A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity

dc.creatorWang, Hao
dc.creatorShen, Chan
dc.creatorBarbaro, Michael
dc.creatorHo, Amy F.
dc.creatorPathak, Mona
dc.creatorDunn, Cita
dc.creatorSambamoorthi, Usha
dc.creator.orcid0000-0001-8311-1360 (Sambamoorthi, Usha)
dc.date.accessioned2023-02-23T16:06:52Z
dc.date.available2023-02-23T16:06:52Z
dc.date.issued2023-01-22
dc.description.abstractBACKGROUND: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). METHODS: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients' neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. RESULTS: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07-6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23-2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. CONCLUSIONS: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.
dc.description.sponsorshipThe project described was supported by the National Institute on Minority Health and Health Disparities through the Texas Center for Health Disparities (NIMHD) 5S21MD012472-05 (Usha Sambamoorthi, Hao Wang), and the National Institute of Health/Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Grant # 1OT2OD032581-01 (Usha Sambamoorthi). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
dc.identifier.citationWang, H., Shen, C., Barbaro, M., Ho, A. F., Pathak, M., Dunn, C., & Sambamoorthi, U. (2023). A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity. International journal of environmental research and public health, 20(2), 1231. https://doi.org/10.3390/ijerph20021231
dc.identifier.issn1660-4601
dc.identifier.issue2
dc.identifier.urihttps://hdl.handle.net/20.500.12503/32046
dc.identifier.volume20
dc.publisherMDPI
dc.relation.urihttps://doi.org/10.3390/ijerph20021231
dc.rights.holder© 2023 by the authors.
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceInternational Journal of Environmental Research and Public Health
dc.subjectadults
dc.subjectemergency department
dc.subjectmulti-level models
dc.subjectpatient portal
dc.subject.meshHumans
dc.subject.meshAdult
dc.subject.meshMiddle Aged
dc.subject.meshPatient Portals
dc.subject.meshMultimorbidity
dc.subject.meshCross-Sectional Studies
dc.subject.meshRetrospective Studies
dc.subject.meshEmergency Service, Hospital
dc.titleA Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity
dc.typeArticle
dc.type.materialtext

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