In-hospital Enrollment Into an Electronic Patient Portal Results in Improved Follow-up After Orthopedic Surgery: Cluster Randomized Controlled Trial

Abhiram R Bhashyam, Mira Bansal, Madeline M McGovern, Quirine M J van der Vliet, Marilyn Heng, Abhiram R Bhashyam, Mira Bansal, Madeline M McGovern, Quirine M J van der Vliet, Marilyn Heng

Abstract

Background: Electronic patient portal (EPP) use is associated with lower no-show rates and increased patient satisfaction. However, there are disparities in enrollment into these communication platforms.

Objective: We hypothesized that guided inpatient enrollment into an EPP would improve clinical follow-up and EPP use rates for patients who underwent orthopedic surgery compared to the usual practice of providing information in the discharge summary.

Methods: We performed a randomized controlled trial of 229 adult patients who were admitted to the hospital for an orthopedic condition that required a 3-month follow-up visit. Patients were cluster-randomized by week to either the control or intervention group. The control group received information on how to enroll into and use the EPP in their discharge paperwork, whereas the intervention group was actively enrolled and taught how to use the EPP. At 3 months postdischarge, the patients were followed to see if they attended their follow-up appointment or used the EPP.

Results: Of the 229 patients, 83% (n=190) presented for follow-up at 3 months (control: 93/116, 80.2%; intervention: 97/113, 85.8%; P=.25). The likelihood of EPP use was significantly higher in the intervention group (control: 19/116, 16.4%; intervention: 70/113, 62%; odds ratio [OR] 8.3, 95% CI 4.5-15.5; P<.001). Patients in the intervention group who used the EPP were more likely to present for postsurgical follow-up (OR 3.59, 95% CI 1.28-10.06; P=.02).

Conclusions: The inpatient enrollment of patients who underwent orthopedic surgery into an EPP increased EPP use but did not independently result in enhanced follow-up. Patients who were enrolled as inpatients and subsequently used the portal had the highest likelihood of 3-month follow-up.

Trial registration: ClinicalTrials.gov NCT03431259; https://ichgcp.net/clinical-trials-registry/NCT03431259.

Keywords: eHealth; electronic health records; orthopedic; outcomes; patient portals; surgery.

Conflict of interest statement

Conflicts of Interest: None declared.

©Abhiram R Bhashyam, Mira Bansal, Madeline M McGovern, Quirine M J van der Vliet, Marilyn Heng. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 11.08.2022.

Figures

Figure 1
Figure 1
Patient enrollment based on CONSORT (Consolidated Standards of Reporting Trials) flow template.

References

    1. Borowsky PA, Kadri OM, Meldau JE, Blanchett J, Makhni EC. The remote completion rate of electronic patient-reported outcome forms before scheduled clinic visits-a proof-of-concept study using patient-reported outcome measurement information system computer adaptive test questionnaires. J Am Acad Orthop Surg Glob Res Rev. 2019 Oct;3(10):e19.00038. doi: 10.5435/JAAOSGlobal-D-19-00038. JAAOSGlobal-D-19-00038
    1. Deshpande PR, Rajan Surulivel, Sudeepthi B Lakshmi, Nazir CPA. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011 Oct;2(4):137–44. doi: 10.4103/2229-3485.86879. PCR-2-137
    1. Weldring T, Smith SM. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) Health Serv Insights. 2013;6:61–8. doi: 10.4137/HSI.S11093. hsi-6-2013-061
    1. Ayers David C, Zheng Hua, Franklin Patricia D. Integrating patient-reported outcomes into orthopaedic clinical practice: proof of concept from FORCE-TJR. Clin Orthop Relat Res. 2013 Nov;471(11):3419–25. doi: 10.1007/s11999-013-3143-z.
    1. Gagnier JJ. Patient reported outcomes in orthopaedics. J Orthop Res. 2017 Oct 13;35(10):2098–2108. doi: 10.1002/jor.23604. doi: 10.1002/jor.23604.
    1. Schamber EM, Takemoto SK, Chenok KE, Bozic KJ. Barriers to completion of patient reported outcome measures. J Arthroplasty. 2013 Oct;28(9):1449–53. doi: 10.1016/j.arth.2013.06.025.S0883-5403(13)00438-5
    1. Stone ME Jr, Marsh J, Cucuzzo J, Reddy SH, Teperman S, Kaban JM. Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban Level I trauma center. J Trauma Acute Care Surg. 2014 Jan;76(1):185–90. doi: 10.1097/TA.0b013e3182aafcd5.01586154-201401000-00028
    1. Turner C, Hiatt S, Mullis B. Fact or fiction: is orthopedic follow-up worse for patients who sustain penetrating trauma? Am J Orthop (Belle Mead NJ) 2016;45(6):E331–E334.
    1. Brook EM, Glerum KM, Higgins LD, Matzkin EG. Implementing patient-reported outcome measures in your practice: pearls and pitfalls. Am J Orthop (Belle Mead NJ) 2017;46(6):273–278.
    1. Franklin PD, Harrold L, Ayers David C. Incorporating patient-reported outcomes in total joint arthroplasty registries: challenges and opportunities. Clin Orthop Relat Res. 2013 Nov;471(11):3482–8. doi: 10.1007/s11999-013-3193-2.
    1. Franklin PD, Lewallen D, Bozic K, Hallstrom B, Jiranek W, Ayers DC. Implementation of patient-reported outcome measures in U.S. total joint replacement registries: rationale, status, and plans. J Bone Joint Surg Am. 2014 Dec 17;96 Suppl 1:104–9. doi: 10.2106/JBJS.N.00328. 96/Supplement_1/104
    1. Greenlaw C, Brown-Welty S. A comparison of web-based and paper-based survey methods: testing assumptions of survey mode and response cost. Eval Rev. 2009 Oct;33(5):464–80. doi: 10.1177/0193841X09340214.0193841X09340214
    1. Burnham JM, Meta F, Lizzio V, Makhni EC, Bozic KJ. Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment. Curr Rev Musculoskelet Med. 2017 Jun 19;10(2):233–239. doi: 10.1007/s12178-017-9407-6. 10.1007/s12178-017-9407-6
    1. Kolodychuk NL, Wong M, Chimento G, Adams T, Gastanaduy M, Waddell BS. Web-based patient portal access in an orthopedic adult reconstruction patient population. Arthroplast Today. 2019 Mar;5(1):83–87. doi: 10.1016/j.artd.2019.01.004. S2352-3441(19)30006-8
    1. Makhni EC, Meadows M, Hamamoto JT, Higgins JD, Romeo AA, Verma NN. Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting? J Shoulder Elbow Surg. 2017 Feb;26(2):352–357. doi: 10.1016/j.jse.2016.09.054.S1058-2746(16)30496-7
    1. Basch E, Barbera L, Kerrigan CL, Velikova G. Implementation of patient-reported outcomes in routine medical care. Am Soc Clin Oncol Educ Book. 2018 May 23;38:122–134. doi: 10.1200/EDBK_200383.
    1. Bell K, Warnick E, Nicholson K, Ulcoq S, Kim SJ, Schroeder GD, Vaccaro A. Patient adoption and utilization of a web-based and mobile-based portal for collecting outcomes after elective orthopedic surgery. Am J Med Qual. 2018 Mar 21;33(6):649–656. doi: 10.1177/1062860618765083.
    1. Fatehi A, Gonzalez A, Ring DC, Queralt M. Psychosocial factors are associated with electronic portal registration. Clin Orthop Relat Res. 2020 Sep;478(9):2079–2084. doi: 10.1097/CORR.0000000000001278. 00003086-202009000-00023
    1. Varady NH, d'Amonville Suzanne, Chen Antonia F. Electronic patient portal use in orthopaedic surgery is associated with disparities, improved satisfaction, and lower no-show rates. J Bone Joint Surg Am. 2020 Aug 05;102(15):1336–1343. doi: 10.2106/JBJS.19.01080.00004623-202008050-00011
    1. QuickFacts Massachusetts. United States Census Bureau. [2020-05-31]. .
    1. Schwebel FJ, Larimer ME. Using text message reminders in health care services: a narrative literature review. Internet Interv. 2018 Sep;13:82–104. doi: 10.1016/j.invent.2018.06.002. S2214-7829(18)30002-2
    1. Bigby J, Giblin J, Pappius E M, Goldman L. Appointment reminders to reduce no-show rates. a stratified analysis of their cost-effectiveness. JAMA. 1983 Oct 07;250(13):1742–5.
    1. Horvath M, Levy J, L'Engle P, Carlson B, Ahmad A, Ferranti J. Impact of health portal enrollment with email reminders on adherence to clinic appointments: a pilot study. J Med Internet Res. 2011 May 26;13(2):e41. doi: 10.2196/jmir.1702. v13i2e41

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever