alpha-2 agonists, ketamine, magnesium, neosaxitoxin, and methylene blue. Alpha-2 agonists have the most evidence to support their use as adjuncts to LA infiltration. Fentanyl, ketorolac, dexamethasone, magnesium and several other agents show potential as adjuncts but require more evidence. Most studies support the safety of these agents. Our findings suggest benefits of several adjuncts to local infiltrative anesthesia for postoperative analgesia. Further well-powered RCTs are needed to compare various infiltration regimens and agents.Protocol registrationPROSPERO (CRD42018103851) (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=103851)


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 125-125
Author(s):  
Marcela Radtke ◽  
Stephanie Jilcott Pitts ◽  
Lisa Jahns ◽  
Gina Firnhaber ◽  
Brittany Loofbourrow ◽  
...  

Abstract Objectives The purpose of this study was to conduct a systematic review to assess criterion-related validity of spectroscopy-based skin carotenoid measurements against serum/plasma carotenoids and/or dietary intake of fruit and vegetables. Methods PubMed, Embase, ProQuest, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were systematically searched in December 2018 to identify articles for inclusion. Articles published from 1990–2018 that correlated spectroscopy-based skin carotenoid measurements to blood carotenoids and/or fruit and vegetable intake met inclusion criteria. The articles were reviewed independently by at least two authors and discrepancies were mediated by a third author. A hand search was conducted of the included papers to ensure no relevant articles were excluded. Results Of the 7931 articles identified in the literature search, 54 articles met the eligibility criteria for full-text review. Following the full-text review, 22 articles were selected for data extraction and were included in the present review. Following the hand search, seven additional articles were eligible for inclusion, resulting in a total of 29 articles. All 29 articles demonstrated statistically significant correlations between spectroscopy-based skin carotenoid measurements and serum/plasma carotenoids and/or dietary intake of fruits and vegetables. Three methods of spectroscopic detection were used: 20 articles used resonance Raman spectroscopy (RRS), seven articles used spectrophotometers, and two articles used reflection spectroscopy (RS) to measure skin carotenoids. Twenty of the articles described the racial/ethnic demographics of the study population, with seven articles containing more than 20% from a non-white, minority population. Four studies were conducted with infants, six studies included children, and the remaining 19 studies focused on adults. Conclusions The results of the systematic review support the use of spectroscopy-based skin carotenoid measurements as an alternative measure of fruit and vegetable intake. Additional research is warranted to examine the use of different spectroscopy techniques in diverse populations and populations of varying ages. Funding Sources N/A.


2018 ◽  
Author(s):  
Ashley Brook McGar ◽  
Christine Kindler ◽  
Meghan Marsac

BACKGROUND Pediatric medical conditions have the potential to result in challenging psychological symptoms (eg, anxiety, depression, and posttraumatic stress symptoms [PTSS]) and impaired health-related quality of life in youth. Thus, effective and accessible interventions are needed to prevent and treat psychological sequelae associated with pediatric medical conditions. Electronic health (eHealth) interventions may help to meet this need, with the capacity to reach more children and families than in-person interventions. Many of these interventions are in their infancy, and we do not yet know what key components contribute to successful eHealth interventions. OBJECTIVE The primary objective of this study was to conduct a systematic review to summarize current evidence on the efficacy of eHealth interventions designed to prevent or treat psychological sequelae in youth with medical conditions. METHODS MEDLINE (PubMed) and PsycINFO databases were searched for studies published between January 1, 1998, and March 1, 2019, using predefined search terms. A total of 2 authors independently reviewed titles and abstracts of search results to determine which studies were eligible for full-text review. Reference lists of studies meeting eligibility criteria were reviewed. If the title of a reference suggested that it might be relevant for this review, the full manuscript was reviewed for inclusion. Inclusion criteria required that eligible studies (1) had conducted empirical research on the efficacy of a Web-based intervention for youth with a medical condition, (2) had included a randomized trial as part of the study method, (3) had assessed the outcomes of psychological sequelae (ie, PTSS, anxiety, depression, internalizing symptoms, or quality of life) in youth (aged 0-18 years), their caregivers, or both, (4) had included assessments at 2 or more time points, and (5) were available in English language. RESULTS A total of 1512 studies were reviewed for inclusion based on their title and abstracts; 39 articles qualified for full-text review. Moreover, 22 studies met inclusion criteria for the systematic review. Of the 22 included studies, 13 reported results indicating that eHealth interventions significantly improved at least one component of psychological sequelae in participants. Common characteristics among interventions that showed an effect included content on problem solving, education, communication, and behavior management. Studies most commonly reported on child and caregiver depression, followed by child PTSS and caregiver anxiety. CONCLUSIONS Previous research is mixed but suggests that eHealth interventions may be helpful in alleviating or preventing problematic psychological sequelae in youth with medical conditions and their caregivers. Additional research is needed to advance understanding of the most powerful intervention components and to determine when and how to best disseminate eHealth interventions, with the goal of extending the current reach of psychological interventions.


2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 810-810
Author(s):  
Gursharan Kaur Sohi ◽  
Jordan Levy ◽  
Victoria Delibasic ◽  
Laura Davis ◽  
Alyson Mahar ◽  
...  

810 Background: Cancer treatment is a significant driver of healthcare costs worldwide, however, the economic impact of treating patients with anti-neoplastic agents is poorly elucidated. Hence, we conducted a systematic review and meta-analysis to estimate the direct costs associated with administering intravenous chemotherapy in an outpatient setting. Methods: We systematically searched four databases from 2010 to present and extracted hourly administration costs and the respective components of each estimate. Separate analyses were conducted of Canadian and United States (US) studies, respectively, to address a priori hypotheses regarding heterogeneity amongst administration cost estimates. The Drummond checklist was used to assess risk-of-bias. Data were summarized using medians with interquartile ranges and five outliers were identified; costs were presented in 2019 USD. Results: A total of 44 studies were analyzed, including sub-analyses of 19 US and seven Canadian studies. 26/44 studies were of moderate or high quality. When components of administration cost were evaluated, physician costs were reported most frequently (24 studies), followed by lab tests (13) and overhead costs (9). The median cost estimate when outliers were excluded was $142/hour (IQR = $103-166). Sensitivity analyses determined the median administration cost in the US was $149/hour (IQR = $118-158), and was $128/hour (IQR = $102-137) in Canada. Conclusions: There is currently a paucity of literature addressing the costs of chemotherapy administration, and existing studies utilize a patchwork of reporting methodologies which renders direct comparison challenging. Our results demonstrate that the cost of administering chemotherapy is approximately $125-150/hour, globally. This value is dependent upon the region of analysis, inclusiveness of cost subcomponents as well as the methodology used to estimate unit prices, as described here.


2021 ◽  
Vol 6 (5) ◽  
pp. e005531
Author(s):  
Shannon E King ◽  
Ping Teresa Yeh ◽  
Dong Keun Rhee ◽  
Özge Tuncalp ◽  
Lisa M Rogers ◽  
...  

IntroductionWhile the use of folic acid pre-pregnancy and iron and folic acid (IFA) during pregnancy and postnatal have been demonstrated to be effective and are recommended interventions by WHO, ensuring individuals adhere to the supplementation regimen can be a challenge. Self-care interventions that support an individual’s ability to promote their own health with or without the support of health workers could help promote the uptake and adherence to supplementation. This systematic review assessed the evidence around self-management of IFA or folic acid supplementation accessed over-the-counter during pre-pregnancy, pregnancy and postnatal periods.MethodsPeer-reviewed studies were included if they compared self-management of IFA or folic acid supplementation with health worker-initiated supplement use on maternal and/or fetal and newborn health outcomes, end-users’ or health workers’ values and preferences, or cost and/or cost-effectiveness. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through November 2020, hand-searched clinical trial registries, reviewed databases and contacted experts in the field. Abstract screening and full-text review were conducted independently by two reviewers.ResultsOverall, 2344 results were identified, and 28 studies were identified for full-text review. All studies were excluded, as they were not primary research, lacked the outcomes of interest, lacked specificity in supplement type, and/or lacked a comparison group.ConclusionNo evidence was identified that distinguishes self-management of folic acid supplements pre-pregnancy and of IFA supplements during pregnancy and postnatal, highlighting a gap in our current understanding of self-care related to dietary supplementation in pregnancy. The findings of this review identify an area for further research to support the current movement towards self-care interventions as an added choice to help individuals more fully attain their reproductive health and rights.Systematic review registration numberPROSPERO CRD42020205548


Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 389
Author(s):  
Erin Louise Robinson ◽  
Jennifer StGeorge ◽  
Emily Elsa Freeman

Father–child play engagement has been linked to a variety of child developmental outcomes. However, the most prevalent types of play and child developmental outcomes utilised in research remains unclear. The aim of this study was to systematically review the literature on father–child play interactions and the association with child developmental outcomes for children aged 0–10 years. Database searches generated 1622 abstracts that matched the specified search criteria. Abstract screening and full-text review resulted in 39 included publications. The systematic review revealed that while some paternal play behaviours resulted in different impacts across play types, others reported similar impacts. The findings of this review have implications for potential interventions and parenting resources.


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