No link between in-patient portal use and 30-day readmissions, study finds

By Jonah Comstock
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published last week in the Journal of the American Medical Informatics Association shows that in one patient population, use or non use of a patient portal had no statistically significant effect on 30-day readmissions or 30-day mortality. The retrospective analysis of more than 17,000 patients is interesting in that it's the first study of patient portals to look for effects on readmission as a primary endpoint.

"Most of the information regarding inpatient portal use is obtained from survey-based quasi-experimental studies of limited numbers of patients. These studies report usability and satisfaction outcomes: patients’ intention to use the portal, inpatient portal utilization, and satisfaction with use of the portal tool," researchers wrote. "...While these studies offer an indication that immediate health outcomes may be positive, to date no study has examined the association between hospital outcomes of 30-day readmissions, inpatient mortality, and 30-day mortality and patient portal use. Patients who use the portal to access their medical records while hospitalized may have an active interest in their outcome and information about their hospital stay. We pose the question of whether this engagement would reduce 30-day readmissions or decrease mortality."

Researchers analyzed data from the Cerner EHR at the Mayo Clinic Hospital in Jacksonville Florida, which launched its patient portal in 2010 and launched a mobile version, first for iOS and then for Android, the following year. Researchers had information about when and how often the patient (or someone else with their login) accessed the portal, but no detailed information about what they did within the portal. 

They used matched pair techniques to compare the 1,566 patients who used a portal to the 5,972 who did not, accounting as much as possible for other confounding factors. 

While the study showed no effect on outcome measures from patient portal use, researchers were careful to assert that it doesn't mean patient portals are without value.

First, they noted, the design of this specific patient portal was limited, and not primarily intended for in-patient use. Citing older research, they observed that portals might prove more effective if "augmented by interactive learning focused on information sharing, self-assessment and feedback, tailored education, user-centered design, and user support."

Second, results might differ if patients were actually trained to use the portal or educated about its benefits. Finally, the researchers suggested, patients portals might have more value in outpatient settings, especially for patients managing chronic diseases; many of the patients in this analysis were in the hospital for acute care, where engagement might be less relevant.

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