Disparities in Electronic Health Record Portal Access and Use among Patients with Cancer.

Journal

Journal of the National Cancer Institute

ISSN: 1460-2105

Titre abrégé: J Natl Cancer Inst

Pays: United States

ID NLM: 7503089

Informations de publication

Date de publication:
01 Nov 2023

Historique:

received: 20 07 2023

revised: 12 09 2023

accepted: 18 10 2023

medline: 6 11 2023

pubmed: 6 11 2023

entrez: 6 11 2023

Statut: aheadofprint

Résumé

Electronic health record (EHR)-linked portals may improve healthcare quality for cancer patients. Barriers to portal access and use undermine interventions leveraging portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient- and structural-factors prior to the implementation of three portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. Portal use data were extracted from EHRs for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs. mobile), and number of clinical encounters prior to intervention implementation were also extracted. Rurality was derived using Rural Urban Commuting Area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested associations of these factors with portal access (ever access/never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs. ≥21 weeks in the 35 week study period). Of the 28,942 eligible patients, 10,061 (35%) never accessed the portal. Male, racial/ethnic minority, rural dwelling, not working, and limited broadband access were significantly associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were significantly associated with persistent portal use. Patient- and structural-factors affect portal access and use and may exacerbate disparities in EHR-based cancer symptom surveillance and management.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Portal use data were extracted from EHRs for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs. mobile), and number of clinical encounters prior to intervention implementation were also extracted. Rurality was derived using Rural Urban Commuting Area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested associations of these factors with portal access (ever access/never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs. ≥21 weeks in the 35 week study period).

RESULTS RESULTS

Of the 28,942 eligible patients, 10,061 (35%) never accessed the portal. Male, racial/ethnic minority, rural dwelling, not working, and limited broadband access were significantly associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were significantly associated with persistent portal use.

CONCLUSION CONCLUSIONS

Patient- and structural-factors affect portal access and use and may exacerbate disparities in EHR-based cancer symptom surveillance and management.

Identifiants

DOI: 10.1093/jnci/djad225 PMID: 37930884

pubmed: 37930884

pii: 7335843

doi: 10.1093/jnci/djad225

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

David Cella (D)

Andrea Cheville (A)

Michael J Hassett (MJ)

Raymond U Osarogiagbon (RU)

Deborah Schrag (D)

Sandra L Wong (SL)

Barbara L Kroner (BL)

Ashley Wilder Smith (AW)

Lisa DiMartino (L)

Sofia Garcia (S)

Joan Griffin (J)

Roxanne Jensen (R)

Sandra Mitchell (S)

Kathryn Ruddy (K)

Justin D Smith (JD)

Betina Yanez (B)

Jessica J Bian (JJ)

Don S Dizon (DS)

Hannah W Hazard-Jenkins (HW)

Mary-Anne Ardini (MA)

Paige Ahrens (P)

Jessica Austin (J)

Fiona Barrett (F)

Michael Bass (M)

Megan Begnoche (M)

September Cahue (S)

Kimberly Caron (K)

Linda Chlan (L)

Ava Coughlin (A)

Christine Cronin (C)

Samira Dias (S)

Nicolas Faris (N)

Ann Marie Flores (AM)

Martha Garcia (M)

Karla Hemming (K)

Jeph Herrin (J)

Christine Hodgdon (C)

Sheetal Kircher (S)

Kurt Kroenke (K)

Veronica Lam (V)

Nicola Lancki (N)

Quan H Mai (QH)

Jennifer Mallow (J)

Nadine J McCleary (NJ)

Wynne Norton (W)

Mary O'Connor (M)

Deirdre Pachman (D)

Loretta Pearson (L)

Frank Penedo (F)

Jewel Podratz (J)

Jennifer Popovic (J)

Liliana Preiss (L)

Parvez Rahman (P)

Sarah Redmond (S)

James Reich (J)

Joshua Richardson (J)

Kimberly Richardson (K)

Jennifer Ridgeway (J)

Lila Rutten (L)

Karen Schaepe (K)

Denise Scholtens (D)

Tiana Poirier-Shelton (T)

Philip Silberman (P)

Jaclyn Simpson (J)

Laura Tasker (L)

Nathan Tesch (N)

Cindy Tofthagen (C)

Angela Tramontano (A)

Benjamin D Tyndall (BD)

Hajime Uno (H)

Firas Wehbe (F)

Bryan Weiner (B)