Portals linked to lower rates of hospitalization, readmission

Use by CHF patients results in better engagement, helps prevent worsening of conditions.

Research still underway shows that congestive heart failure patients using a patient portal offered by a hospital or physician practice have higher engagement rates, lower hospitalization and readmission rates, and higher outpatient visit rates.

Use of portals is associated with 20 percent lower hospital admissions and a similar lower rate of readmissions, said Indranil Bardhan, a professor at the University of Texas at Dallas, during a session at Health Data Management’s Healthcare Analytics Symposium in Chicago.

The higher rate of outpatient visits is a positive sign, Bardhan adds. While utilization grows, patients who get more outpatient treatment are less likely to have hospitalizations or readmissions.

Some 50 percent of all hospitals and 40 percent of all physician group practices now offer some type of portal to their patients. The portal market, he added, should near $900 million by 2017.

Bardhan and a team of researchers have been analyzing 100,000 emergency room and outpatient visits among congestive heart failure patients in the Dallas-Fort Worth region using data from the DFW Hospital Council database. The DFW database is helpful because if a patient recently had an ER or hospital visit, as many as 25 percent of those patients could have another admission at a different hospital, so the database helps better track patient encounters.

Patients use portals, an application created on top of an electronic health record, to communicate with clinicians on such issues as requesting an appointment or medication refill, viewing test results, paying and managing bills, and sending secure messages if they have questions for a provider. In the sample population studied, lab results and communicating with a provider are the most frequent uses of patient portals. Providers supplying data to the research use Epic EHRs and the MyChart portal.

Patient portals, a requirement for providers seeking to qualify for incentive funding under the HITECH Act, are growing in popularity with patients because one-third of them cannot easily get an appointment, Bardhan said. Further, 70 percent of patients needing chronic care prefer online healthcare interactions despite their concerns about technological complexity, he added. Bardhan acknowledged that researchers don’t know the extent to which family members are actually the ones logging on to the portal, but use of the portal remains beneficial.

In the study, males are likely to have higher inpatient hospital or emergency department rates than females, but males also have much lower outpatient visit rates. Bardhan said this suggests that females are more risk-adverse. Further, patients covered under Medicare or Medicaid are more likely to have inpatient treatment than patients covered under private insurance.

Bardhan suggested several interventions that providers can use to improve patient use of portals:

* Target male congestive heart failure patients for portal training.

* Offer financial incentives to patients for using portals.

* Give patients free smartphones so they can use the portal. A phone might cost $200, but one hospitalization, headed off by earlier intervention, costs vastly more.

The researchers now are going deeper into their study to do a more definitive cost-benefit analysis.

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