Evaluating the Use of an e-Portal in a Population of Chronically Ill Patients
An abstract written by J.B. Jones, MBA, PhD Candidate, Johns Hopkins Bloomberg School of Public Health

Background:
Electronic patient portals (e-portals) are a new type of health information technology (HIT) that allow patients to use the Internet to manage many aspects of their healthcare. Using an e-portal, patients can communicate electronically with their providers, carry out administrative transactions (e.g. renew prescriptions, schedule appointments), and view and track information (e.g. test results) contained in their electronic health record. E-portals also provide a new means for delivering customized behavioral interventions to patients to help them better self-manage their condition. Providing patients these new tools has the potential to affect health services utilization and the cost and quality of care. E-portal use may be especially beneficial to patients with chronic disease, for which the burden of day-to-day management is primarily the responsibility of the patient. To date, relatively few e-portal evaluations have been conducted.

Goals and Specific Aims:
The main goal of this study is to evaluate the use of an e-portal in a population of chronically ill patients. The first aim of this study is to develop a typology for describing the various patterns of e-portal use. The second aim is to describe the patient-level factors that are associated with: 1) the decision to use an electronic patient portal, and 2) different patterns of portal use. The final aim of this study is to evaluate the effect of portal use on health services utilization and outcomes of care. Each aim will also evaluate the degree to which patient activation is associated with portal use, health services utilization, and outcomes.

Methods & Data Sources:
This study is a secondary analysis of data obtained as part of an ongoing randomized study of an e-portal intervention for chronically ill patients being conducted by Geisinger Health Systems (GHS) as part of the Robert Wood Johnson Health e-Technologies Initiative. GHS is a large integrated delivery system located in rural Pennsylvania. Data from a random sample of approximately 3,300 e-portal users will be available for comparison with a matched sample (i.e. matched on age, sex, chronic disease diagnosis, and clinic) of 1,650 non-users of the e-portal. All study participants had a primary care physician in one of Geisinger’s 41 community practice sites, all of which use an electronic health record. A telephone survey conducted by GHS will provide detailed information on patient-level variables, including patient activation and Internet use, for a subset of approximately 150 users from each arm of the GHS study. Process and clinical outcome measures will be available from GHS’s electronic health record. Claims data are available for the subset of patients enrolled in the Geisinger Health Plan. The first aim will use log-file analysis and factor analysis models to develop a typology of portal use. The second aim will use regression models to describe the association between portal usage patterns and patient characteristics. The third aim will use regression models to describe the association between portal use and utilization and clinical outcomes.

Significance:
The major contribution of this study will be to provide an improved understanding of the types of individuals that will adopt patient-centered information technologies. It will likely be one of the first studies to develop a typology for describing the different ways in which chronically ill patients interact with an e-portal as part of the normal management of their health care needs. Finally, this study will provide evidence of the potential for patient-centered HIT to improve chronic disease care, a significant public health issue requiring new approaches and tools.

Acknowledgements:
This project is funded by the Agency for Healthcare Research and Quality (R36 Dissertation Grant).

Contact:
For more information, please contact J.B. Jones at jjones@jhsph.edu.