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- Title
Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal: A Secondary Analysis of a Randomized Clinical Trial.
- Authors
Walker, Daniel M.; Hefner, Jennifer L.; MacEwan, Sarah R.; Di Tosto, Gennaro; Sova, Lindsey N.; Gaughan, Alice A.; Huerta, Timothy R.; McAlearney, Ann Scheck
- Abstract
Key Points: Question: Does the effectiveness of patient training and portal functionality interventions implemented to increase patient portal use differ by racial groups? Findings: In a secondary analysis of a randomized clinical trial of 2892 participants, Black participants had lower frequency of portal use compared with White participants, but the in-person training (compared with a training video) and the full set of portal functions (compared with a limited set of functions) interventions were not different in Black individuals and White individuals at increasing inpatient portal use. Meaning: These findings suggest that despite evidence that in-person training and robust portal functionality increased use across participants of all races, Black individuals still used the portal less than White individuals. This secondary analysis of a randomized clinical trial assesses differences of the effectiveness of patient training and portal functionality interventions implemented to impact portal use by race. Importance: Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap. Objective: To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. Design, Setting, and Participants: This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023. Interventions: A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]). Main Outcomes and Measures: Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs. Results: Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race. Conclusions and Relevance: In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity. Trial Registration: ClinicalTrials.gov Identifier: NCT02943109
- Subjects
PATIENT education; SELF-evaluation; SECONDARY analysis; HOSPITAL care; LOGISTIC regression analysis; EVALUATION of medical care; PATIENT portals; RACE; ODDS ratio; RESEARCH; CONFIDENCE intervals; DATA analysis software
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe245091
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.5091