Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
J Arthroplasty. 2019 Feb;34(2):211-214. doi: 10.1016/j.arth.2018.11.002. Epub 2018 Nov 10.
At the investigating institution, an electronic messaging portal (MyChart) allows patients to directly communicate with their healthcare provider. As reimbursement models evolve, there is an increasing effort to decrease 90-day hospital resource utilization and patient returns, and secure messaging portals have been proposed as one way to achieve this goal. We sought to determine which patients utilize this portal, and to determine the impact of secure messaging on emergency department (ED) visits and readmissions within 90 days postoperatively.
The institutional database was used to analyze 6426 procedures including 3297 primary total knee and 3129 primary total hip arthroplasties. Patient demographics, comorbidities, and secure communication activity status were recorded. Subsequently, statistical analysis was performed to determine which patients utilized MyChart, as well as to correlate patient outcomes to the utilization of secure messaging portals.
Active MyChart users were significantly more likely to be young, healthy (American Society of Anesthesiologists 1 or 2), Caucasian, married, employed, have private insurance, and be discharged to home. Decreased utilization was seen in patients who were unhealthy (American Society of Anesthesiologists 3 or 4), were African American, unmarried, unemployed, had Medicare or Medicaid insurance, and were discharged to a skilled nursing facility; these characteristics were also independent significant risks for returning to the ED. Active MyChart status was not significantly associated with 90-day ED return (P = .781) or readmission (P = .512). However, if multiple messages to providers were sent, and the provider response rate was <75%, patients had significantly more readmissions (P = .004).
Primary total joint arthroplasty patients who were at high risk for ED returns were less likely to utilize MyChart. However, MyChart use did not decrease the 90-day rate of return to the ED or readmissions. A low provider response rate to the secure messages may lead to increased resource utilization in patients using secure messaging as their preferred communication tool. Alternative means of communication with the most vulnerable patients must be investigated to effectively decrease postoperative complications and resource utilization.
在调查机构中，电子消息门户（MyChart）允许患者直接与医疗保健提供者进行沟通。随着报销模式的发展，人们越来越努力地减少 90 天的医院资源利用和患者返回，并且安全消息门户已被提议作为实现这一目标的一种方式。我们试图确定哪些患者使用该门户，并确定安全消息传递对术后 90 天内急诊部（ED）就诊和再入院的影响。
使用机构数据库分析了包括 3297 例初次全膝关节和 3129 例初次全髋关节置换术在内的 6426 例手术。记录了患者的人口统计学，合并症和安全通讯活动状态。随后，进行了统计分析，以确定哪些患者使用了 MyChart，并将患者的结果与安全消息门户的使用相关联。
活跃的 MyChart 用户更有可能年轻，健康（美国麻醉师协会 1 级或 2 级），白种人，已婚，有工作，有私人保险，并且出院回家。在不健康的患者（美国麻醉师协会 3 级或 4 级），非裔美国人，未婚，失业，拥有医疗保险或医疗补助保险以及出院到康复护理机构的患者中，使用量减少；这些特征也是返回 ED 的独立重要危险因素。活跃的 MyChart 状态与 90 天 ED 回归（P=0.781）或再入院（P=0.512）无显着相关性。但是，如果向提供者发送了多条消息，并且提供者的回复率<75％，则患者的再入院率显着更高（P=0.004）。
有 ED 回归高风险的初次全关节置换术患者不太可能使用 MyChart。但是，MyChart 的使用并未降低 90 天内返回 ED 或再入院的比率。安全消息的提供者响应率低可能会导致使用安全消息作为首选沟通工具的患者增加资源利用。必须调查与最脆弱患者进行其他沟通方式，以有效减少术后并发症和资源利用。
