A Nudge for Health: Using Behavioral Economics to Increase Online Scheduling and Health Maintenance Completion (Preprint)

2021 ◽  
Author(s):  
Su-Ying Liang ◽  
Cheryl D. Stults ◽  
Veena G. Jones ◽  
Qiwen Huang ◽  
Qiwen Huang ◽  
...  
Keyword(s):  
Behavioral Economics ◽  
Healthcare System ◽  
Patient Engagement ◽  
Online Scheduling ◽  
Pap Smears ◽  
Patient Portal ◽  
Patient Portals ◽  
Electronic Health Record Data ◽  
Integrated Healthcare ◽  
Health Maintenance

BACKGROUND Behavioral economics has been an increasingly utilized method in healthcare to “nudge” behavior change through the use of techniques such as choice architecture and framing of words. Patient portals are a key tool for facilitating patient engagement in their health, and deployment of interventions via patient portals have been effective in improving utilization of preventive health services. Our integrated healthcare system was one of the first to employ behavioral economics in health maintenance reminder (HMR) messages sent through the online patient portal to improve patient engagement and preventive service use. OBJECTIVE We examined the impacts of behavioral economics-based nudge HMRs on online scheduling uptake and appointment completion for two preventive services, Medicare wellness visits (MWV) and pap smears. METHODS This was a retrospective observational study using electronic health record data from an integrated healthcare system in Northern California. Nudge HMRs with behavioral economics-based language were implemented in November 2017 to all sites for MWV and selected sites in February 2018 for pap smears. We analyzed 125,369 HMRs for MWV, and 585,358 HMRs for pap smears sent between January 2017 and February 2020. The primary outcomes were online scheduling and appointment completion. The predictor was the receipt of a nudge HMR. We used segmented regression with interrupted time series design to assess the immediate and gradual effect of the nudge for MWV. For Pap smear, we used logistic regression models to assess the association of the nudge HMR on study outcomes, adjusting for the propensity to receive a nudge HMR. RESULTS Rates of online scheduling were higher for nudge HMRs recipients than control HMRs (13.0% nudge vs. 9.7% control for MWV; 1.4% nudge vs. 0.6% control for pap smears; p<0.001 for all comparisons). Rates of appointment completion were higher in nudge HMRs for pap smears (21.4% nudge vs. 15.3% control, p<0.001) but comparable for MWV between the two groups (51.5% nudge vs. 51.8% control, p=0.30). Regression results suggest a marginally gradual effect of nudge on online scheduling for the overall MWV sample (at a monthly rate of 0.26%, p=0.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, p=0.04). For pap smears, nudge HMRs were positively associated with online scheduling (propensity adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.50–1.88 overall sample; propensity adjusted OR 1.65 [1.45–1.87] among scheduled appointments) and appointment completion (propensity adjusted OR 1.07 [1.04–1.10]). CONCLUSIONS Nudge for health, a behavioral economics-based approach to providing HMRs, improves patient online scheduling for Medicare wellness visits and pap smears. Our study demonstrates that a simple approach of framing and modifying language in an electronic message can have a significant and long-term impact on patient engagement and access to care. CLINICALTRIAL No

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

scholarly journals P356 A comparison of innovative strategies to promote engagement with an IBD patient portal

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S376-S377
Author(s):  
S Carlson ◽  
S McCartney ◽  
P Harrow
Keyword(s):  
Patient Satisfaction ◽  
Patient Engagement ◽  
High Intensity ◽  
Intervention Group ◽  
Patient Portal ◽  
Healthcare Outcomes ◽  
Patient Portals ◽  
Quality Of Data ◽  
Low Intensity ◽  
Patient Reported

Abstract Background Patient portals are available on most major electronic health record (EHR) platforms and present many opportunities to improve patient engagement with services, the quality of data captured and therefore healthcare outcomes and patient satisfaction. Our centre looks after 5100 patients with IBD. We recently adopted the EPIC Systems patient portal MyChart which allows patients to view results, letters and complete patient reported outcomes (PRO). At baseline, few patients were registered for this platform. Our aim was to compare patient engagement with MyChart using a low and higher cost approach and to evaluate patient satisfaction with the platform. Methods 160 consecutive patients were invited to join MyChart between September and October 2020. The low-intensity intervention group were invited to join MyChart via a standardised email without further communication. Newly registered patients and active patients were sent a portal message with disease-specific PRO questionnaire 7 days prior to clinic (HBI, SCCAI and IBD Control). Patients in the high-intensity intervention group received a telephone reminder to encourage completion at each step, which took on average 2 minutes, in addition to email. Engagement with the platform was measured prospectively. After clinic a patient-experience questionnaire was sent to all patients who signed up to the platform. Results 72 patients were included in the low intensity group and 88 in the high intensity group. At baseline only 33% patients were already signed up to MyChart. Significantly more patients newly registered with the patient portal following the high intensity intervention compared to the low (75% vs. 30%, p &lt;0.0001). Overall, patients in the high intensity group were significantly more likely to complete the PRO compared to the low (53% vs. 28%, p=0.002). Patients already registered were 5 times more likely to complete the PRO in the high intensity group compared to low (p=0.017). Platform engagement was not significantly impacted by gender or ethnicity. There was a trend toward lower engagement in patients over 65. 63 patients provided feedback. 87% found MyChart easy to use and 94% said they would complete the PRO questionnaires again. Conclusion In our patient cohort, a higher intensity strategy significantly increased patient registration and engagement with a new patient portal at a minimal cost of time and resource. Healthcare providers can facilitate patient engagement with patient portals and overcome barriers to adoption to unlock transformative opportunities for better quality IBD care, disease monitoring and population-based research.

scholarly journals Disparities in Pediatric Patient Portal Activation and Feature Use

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Jennifer H LeLaurin ◽  
Oliver T Nguyen ◽  
Lindsay A Thompson ◽  
Jaclyn Hall ◽  
Jiang Bian ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
White Female ◽  
Patient Portal ◽  
Patient Portals ◽  
Electronic Health Record Data ◽  
Factors Associated ◽  
Academic Medical ◽  
Vulnerable Individual ◽  
Records Access

Abstract Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

scholarly journals Benefits, Problems, and Potential Improvements in a Nationwide Patient Portal: Cross-sectional Survey of Pharmacy Customers’ Experiences (Preprint)

2021 ◽  
Author(s):  
Maria Sääskilahti ◽  
Anna Ojanen ◽  
Riitta Ahonen ◽  
Johanna Timonen
Keyword(s):  
Patient Engagement ◽  
Care Patient ◽  
Health Data ◽  
Patient Portal ◽  
Patient Portals ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comprehensive Health ◽  
Prescription Medicines ◽  
Potential Improvement

BACKGROUND Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients’ knowledge about their health and care and therefore enhance patient engagement. Portal users’ experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. OBJECTIVE The aim of this study is to analyze pharmacy customers’ experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. METHODS A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged &lt;18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. RESULTS Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). CONCLUSIONS Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement.

scholarly journals Predictors of Online Patient Portal Use among a Diverse Sample of Emerging Adults: A Cross-Sectional Survey (Preprint)

2021 ◽  
Author(s):  
Julie A. Wright ◽  
Julie E Volkman ◽  
Suzanne G Leveille ◽  
Daniel J. Amante
Keyword(s):  
Health Literacy ◽  
Emerging Adults ◽  
Patient Engagement ◽  
Self Management ◽  
Healthcare Team ◽  
Patient Portal ◽  
Patient Portals ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample

BACKGROUND Self-management of health is becoming increasingly more influenced by Health IT as online patient portals become more common. Patient portals allow patients direct access to their health information and opportunities to engage with their healthcare team. Data suggest that e-Health literacy is an important skill for using portals. Emerging adults (EA; ages 18-29), while generally healthy, are regular users of the healthcare system. A good understanding about their use of online patient portals and how their e-Health literacy skills impact their use is lacking. OBJECTIVE To describe patient portal use and explore the predictors of portal use among a diverse sample of EAs. METHODS A convenience sample, cross-sectional survey study was conducted at two universities. Demographics, healthcare visits, e-Health literacy, patient engagement and use of patient portal features (administrative and clinical) were asked. Logistic regression models were used to examine factors associated with portal use. RESULTS Of the 340 EAs (76% female, 65% white, 47% low income), 54% reported having patient portal access. Of those reporting access, 77% used at least 1 portal feature and 23% reported using none. Significant predictors were patient engagement (OR 1.08, 95% CI 1.04-1.13, p=.001;) and total encounters (OR 1.23, 95% CI 1.05-1.44, p=.009;) but not e-Health literacy. Hispanic and Asian EAs were more likely to be frequent users of clinical portal features than white EAs (Hispanic, OR 2.97, 95%CI 1.03-8.52 p=.043; and Asian, OR 4.28, 95%CI 1.08-16.89, p=.038). CONCLUSIONS Surprisingly, e-Health literacy did not predict use of patient portals in this diverse sample of EAs. Moreover, there may be ethnic differences that are important for healthcare systems to consider. Interventions to promote patient portal use, an essential self-management skill, should include strategies to increase patient engagement with patient portals in EA populations. CLINICALTRIAL N/A

scholarly journals Benefits, Problems, and Potential Improvements in a Nationwide Patient Portal: Cross-sectional Survey of Pharmacy Customers’ Experiences

10.2196/31483 ◽  
2021 ◽  
Vol 23 (11) ◽  
pp. e31483
Author(s):  
Maria Sääskilahti ◽  
Anna Ojanen ◽  
Riitta Ahonen ◽  
Johanna Timonen
Keyword(s):  
Patient Engagement ◽  
Care Patient ◽  
Health Data ◽  
Patient Portal ◽  
Patient Portals ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comprehensive Health ◽  
Prescription Medicines ◽  
Potential Improvement

Background Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients’ knowledge about their health and care and therefore enhance patient engagement. Portal users’ experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. Objective The aim of this study is to analyze pharmacy customers’ experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. Methods A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. Results Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). Conclusions Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement.

Examination of the Impact of Patient Engagement Tools on Patient Satisfaction

2020 ◽  
Vol 10 (1) ◽  
pp. 37-46
Author(s):  
Lesley Clack ◽  
Bhoomica Nagi
Keyword(s):  
Patient Satisfaction ◽  
Data Analysis ◽  
Healthcare System ◽  
Patient Engagement ◽  
Secondary Data ◽  
Patient Portals ◽  
Satisfaction Rating ◽  
The Past ◽  
The Impact ◽  
Patient Satisfaction Rating

The healthcare system has experienced a rapid advancement in technology over the past few decades, which has led to an increased focus on patient engagement and satisfaction. The purpose of this study was to investigate the association between patient engagement tools and the level of patient satisfaction. A secondary data analysis was conducted to determine if a relationship exists between patient satisfaction and use of patient engagement tools. Findings revealed that patient portals were equally accessible to patients (83%) regardless of the institution's patient satisfaction rating. However, more advanced engagement tools, such as online scheduling of appointments, were more commonly found in hospitals with higher patient satisfaction ratings. While the availability, knowledge, interest, and age of the patient play an important role, patient engagement tools were found to be positively linked to patient satisfaction.

scholarly journals The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

10.2196/17744 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17744
Author(s):  
Maureen T Stewart ◽  
Timothy P Hogan ◽  
Jeff Nicklas ◽  
Stephanie A Robinson ◽  
Carolyn M Purington ◽  
...  
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Patient Engagement ◽  
Critical Role ◽  
Patient Portal ◽  
Patient Portals ◽  
Secure Messaging ◽  
Telephone Interviews ◽  
Wide Range ◽  
Negative Impacts

Background Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. Objective Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. Methods This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. Results Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. Conclusions Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care.

scholarly journals Focused Bedside Education May Improve Engagement of Hospitalized Patients with Their Patient Portals

2020 ◽  
Vol 15 (1) ◽  
pp. 251-253
Author(s):  
Joanne M. Muellenbach
Keyword(s):  
Randomized Controlled Trial ◽  
Observational Study ◽  
Patient Engagement ◽  
Controlled Trial ◽  
Intervention Group ◽  
Hospitalized Patients ◽  
Patient Portal ◽  
Tablet Computers ◽  
Patient Portals ◽  
Randomized Controlled

A Review of: Greysen, S.R., Harrison, J.D., Rareshide, C., Magan, Y., Seghal, N., Rosenthal, J., Jacolbia, R., & Auerbach, A.D. (2018). A randomized controlled trial to improve engagement of hospitalized patients with their patient portals. Journal of the American Medical Informatics Association, 25(12), 1626-1633. https://doi.org/10.1093/jamia/ocy125 Abstract Objectives – To study hospitalized patients who were provided with tablet computers and the extent to which having access to these computers increased their patient portal engagement during hospitalization and following their discharge.    Design – Prospective, randomized controlled trial (RCT) within a larger, observational study of patient engagement in discharge planning. Setting – A large, academic medical centre in the Western United States of America. Subjects – Of a total of 250 potential subjects from a larger observational study, 137 declined to participate in this one; of the remaining 113 subjects, 16 were unable to access the patient portal, leaving 97 adult (18 years of age or older) patients in the final group. All subjects (50 intervention and 47 control) were randomized but not blinded, had been admitted to medical service, and spoke English. In addition, all participants were supplied with tablet computers for one day during their inpatient stay and were provided with limited assistance to the portal registration and login process as needed. They were also required to have access to a tablet or home computer when discharged. Methods – The intervention group participants received focused bedside structured education by trained research assistants (RAs) who demonstrated portal key functions and explained the importance of these functions for their upcoming transition to post-discharge care. Following enrolment and consent, RAs administered a brief pre-study survey to assess baseline technology use. Then, at the end of the observation day, the RAs performed a debrief interview in which participants were asked to demonstrate their ability to perform key portal tasks. The RAs recorded which tasks were accomplished or if the RAs had provided assistance. Patient demographics and clinical information were obtained from the Electronic Health Record (EHR).    Main results – Of the 97 patients who were enrolled in the RCT, 57% logged into their portals at least once within seven days of their discharge. The mean number of logins and specific portal tasks performed was higher for the intervention group than for the control group. In addition, while in the hospital, the intervention group was better able to log in and navigate the portal. Only one specific portal task reached statistical significance—the use of the tab for viewing the messaging interaction with the provider. The time needed to deliver the intervention was brief—less than 15 minutes for 80% of participants. The intervention group’s overall satisfaction with the bedside tablet to access the portal was high. Conclusion – Data analysis revealed that the bedside tablet educational intervention succeeded in increasing patient engagement in the use of the patient portal, both during hospitalization and following discharge. As the interest and demand for patient access to EHRs increases among patients, caregivers, and healthcare providers, more rigorous studies will be needed to guide the implementation of patient portals during and after hospitalization.

scholarly journals The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement (Preprint)

2020 ◽  
Author(s):  
Maureen T Stewart ◽  
Timothy P Hogan ◽  
Jeff Nicklas ◽  
Stephanie A Robinson ◽  
Carolyn M Purington ◽  
...  
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Patient Engagement ◽  
Critical Role ◽  
Patient Portal ◽  
Patient Portals ◽  
Secure Messaging ◽  
Telephone Interviews ◽  
Wide Range ◽  
Negative Impacts

BACKGROUND Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. OBJECTIVE Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. METHODS This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. RESULTS Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. CONCLUSIONS Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care. CLINICALTRIAL

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