Wakefield Bonnie J, Turvey Carolyn, Hogan Timothy, Shimada Stephanie, Nazi Kim, Cao Lishan, Stroupe Kevin, Martinez Rachael, Smith Bridget
Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA.
Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA.
Telemed J E Health. 2020 Oct;26(10):1211-1220. doi: 10.1089/tmj.2019.0237. Epub 2020 Feb 11.
Background:Patients seek care across multiple health care settings. One coordination issue is the unnecessary duplication of laboratory across different health care settings. This analysis examined the association between patient portal use and duplication of laboratory testing among Veterans who are dual users of Veterans Affairs (VA) and non-VA providers.
Materials and Methods:A national sample of Veterans who were newly authenticated users of the portal during fiscal year (FY) 2013 who used Blue Button at least once were compared with a random sample of Veterans who were not registered to use the portal. From these two groups, Veterans who were also Medicare-eligible users in FY2014 were identified. Duplicate testing was defined as receipt of more than five HbA1c (hemoglobin A1c) in 1 year.
Results:Use of the Blue Button decreased the odds of duplicate HbA1c testing in VA and Medicare-covered facilities across three comparisons: (1) overall between users and nonusers: portal users were less likely to have duplicate testing; (2) pre-post comparison: there was a trend toward lower duplicate testing in both groups across time; and (3) pre-post comparisons accounting for use of the portal: the trend toward lower duplicate testing was greater in Blue Button users.
Conclusion:Duplicate HbA1c testing was significantly lower in dual users of VA and Medicare services who used the Blue Button feature of their VA patient portal. Non-VA providers encounter barriers to access of complete information about Veterans who also use VA health care. Provider endorsement of consumer-mediated health information exchange could help further this model of sharing information.
患者会在多个医疗环境中寻求治疗。一个协调问题是不同医疗环境中实验室检查的不必要重复。本分析研究了退伍军人事务部（VA）和非VA医疗服务双重使用者中患者门户使用与实验室检查重复之间的关联。
将2013财年新认证为门户使用者且至少使用过一次蓝按钮的退伍军人全国样本，与未注册使用门户的退伍军人随机样本进行比较。从这两组中，确定了2014财年也是符合医疗保险资格的使用者的退伍军人。重复检查定义为1年内接受超过5次糖化血红蛋白（HbA1c）检测。
在三次比较中，使用蓝按钮降低了在VA和医疗保险覆盖机构中糖化血红蛋白重复检测的几率：（1）使用者与非使用者总体比较：门户使用者重复检测的可能性较小；（2）前后比较：两组随时间推移重复检测均有降低趋势；（3）考虑门户使用情况的前后比较：蓝按钮使用者重复检测降低的趋势更大。
使用VA患者门户蓝按钮功能的VA和医疗保险服务双重使用者中，糖化血红蛋白重复检测显著降低。非VA医疗服务提供者在获取同时使用VA医疗服务的退伍军人的完整信息方面存在障碍。医疗服务提供者对消费者介导的健康信息交换的认可有助于推广这种信息共享模式。
