Disparities in electronic health record portal access and use among patients with cancer
Author:
Griffin Joan M12ORCID, Kroner Barbara L3ORCID, Wong Sandra L4ORCID, Preiss Liliana3, Wilder Smith Ashley5, Cheville Andrea L6ORCID, Mitchell Sandra A5ORCID, Lancki Nicola7ORCID, Hassett Michael J8, Schrag Deborah9ORCID, Osarogiagbon Raymond U10ORCID, Ridgeway Jennifer L12ORCID, Cella David1112ORCID, Jensen Roxanne E5ORCID, Flores Ann Marie111213ORCID, Austin Jessica D14ORCID, Yanez Betina11ORCID, Cella David, Cheville Andrea, Hassett Michael J, Osarogiagbon Raymond U, Schrag Deborah, Wong Sandra L, Kroner Barbara L, Wilder Smith Ashley, DiMartino Lisa, Garcia Sofia, Griffin Joan, Jensen Roxanne, Mitchell Sandra, Ruddy Kathryn, Smith Justin D, Yanez Betina, Bian Jessica J, Dizon Don S, Hazard-Jenkins Hannah W, Ardini Mary-Anne, Ahrens Paige, Austin Jessica, Barrett Fiona, Bass Michael, Begnoche Megan, Cahue September, Caron Kimberly, Chlan Linda, Coughlin Ava, Cronin Christine, Dias Samira, Faris Nicolas, Flores Ann Marie, Garcia Martha, Hemming Karla, Herrin Jeph, Hodgdon Christine, Kircher Sheetal, Kroenke Kurt, Lam Veronica, Lancki Nicola, Mai Quan H, Mallow Jennifer, McCleary Nadine J, Norton Wynne, Connor Mary O, Pachman Deirdre, Pearson Loretta, Penedo Frank, Podratz Jewel, Popovic Jennifer, Preiss Liliana, Rahman Parvez, Redmond Sarah, Reich James, Richardson Joshua, Richardson Kimberly, Ridgeway Jennifer, Rutten Lila, Schaepe Karen, Scholtens Denise, Poirier-Shelton Tiana, Silberman Philip, Simpson Jaclyn, Tasker Laura, Tesch Nathan, Tofthagen Cindy, Tramontano Angela, Tyndall Benjamin D, Uno Hajime, Wehbe Firas, Weiner Bryan,
Affiliation:
1. Division of Health Care Delivery Research, Mayo Clinic , Rochester, MN, USA 2. Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, MN, USA 3. Center for Clinical Research, RTI International, Research Triangle Park , NC, USA 4. Department of Surgery, Dartmouth-Hitchcock Medical Center , Lebanon, NH, USA 5. Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute , Bethesda, MD, USA 6. Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN, USA 7. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL, USA 8. Department of Medical Oncology, Dana-Farber Cancer Institute , Boston, MA, USA 9. Department of Medical Oncology, Memorial Sloan Kettering Cancer Center , New York, NY, USA 10. Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center , Memphis, TN, USA 11. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL, USA 12. Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL, USA 13. Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine , Chicago, IL, USA 14. Department of Quantitative Health Sciences, Mayo Clinic , Rochester, MN, USA
Abstract
Abstract
Background
Electronic health record–linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium.
Methods
Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period).
Results
Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use.
Conclusion
Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record–based cancer symptom surveillance and management.
Funder
Cancer Moonshot Research Initiative National Institutes of Health Mayo Clinic Northwestern University Baptist Health System Dana-Farber Cancer Institute Dartmouth Hitchcock Medical Center Lifespan Health System Maine Medical Center West Virginia University RTI International
Publisher
Oxford University Press (OUP)
Subject
Cancer Research,Oncology
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