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A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity

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Listed:
  • Hao Wang

    (Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA)

  • Chan Shen

    (Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA)

  • Michael Barbaro

    (Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA)

  • Amy F. Ho

    (Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA)

  • Mona Pathak

    (Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA)

  • Cita Dunn

    (TCU and UNTHSC School of Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA)

  • Usha Sambamoorthi

    (Texas Center for Health Disparities, Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA)

Abstract

Background: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). Methods: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients’ neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. Results: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07–6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23–2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. Conclusions: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.

Suggested Citation

  • Hao Wang & Chan Shen & Michael Barbaro & Amy F. Ho & Mona Pathak & Cita Dunn & Usha Sambamoorthi, 2023. "A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity," IJERPH, MDPI, vol. 20(2), pages 1-14, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:2:p:1231-:d:1030804
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    References listed on IDEAS

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    1. Juan Merlo & Philippe Wagner & Nermin Ghith & George Leckie, 2016. "An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-31, April.
    2. Hao Wang & Amy F. Ho & R. Constance Wiener & Usha Sambamoorthi, 2021. "The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States," IJERPH, MDPI, vol. 18(19), pages 1-11, September.
    3. Katherine L. Forthman & Janna M. Colaizzi & Hung-wen Yeh & Rayus Kuplicki & Martin P. Paulus, 2021. "Latent Variables Quantifying Neighborhood Characteristics and Their Associations with Poor Mental Health," IJERPH, MDPI, vol. 18(3), pages 1-19, January.
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