Patient Portals and Hospital Readmissions

Increasing the use of information technology in health care supposedly makes more data available for providers, payers and patients.  Having more information available to patients is believed to encourage greater engagement in care and health, improving outcomes.  One form of information availability to patients is a portal, managed by their health plan or their providers, which gives them access to a variety of their medical records.  Researchers, in a study published in the Journal of the American Medical Informatics Society, examined whether access to and/or use of a portal for hospitalized patients had an impact on readmission and mortality outcomes.   (JAMIA Study)   The research covered patients about 1560 patients admitted to a Mayo Clinic hospital in Florida between August 2012 and August 2014.  All of these patients had signed up for a portal account before they were hospitalized, but only 21% of them actually used the portal while they were hospitalized.  The portal allowed access to most, but not all, of the patient’s medical records and facilitated communication with some, but not all, providers.  The researchers were interested in differences between patients who did and didn’t access the portal and the impact of use or non-use on outcomes.

Portal users during admission were slightly younger, more likely to have been an urgent rather than elective admission, to have higher disease severity scores and to be admitted for medical rather than surgical purposes.  There was no statistically significant difference in inpatient mortality, 30-day mortality, or 30 day readmissions between those patients who accessed the portal during hospitalization and those who did not.  The theory in regard to mortality would be that more informed patients would be more compliant with care plans and more attentive to health and therefore have a better outcome.  The theory in regard to readmissions would be that the portal users would be more aware of discharge plans and instructions and follow-up care recommendations.  The theories may be good, but they aren’t showing up as creating a statistical difference.  Portal use was relatively low, but probably concentrated among already engaged patients, so that makes the results even more puzzling.  Portal design and functionality may play a role.  The portal, or more accurately, the data it provides, might make more of an impact if it provided specific guidance to the patient on actions he or she should take.  Patients having better access to their health information is a good in itself, but it may not produce better outcomes if patients aren’t educated on how to take advantage of the data.