Bedside Coaching Improves Patient Engagement through Patient Portals During and after Hospital Care
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Abstract
Background: Online patient portals to the EMR can provide opportunities for hospitalized patients to engage in their care during and after discharge but use of bedside coaching to improve patient use of portals in these settings has not been studied to date.
Objective: to assess effects of a bedside intervention to increase inpatient engagement with their patient portal to the EMR.
Methods: We developed a bedside intervention using iPad tablets for inpatients at our hospital to engage with their patient portal for specific tasks: view their medications, test results, appointments, and provider messages. Intervention patients received a brief (15-30min) tutorial on patient portal use tailored to individual abilities including “teach back” for viewing medications specifically. Inclusion criteria were age ≥18, non-ICU, no cognitive impairment, English-speaking. We also created a control cohort of medicine patients admitted to our hospital in the same time period (Dec 2012-Nov 2013) and used paired t-tests and multivariable regression analysis (adjusted for age, gender, race/ethnicity, length of stay (LOS), and prior portal experience) to characterize effects of our intervention on patient portal use during hospitalization and 7 days after discharge. Specifically, we analyzed mean (per person) values for the following during and after hospitalization: total portal logins, medication list views, test results views, appointments list views, provider messaging inbox views.
Results: We enrolled 45 medicine inpatients in the intervention group and the control cohort contained 400 medicine inpatients. Compared to control patients, intervention patients were younger (mean 48yrs vs. 55yrs) and more likely male (61% vs. 49%) but race/ethnicity and mean LOS were similar for both groups.
During hospitalization, the mean number of portal logins was similar in both groups. Mean views for medications was higher in the intervention group (2.1 vs. 1.1 views/person) but mean views for provider messaging inbox was higher in the control group (4.3 vs. 1.6 views/person). All other comparisons were non-significant. In multi-variable (MV) regression, intervention patients were more likely to view their medications (OR 2.5, CI 1.4-2.9) but less likely to view their provider messaging inbox (OR 0.72; 95% CI 0.53-0.99).
Within 7 days after discharge, the mean number of portal logins was similar in both groups and mean views for medications was still higher in the intervention group (2.9 vs. 1.5 views/person) but there was no longer a difference in provider messaging inbox views. In MV regression, there were no significant associations for any PHR actions in Table 1 by intervention status.
Conclusion: Patients who received bedside training on how to use their patient portal, including “teach back” for viewing medications, were more likely than a control cohort to view their medications during hospitalization but not after discharge. Future inpatient portal interventions should further explore “teach back” features for other portal tasks with additional emphasis on post-discharge portal use.
Objective: to assess effects of a bedside intervention to increase inpatient engagement with their patient portal to the EMR.
Methods: We developed a bedside intervention using iPad tablets for inpatients at our hospital to engage with their patient portal for specific tasks: view their medications, test results, appointments, and provider messages. Intervention patients received a brief (15-30min) tutorial on patient portal use tailored to individual abilities including “teach back” for viewing medications specifically. Inclusion criteria were age ≥18, non-ICU, no cognitive impairment, English-speaking. We also created a control cohort of medicine patients admitted to our hospital in the same time period (Dec 2012-Nov 2013) and used paired t-tests and multivariable regression analysis (adjusted for age, gender, race/ethnicity, length of stay (LOS), and prior portal experience) to characterize effects of our intervention on patient portal use during hospitalization and 7 days after discharge. Specifically, we analyzed mean (per person) values for the following during and after hospitalization: total portal logins, medication list views, test results views, appointments list views, provider messaging inbox views.
Results: We enrolled 45 medicine inpatients in the intervention group and the control cohort contained 400 medicine inpatients. Compared to control patients, intervention patients were younger (mean 48yrs vs. 55yrs) and more likely male (61% vs. 49%) but race/ethnicity and mean LOS were similar for both groups.
During hospitalization, the mean number of portal logins was similar in both groups. Mean views for medications was higher in the intervention group (2.1 vs. 1.1 views/person) but mean views for provider messaging inbox was higher in the control group (4.3 vs. 1.6 views/person). All other comparisons were non-significant. In multi-variable (MV) regression, intervention patients were more likely to view their medications (OR 2.5, CI 1.4-2.9) but less likely to view their provider messaging inbox (OR 0.72; 95% CI 0.53-0.99).
Within 7 days after discharge, the mean number of portal logins was similar in both groups and mean views for medications was still higher in the intervention group (2.9 vs. 1.5 views/person) but there was no longer a difference in provider messaging inbox views. In MV regression, there were no significant associations for any PHR actions in Table 1 by intervention status.
Conclusion: Patients who received bedside training on how to use their patient portal, including “teach back” for viewing medications, were more likely than a control cohort to view their medications during hospitalization but not after discharge. Future inpatient portal interventions should further explore “teach back” features for other portal tasks with additional emphasis on post-discharge portal use.
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