Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA.
J Am Med Inform Assoc. 2019 Dec 1;26(12):1525-1535. doi: 10.1093/jamia/ocz115.
OBJECTIVES: Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP). MATERIALS AND METHODS: The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. RESULTS: Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. CONCLUSIONS: Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.
目的：由于患者门户使用和《平价医疗法案》带来的有益的以患者为中心的结果，门户的实施已经扩展到了安全网医疗系统，这些系统为大量未参保者、医疗补助计划（Medicaid）和其他弱势群体提供了获得医疗服务的途径。然而，几乎没有关注到这些医疗系统服务的弱势群体患者（包括那些英语能力有限的患者）对门户的可及性产生影响的因素。
材料与方法：洛杉矶县卫生服务部（LAC DHS）是美国第二大安全网系统，于 2015 年 3 月推出了其第一个患者门户，也是现有的少数几个双语英语-西班牙语界面之一。为了探索门户的认知度和感知度，我们对 LAC DHS 的患者进行了英语和西班牙语（LEP）的焦点小组讨论。技术接受模型被用于指导焦点小组数据的主题分析。
结果：在 46 名参与者中，有 37 名是患者，9 名是照顾者；23 名是英语使用者，23 名是 LEP 西班牙语使用者。所有患者都患有糖尿病或高血压。超过一半的人家庭年收入<$10000，但 78%的英语使用者和 65%的 LEP 西班牙语使用者报告在家中可以上网。参与者的讨论集中在 3 个主要主题叙述上：（1）参与者对 LAC DHS 门户的意识或态度；（2）文化、语言或社区在门户可及性和实用性方面的作用；（3）成功实施门户的感知需求。
结论：安全网参与者确定了门户的具体好处，并强调需要进行门户参与，以便在临床和社区环境中提供可访问的教育、支持和资源。该门户为患者及其家庭提供了接触可信和经过验证的健康信息的额外机会，应该在此方面进一步发展。本研究更深入地了解了改善患者门户参与度的偏好，这为解决电子健康差距的更广泛的卫生技术工作提供了指导。
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