scholarly journals Using Patient Portals to Improve Patient Outcomes: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Hae-Ra Han ◽  
Kelly T Gleason ◽  
Chun-An Sun ◽  
Hailey N Miller ◽  
Soo Jin Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Service Use ◽  
The United States ◽  
Preventive Service ◽  
Patient Portal ◽  
Patient Portals ◽  
Wide Range

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.

scholarly journals Using Patient Portals to Improve Patient Outcomes: Systematic Review

10.2196/15038 ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. e15038 ◽  
Author(s):  
Hae-Ra Han ◽  
Kelly T Gleason ◽  
Chun-An Sun ◽  
Hailey N Miller ◽  
Soo Jin Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Service Use ◽  
The United States ◽  
Preventive Service ◽  
Patient Portal ◽  
Patient Portals ◽  
Wide Range

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.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals An evaluation of service user experience, clinical outcomes and service use associated with urgent care services that utilise telephone-based digital triage: a systematic review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Vanashree Sexton ◽  
Jeremy Dale ◽  
Helen Atherton
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Clinical Outcomes ◽  
User Experience ◽  
Service User ◽  
Service Use ◽  
Urgent Care ◽  
Narrative Synthesis ◽  
Service User Experience ◽  
Synthesis Approach

Abstract Background Telephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient’s symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery. Methods Studies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings. Discussion This is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy. Systematic review registration This systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500).

scholarly journals Youth violence secondary prevention initiatives in emergency departments: a systematic review

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 161-168 ◽  
Author(s):  
Carolyn Snider ◽  
Jacques Lee
Keyword(s):  
Systematic Review ◽  
Case Management ◽  
Youth Violence ◽  
Service Use ◽  
Injured Patient ◽  
The United States ◽  
Small Sample ◽  
Future Research ◽  
Control Group ◽  
Management Interventions

ABSTRACTObjective:Youth violence continues to trouble Canadians. Emergency department (ED) visits by youth after a violent injury may represent a “teachable moment,” and thus secondary violence prevention interventions may be effective. We conducted a systematic review to identify the success rates of any interventions, the populations likely to benefit and the outcome measures used.Data source:We searched 8 databases (i.e., MEDLINE, EMBASE, PubMed, CINAHL, the Cochrane Database of Systematic Reviews, the ACP Journal Club, DARE and CENTRAL).Study selection:Studies were included if they described and evaluated an intervention, were health care–based and targeted youth who were injured by violence. Two blinded investigators selected 15 articles from 181 abstracts. After full-text review, 8 articles were excluded, leaving 7 articles from 4 intervention programs.Data extraction:All interventions used ED case management of the violently injured patient. One randomized control trial (RCT) demonstrated a significant reduction in reinjury rates (treatment group 8.1% v. control group 20.3%,p= 0.05). Another small RCT found no statistically significant reductions in repeat violence or service use. One retrospective cohort study demonstrated a lower relative risk (RR) in future criminal justice involvement (RR = 0.67, 95% confidence interval 0.45–0.99). A retrospective study of pediatric patients with violent injuries found only 1% of these youth returned with injuries as a result of repeat violence.Data synthesis:Although all 4 case management interventions that we reviewed showed promise in the United States, small sample sizes and incomplete follow-up limited their ability to demonstrate significant decreases in reinjury.Conclusion:Future research is necessary to help EDs capitalize on the opportunity to effectively reduce youth violence.

scholarly journals Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups

2015 ◽  
Vol 23 (e1) ◽  
pp. e28-e33 ◽  
Author(s):  
Courtney R. Lyles ◽  
Urmimala Sarkar ◽  
Dean Schillinger ◽  
James D. Ralston ◽  
Jill Y. Allen ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Health Behaviors ◽  
Ethnic Groups ◽  
Patient Portal ◽  
Patient Portals ◽  
Statin Adherence ◽  
Changes Over Time ◽  
Racial Ethnic ◽  
Over Time ◽  
Diabetes Patients

Abstract Objective Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the online refill function in patient portals had similar changes over time compared with Whites. Methods We examined a retrospective cohort of diabetes patients who were existing patient portal users. The primary exposure was initiating online refill use (either exclusively for all statin refills or occasionally for some refills), compared with using the portal for other tasks (eg, exchanging secure messages with providers). The primary outcome was change in statin adherence, measured as the percentage of time a patient was without a supply of statins. Adjusted generalized estimating equation models controlled for race/ethnicity as a primary interaction term. Results Fifty-eight percent of patient portal users were white, and all racial/ethnic minority groups had poorer baseline statin adherence compared with Whites. In adjusted difference-in-difference models, statin adherence improved significantly over time among patients who exclusively refilled prescriptions online, even after comparing changes over time with other portal users (4% absolute decrease in percentage of time without medication). This improvement was statistically similar across all racial/ethnic groups. Discussion Patient portals may encourage or improve key health behaviors, such as medication adherence, for engaged patients, but further research will likely be required to reduce underlying racial/ethnic differences in adherence. Conclusion In a well-controlled examination of diabetes patients’ behavior when using a new online feature for their healthcare management, patient portals were linked to better medication adherence across all racial/ethnic groups.

Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis

2006 ◽  
Vol 37 (1) ◽  
pp. 3-14 ◽  
Author(s):  
STEPHEN KISELY ◽  
LESLIE ANNE CAMPBELL ◽  
ANITA SCOTT ◽  
NEIL J. PRESTON ◽  
JIANGUO XIAO
Keyword(s):  
Systematic Review ◽  
Service Use ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Community Treatment ◽  
Patient Treatment ◽  
Wide Range ◽  
Compulsory Community Treatment ◽  
Bed Days

Background. There is limited randomized controlled trial (RCT) evidence for compulsory community treatment. Other study methods may clarify their effectiveness. We reviewed RCT and non-RCT evidence for the effect of compulsory community treatment on hospital admissions, bed-days, compliance and out-patient contacts.Method. A systematic review of RCTs, controlled before-and-after (CBA) studies, and interrupted time series (ITS) analyses. Meta-analysis of RCTs.Results. Eight papers covering five studies (two RCTs and three CBAs) met inclusion criteria (total n=1108). There was no statistical difference in 12-month admission rates between subjects on involuntary out-patient treatment and controls. Survival analyses of time to admission were equivocal. All five studies reported decreases in the number of bed-days following involuntary out-patient treatment but this only reached statistical significance in one situation; patients receiving the intervention were less likely to have admissions of over 100 days. There was no difference in treatment adherence between the intervention and control groups in either RCT or two of the CBA studies. However, the third CBA study reported a statistically significant increase of nearly five visits in the mean number of overall contacts in the involuntary out-patient treatment group.Conclusions. The evidence for involuntary out-patient treatment in reducing either admissions or bed-days is very limited. It therefore cannot be seen as a less restrictive alternative to admission. Other effects are uncertain. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.

scholarly journals The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review

PLoS ONE ◽  
2017 ◽  
Vol 12 (10) ◽  
pp. e0185453 ◽  
Author(s):  
Milou van Heuckelum ◽  
Cornelia H. M. van den Ende ◽  
Anne E. J. Houterman ◽  
Charlotte P. M. Heemskerk ◽  
Sandra van Dulmen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Electronic Monitoring

Antimicrobial Stewardship Programs in Inpatient Hospital Settings: A Systematic Review

2014 ◽  
Vol 35 (10) ◽  
pp. 1209-1228 ◽  
Author(s):  
Brittin Wagner ◽  
Gregory A. Filice ◽  
Dimitri Drekonja ◽  
Nancy Greer ◽  
Roderick MacDonald ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
English Language ◽  
Guideline Implementation ◽  
Hospital Setting ◽  
The United States ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Cochrane Library

ObjectiveEvaluate the evidence for effects of inpatient antimicrobial stewardship programs (ASPs) on patient, prescribing, and microbial outcomes.DesignSystematic review.MethodsSearch of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (ie, infectious conditions and prescriptions required for antimicrobials) that evaluated ASP interventions and reported outcomes of interest. Study characteristics and outcomes data were extracted and reviewed by investigators and trained research personnel.ResultsFew intervention types (eg, audit and feedback, guideline implementation, and decision support) substantially impacted patient outcomes, including mortality, length of stay, readmission, or incidence of Clostridium difficile infection. However, most interventions were not powered adequately to demonstrate impacts on patient outcomes. Most interventions were associated with improved prescribing patterns as measured by decreased antimicrobial use or increased appropriate use. Where reported, ASPs were generally associated with improvements in microbial outcomes, including institutional resistance patterns or resistance in the study population. Few data were provided on harms, sustainability, or key intervention components. Studies were typically of short duration, low in methodological quality, and varied in study design, populations enrolled, hospital setting, ASP intent, intervention composition and implementation, comparison group, and outcomes assessed.ConclusionsNumerous studies suggest that ASPs can improve prescribing and microbial outcomes. Strength of evidence was low, and most studies were not designed adequately to detect improvements in mortality or other patient outcomes, but obvious adverse effects on patient outcomes were not reported.

scholarly journals Optimization of Primary Care Among Black Americans Using Patient Portals: A Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Omar H Ordaz ◽  
Raina L Croff ◽  
LaTroy D Robinson ◽  
Steven A Shea ◽  
Nicole P Bowles
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Black Americans ◽  
The United States ◽  
Black American ◽  
Patient Portal ◽  
Treatment Team ◽  
Patient Portals

BACKGROUND The existence of lower patient portal use among Black Americans is concerning as portals have been shown to improve the control of chronic conditions that are more prevalent and deadlier in Black Americans than the rest of the population. Portal websites at their very simplest connect patients to their electronic health records and often provide tools for patients to interact with their own health information, treatment team members, and insurance companies. However, research suggests that Black American patients have greater concerns over lack of support, loss of privacy, and reduced personalization of care relative to others in the population, which results in a disparity of portal use. OBJECTIVE This qualitative investigation of primary care experiences of Black Americans from across the United States, who participated in remote focus groups in April and May 2020, explores the use and perceived value of patient portal websites to better understand any barriers to optimized treatment in the primary care setting. METHODS To qualitatively assess the experiences of Black American patients with regular access to portal websites, we performed inductive thematic analysis of eight remote focus group interviews with Black American patients aged 30-60. RESULTS Thematic analysis uncovered the following interrelated themes regarding patient portals in primary care: 1) optimization of care; 2) patient empowerment; 3) patient-provider communication; and 4) patient burden. CONCLUSIONS In contrast to what has been described regarding reluctance of Black Americans to engage with patient portals, our focus groups revealed general acceptance of patient portals, which were described overwhelmingly as tools with potential for exceptional, personalized care that may even work to mitigate the unfair burden of disease for Black Americans in primary care settings. Thus, opportunities for better health care clearly exist with increased communication, experience and adoption of remote health care practices among Black Americans.

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