Background
Methods
Study setting and description of the portal
Study design and participants
Study model
Measures
Environment and patient characteristics
Patient safety, utilization, and satisfaction
Data analysis
Results
Participants, adopters, and active inpatient users
Characteristics | Adopters (n = 2,352) | Nonadopters (n = 2,242) | P value | Active Inpatient Users (n = 632) | Inactive Inpatient Users (n = 1,720) | P value | |
---|---|---|---|---|---|---|---|
Age group (years) | Mean (SD) | 62.3 (14.0) | 65.4 (14.8) | <.01b | 60.2 (14.3) | 63.0 (13.8) | <.01b |
≤44 | 259 (11.0) | 191 (8.5) | <.01c | 82 (13.0) | 177 (10.3) | <.01c | |
45-54 | 339 (14.4) | 281 (12.5) | 106 (16.8) | 233 (13.5) | |||
55-64 | 632 (26.9) | 480 (21.4) | 185 (29.3) | 447 (26.0) | |||
65-74 | 702 (29.8) | 652 (29.1) | 166 (26.3) | 536 (31.2) | |||
75-84 | 339 (14.4) | 454 (20.2) | 80 (12.7) | 259 (15.1) | |||
≥85 | 81 (3.4) | 184 (8.2) | 13 (2.1) | 68 (4.0) | |||
Sex | Female | 1,148 (48.8) | 1,055 (47.0) | .25c | 295 (46.7) | 852 (49.5) | .22c |
Male | 1,204 (51.2) | 1,188 (53.0) | 337 (53.3) | 869 (50.5) | |||
Race | African American | 121 (5.2) | 273 (12.4) | <.01c | 18 (2.9) | 103 (6.1) | <.01c |
White | 2,120 (91.3) | 1847 (84.0) | 575 (91.9) | 1,545 (91.2) | |||
Other | 80 (3.4) | 78 (3.5) | 33 (5.3) | 47 (2.8) | |||
Marital status | Married | 1,786 (75.9) | 1,454 (64.9) | <.01c | 506 (80.1) | 1,280 (74.4) | <.01c |
Single/divorced/widowed | 566 (24.1) | 788 (35.1) | 126 (19.9) | 440 (25.6) | |||
Employment status | Employed | 739 (37.7) | 547 (28.9) | <.01c | 206 (38.1) | 533 (37.5) | .79c |
Retired | 836 (42.6) | 935 (49.4) | 208 (38.5) | 628 (44.2) | |||
Not employed/disabled | 386 (19.7) | 411 (21.7) | 126 (23.3) | 260 (18.3) | |||
Income | Below Florida median income | 645 (28.3) | 803 (37.2) | <.01c | 167 (26.5) | 478 (27.8) | .54c |
At or above Florida median income | 1,707 (71.7) | 1,439 (64.1) | 465 (73.5) | 1,242 (72.2) | |||
Health insurance | Commercial insurance/self pay | 1,145 (48.7) | 815 (36.4) | <.01c | 339 (53.6) | 806 (46.9) | <.01c |
Medicare/Medicaid/other government assistance | 1,207 (51.3) | 1,427 (63.6) | 293 (46.4) | 914 (53.1) | |||
Geographic area of residence | Nonlocal | 521 (22.2) | 493 (22.0) | .89c | 166 (26.3) | 335 (20.6) | <.01c |
Local | 1,831 (77.8) | 1,749 (78.0) | 466 (73.7) | 1,365 (79.4) | |||
Comorbidity d | None | 1,115 (47.4) | 1,052 (46.9) | .58c | 289 (45.7) | 826 (48.0) | .32c |
One or more | 1,237 (52.6) | 1,190 (53.1) | 343 (54.3) | 894 (52.0) | |||
Comorbidity typee | Congestive heart failure | 145 (6.2) | 171 (7.6) | .05c | 51 (8.1) | 94 (5.5) | .02c |
Peripheral vascular disease | 322 (13.7) | 338 (15.1) | .18c | 83 (13.1) | 239 (13.9) | .63c | |
Cerebrovascular disease | 165 (7.0) | 224 (10.0) | <.01c | 42 (6.6) | 123 (7.2) | .67c | |
Chronic pulmonary disease | 262 (11.1) | 256 (11.4) | .77c | 61 (9.7) | 201 (11.7) | .16c | |
Mild liver disease | 432 (18.4) | 291 (13.0) | <.01c | 129 (20.4) | 303 (17.6) | .12c | |
Diabetes mellitus | 392 (16.7) | 351 (15.7) | .35c | 115 (18.2) | 277 (16.1) | .23c | |
Moderate/severe renal disease | 196 (8.3) | 179 (8.0) | .66c | 53 (8.4) | 143 (8.3) | .96c | |
Moderate/severe liver disease | 121 (5.1) | 86 (3.8) | .03c | 49 (7.8) | 72 (4.2) | <.01c | |
Admission type based on MSDRG | Surgical | 1,504 (63.9) | 1,315 (58.7) | <.01b | 348 (55.1) | 1,156 (67.2) | <.01b |
Medical | 848 (36.1) | 927 (41.3) | 284 (44.9) | 564 (32.8) | |||
Frequency of hospitalizations, mean (SD) | 1.8 (1.5) | 1.4 (1.1) | <.01b | 2.0 (1.7) | 1.7 (1.4) | <.01b | |
APRDRG weight, mean, (median, SD) | 2.5 (1.5, 2.9) | 2.3 (1.5, 2.3) | .24b | 3.1 (1.9, 3.6) | 2.3 (1.4, 2.6) | <.01b |
Factors | Characteristics | Odds Ratio (95% CI)a | ||
---|---|---|---|---|
Adoptionb | Active Inpatient Usec | |||
Predisposing | Age | 44- |
1.42 (1.03, 1.95)
|
1.89 (1.16, 3.06)
|
45-54 | 1.10 (0.82, 1.47) |
1.73 (1.10, 2.72)
| ||
55-64 | 1.22 (0.95, 1.57) |
1.48 (1.00, 2.19)
| ||
65-74 (reference) | 1.00 | 1.00 | ||
75-84 |
0.71 (0.57, 0.87)
| 1.08 (0.75, 1.56) | ||
85+ |
0.36 (0.24, 0.54)
| 0.77 (0.34, 1.75) | ||
Sex | Male (reference) | 1.00 | 1.00 | |
Female |
1.26 (1.10, 1.45)
| 0.97 (0.78, 1.21) | ||
Race | White (reference) | 1.00 | 1.00 | |
African American |
0.34 (0.27, 0.45)
|
0.51 (0.29, 0.89)
| ||
Others | 0.84 (0.58, 1.23) | 1.39 (0.82, 2.37) | ||
Enabling | Marital status | Divorced/single/widowed (reference) | 1.00 | 1.00 |
Married |
1.60 (1.37, 1.87)
|
1.49 (1.14, 1.94)
| ||
Employment | Employed (reference) | 1.00 | 1.00 | |
Retired | 1.04 (0.83, 1.30) | 1.04 (0.75, 1.46) | ||
Not employed/disabled |
0.70 (0.57, 0.86)
| 1.04 (0.77, 1.40) | ||
Health insurance | Commercial insurance (reference) | 1.00 | 1.00 | |
Medicaid/Medicare |
0.76 (0.61, 0.95)
| 1.07 (0.77, 1.50) | ||
Income | Below FL median income (reference) | 1.00 | 1.00 | |
At or above FL median income |
1.39 (1.20, 1.60)
| 1.10 (0.87, 1.39) | ||
Need | Geographic area of residence | Local (reference) | 1.00 | 1.00 |
Nonlocal | 1.13 (0.96, 1.33) |
1.34 (1.04, 1.71)
| ||
Comorbidities | None (reference) | 1.00 | 1.00 | |
1+ | 1.05 (0.91, 1.21) | 0.97 (0.77, 1.22) | ||
MSDRG type d | Surgical (reference) | - | 1.00 | |
Medical | - |
2.17 (1.68, 2.78)
| ||
Frequency of hospitalizations |
1.43 (1.33, 1.55)
| 1.08 (0.99, 1.19) | ||
APRDRG weight d | - |
1.13 (1.09, 1.17)
|
Bivariate associations of portal behaviors with adverse events, care utilization, and patient satisfaction
Measures | Outcomes | Adopters (n = 2352) | Nonadopters (n = 2242) | P value | Active Inpatient Users (n = 632) | Inactive Inpatient Users (n = 1720) | P value |
---|---|---|---|---|---|---|---|
Patient safety | Had an adverse event, No. (%) | 40 (1.7) | 47 (2.1) | .36a | 13 (2.1) | 27 (1.6) | .42a |
Postdischarge care utilization | Emergency visit within 14-days of discharge, No. (%) | 272 (11.6) | 214 (9.5) | .03a | 75 (11.9) | 197 (11.5) | .78a |
30-day unplanned readmission, No. (%) | 299 (12.7) | 222 (9.9) | <.01a | 96 (15.2) | 203 (11.8) | .03a | |
Patient satisfactionc | Understand responsibilities for self-health management, mean score (SD) | 87.6 (19.6) | 85.5 (20.1) | .02b | 89.1 (18.4) | 87.1 (20.0) | .22b |
Understand the purpose for taking each medication, mean score (SD) | 90.0 (18.8) | 87.8 (20.9) | .05b | 91.8 (16.0) | 89.4 (19.7) | .21b | |
Aggregate self-health management knowledge score | 84.3 (21.3) | 80.0 (23.1) | <.01b | 87.0 (19.2) | 83.3 (21.9) | .05b | |
Overall rating of the hospital stay, mean score (SD) | 95.6 (9.1) | 95.3 (10.3) | .75b | 95.6 (10.5) | 95.7 (8.6) | .56b |
Independent Variables | ||||
---|---|---|---|---|
Active Inpatient Users vs Nonadopters | Inactive inpatient Users vs Nonadopters | |||
Dependent Variablesa | OR (95% CI) | P value | OR (95% CI) | P value |
[adverse events = yes] | 0.76 (0.40, 1.45) | .41 | 0.71 (0.44–1.16) | .17 |
[emergency visits = yes] | 1.28 (0.97, 1.70) | .08 | 1.23 (1.00–1.51) | .08 |
[readmissions = yes] | 1.60 (1.23, 2.08) | <.01 | 1.21 (0.99–1.48) | .06 |
Dependent Variablesa | Beta Coefficient | P value | Beta Coefficient | P value |
Self-health management knowledge | 2.18 | .07 | 1.15 | .17 |
Overall hospital experience | 0.16 | .83 | 0.28 | .60 |