scholarly journals Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal

2018 ◽  
Vol 09 (04) ◽  
pp. 875-883 ◽  
Author(s):  
Jacob Stein ◽  
Jared Klein ◽  
Thomas Payne ◽  
Sara Jackson ◽  
Sue Peacock ◽  
...  
Keyword(s):  
Usual Care ◽  
Safety Net ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Patient Portal ◽  
Patient Portals ◽  
Vulnerable Patients ◽  
Safety Net Hospital ◽  
Randomized Intervention ◽  
Vulnerable Patient

Background Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. Objective This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. Methods Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. Results Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01). Conclusion Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

scholarly journals Patient portal readiness among postpartum patients in a safety net setting

2017 ◽  
Vol 08 (03) ◽  
pp. 698-709 ◽  
Author(s):  
Anne Gibeau ◽  
Caitlin Dewey ◽  
Melanie Roshto ◽  
Hilary Frankel ◽  
Daryl Wieland
Keyword(s):  
Pregnant Women ◽  
Health Information ◽  
Healthcare System ◽  
Safety Net ◽  
The Internet ◽  
Inpatient Setting ◽  
Patient Portal ◽  
Use Of Technology ◽  
Safety Net Hospital ◽  
Barriers To Use

Summary Background: Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. Objectives: In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. Methods: We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. Results: Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. Conclusions: Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting. Citation: Wieland D, Gibeau A, Dewey C, Roshto M, Frankel H. Patient portal readiness among postpartum patients in a safety net setting. Appl Clin Inform 2017; 8: 698–709 https://doi.org/10.4338/ACI-2016-12-RA-0204

Abstract WP375: Fall Risk in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Robynn S Cox ◽  
Cheryl Bradas ◽  
Victoria Bowden ◽  
Beth Buckholz ◽  
Kathleen Kerber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Fall Risk ◽  
Safety Net ◽  
Public Healthcare ◽  
Inpatient Setting ◽  
Stroke Patients ◽  
Safety Net Hospital ◽  
Risk Factors For Falls

Fall Risk Factors among Hospitalized Acute Post-Ischemic Stroke Patients in an Urban Public Healthcare System Background: Falls remain an important benchmarking indicator for hospitals. The incidence of falls is a nursing-sensitive indicator, amenable to preventable measures. Research indicates factors associated with falls, but few studies specifically identify factors among hospitalized patients with acute ischemic stroke (AIS). Purpose: Identify prevalence and risk factors for falls among acute, hospitalized AIS patients within an urban safety net hospital. Methods: Retrospective cohort study. Data abstracted from stroke and fall registries, and medical records from 2013-2015 among all adult patients admitted for AIS. Variables included traditional risk factors for falls, as well as stroke-specific factors (NIHSS score, functional status, stroke location and vessel, administration of tPA). Results: N=683 AIS stroke patients, with 1.6% fall rate. Falls among AIS patients accounted for 6% of all hospital falls. AIS patients who experienced an inpatient fall had a mean age of 67 (range 46-86), were mostly male (82%), and ambulating independently prior to arrival (91%). Mean NIHSS scores upon admission were higher among those who experienced a fall, when compared to AIS patients who did not fall (mean=8.73, 7.01, respectively). Most patients who experienced a fall demonstrated weakness and/or paresis upon initial exam (90%), with 64% experiencing small vessel ischemic changes, and 36% MCA strokes. Administration of tPA was not associated with increased falls. LOS was significantly increased among AIS patients who experienced a fall (7.7 vs. 4.8, respectively, p <0.01). Conclusions: Fall rates among hospitalized AIS patients may be lower than earlier reports, reflecting increased vigilance among providers and widespread integration of fall prevention strategies. Elevated NIHSS scores and weakness/paresis upon initial exam may be important predictors of falls among newly diagnosed AIS patients who had previously been able to ambulate independently. Consistent with fall literature among other populations, the occurrence of a fall in the inpatient setting can substantially increase length of stay.

Identifying Actionable Causes of Potentially Avoidable Readmissions to an Oncology Service at a Safety Net Hospital

2020 ◽  
pp. OP.20.00593
Author(s):  
Vishal K. Gupta ◽  
Michael Dennis ◽  
Emily Mann ◽  
Joseph O. Jacobson ◽  
Naomi Y. Ko
Keyword(s):  
Pleural Fluid ◽  
Cancer Progression ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Oncology Service ◽  
Safety Net Hospital ◽  
Avoidable Readmissions

PURPOSE: Hospital readmissions occur commonly in those receiving cancer care and result in impaired quality of life and increased costs. Causes of readmission in safety net hospitals that serve vulnerable populations are not well understood. The primary goal of this project was to identify potentially avoidable and intervenable causes of readmissions to an urban safety net hospital. METHODS: A retrospective chart review was performed on patients who were readmitted within 30 days of discharge from the hematology and oncology service at Boston Medical Center over the 6-month period between October 2018 and March 2019. Charts were reviewed by three internal medicine residents and discussed under the supervision of an attending oncologist. RESULTS: Two hundred ninety-one patient encounters involving 203 unique patients were identified in the 6-month study period. Of these 291 encounters, 80 encounters (27.5%) were followed by a readmission within 30 days and occurred in 61 (30.0%) unique patients. Nineteen (31.1%) of these 61 patients experienced two readmissions within 30 days of discharge. Twenty-five readmissions (31.3%) were classified as potentially avoidable, with the most common cause of potentially avoidable readmissions attributed to ascitic or pleural fluid reaccumulation (8, 32%). The majority of presumed nonpreventable readmissions were due to expected complications of cancer progression and treatment-related side effects. DISCUSSION: In conclusion, readmissions were common, and a modifiable reason for 30-day readmissions was identified. Addressing recurrent ascitic and pleural fluid reaccumulation in the outpatient setting could help to reduce inpatient hospital readmission on an inpatient oncology service.

scholarly journals Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital

2019 ◽  
Vol 15 (8) ◽  
pp. e644-e651 ◽  
Author(s):  
Neil Keshvani ◽  
Mary Hon ◽  
Arjun Gupta ◽  
Timothy J. Brown ◽  
Lonnie Roy ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Acquisition Cost ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Cost Savings ◽  
Safety Net ◽  
Patient Survey ◽  
Outpatient Setting ◽  
Chemotherapy Administration ◽  
Safety Net Hospital

PURPOSE: EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions. METHODS AND MATERIALS: Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey. RESULTS: From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement. CONCLUSION: Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.

scholarly journals Patient Recommendations to Improve the Implementation of and Engagement With Portals in Acute Care: Hospital-Based Qualitative Study

10.2196/13337 ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. e13337 ◽  
Author(s):  
S Ryan Greysen ◽  
Yimdriuska Magan ◽  
Jamie Rosenthal ◽  
Ronald Jacolbia ◽  
Andrew D Auerbach ◽  
...  
Keyword(s):  
Acute Care ◽  
Qualitative Data ◽  
Average Length ◽  
Acute Care Hospital ◽  
Outpatient Setting ◽  
Bring Your Own Device ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Care Hospital ◽  
Patient Portals

Background The inclusion of patient portals into electronic health records in the inpatient setting lags behind progress in the outpatient setting. Objective The aim of this study was to understand patient perceptions of using a portal during an episode of acute care and explore patient-perceived barriers and facilitators to portal use during hospitalization. Methods We utilized a mixed methods approach to explore patient experiences in using the portal during hospitalization. All patients received a tablet with a brief tutorial, pre- and postuse surveys, and completed in-person semistructured interviews. Qualitative data were coded using thematic analysis to iteratively develop 18 codes that were integrated into 3 themes framed as patient recommendations to hospitals to improve engagement with the portal during acute care. Themes from these qualitative data guided our approach to the analysis of quantitative data. Results We enrolled 97 participants: 53 (53/97, 55%) women, 44 (44/97, 45%) nonwhite with an average age of 48 years (19-81 years), and the average length of hospitalization was 6.4 days. A total of 47 participants (47/97, 48%) had an active portal account, 59 participants (59/97, 61%) owned a smartphone, and 79 participants (79/97, 81%) accessed the internet daily. In total, 3 overarching themes emerged from the qualitative analysis of interviews with these patients during their hospital stay: (1) hospitals should provide both access to a device and bring-your-own-device platform to access the portal; (2) hospitals should provide an orientation both on how to use the device and how to use the portal; and (3) hospitals should ensure portal content is up to date and easy to understand. Conclusions Patients independently and consistently identified basic needs for device and portal access, education, and usability. Hospitals should prioritize these areas to enable successful implementation of inpatient portals to promote greater patient engagement during acute care. Trial Registration ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT01970852

scholarly journals Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations (Preprint)

2019 ◽  
Author(s):  
Alejandra Casillas ◽  
Anshu Abhat ◽  
Anish Mahajan ◽  
Gerardo Moreno ◽  
Arleen F Brown ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Care Disparities ◽  
Health Technology ◽  
Safety Net ◽  
The United States ◽  
Patient Portals ◽  
Department Of Health ◽  
Vulnerable Patients ◽  
English Speaking ◽  
Technology Tool

UNSTRUCTURED Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 262-262
Author(s):  
Ronak Patel ◽  
Victor Chiu ◽  
Darcy V. Spicer
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Post Intervention ◽  
Safety Net Hospital ◽  
The Mean ◽  
Chemotherapy Initiation ◽  
Mean Time

262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.

scholarly journals A Randomized Clinical Trial of Group Acupuncture for Painful Diabetic Neuropathy Among Diverse Safety Net Patients

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2292-2302 ◽  
Author(s):  
Maria T Chao ◽  
Dean Schillinger ◽  
Unity Nguyen ◽  
Trilce Santana ◽  
Rhianon Liu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Neuropathy ◽  
Usual Care ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Safety Net ◽  
Group Differences ◽  
Painful Diabetic Neuropathy ◽  
Safety Net Hospital

Abstract Objective Existing pharmacologic approaches for painful diabetic neuropathy (PDN) are limited in efficacy and have side effects. We examined the feasibility, acceptability, and effects of group acupuncture for PDN. Design and Setting We randomized patients with PDN from a public safety net hospital to 1) usual care, 2) usual care plus 12 weeks of group acupuncture once weekly, or 3) usual care plus 12 weeks of group acupuncture twice weekly. Methods The primary outcome was change in weekly pain intensity (daily 0–10 numerical rating scale [NRS] averaged over seven days) from baseline to week 12. We also assessed health-related quality of life and related symptoms at baseline and weeks 6, 12, and 18. Results We enrolled 40 patients with PDN (baseline pain = 5.3). Among participants randomized to acupuncture, 92% attended at least one treatment (mean treatments = 10.1). We observed no significant differences between once- vs twice-weekly acupuncture and combined those groups for the main analyses. Compared with usual care, participants randomized to acupuncture experienced greater decreases in pain during the 12-week intervention period (between-group differences from baseline = –2.06, 95% confidence interval [CI] = –3.01 to –1.10), but benefits were not maintained after acupuncture ended (baseline to week 18 = –0.61, 95% CI = –1.46 to 0.24). Quality of life improved for acupuncture participants (baseline to week 12 difference = 11.79, 95% CI = 1.92 to 21.66), but group differences were not significant compared with usual care (25.58, 95% CI = –3.90 to 55.06). Conclusions Group acupuncture is feasible and acceptable among linguistically and racially diverse safety net patients. Findings suggest clinically relevant reduction in pain from PDN and quality of life improvements associated with acupuncture, with no differences based on frequency.

scholarly journals Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement

2018 ◽  
Vol 09 (04) ◽  
pp. 860-868 ◽  
Author(s):  
Cynthia Sieck ◽  
Daniel Walker ◽  
Jennifer Hefner ◽  
Jaclyn Volney ◽  
Timothy Huerta ◽  
...  
Keyword(s):  
Medical Center ◽  
Treatment Plan ◽  
Descriptive Analysis ◽  
Academic Medical Center ◽  
Family Members ◽  
Outpatient Setting ◽  
Care Process ◽  
Inpatient Setting ◽  
Patient Portals ◽  
Secure Messaging

Background Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. Objective To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. Materials and Methods This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. Results Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%). Conclusion Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.

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