MITRE Corporation, McLean, VA, United States.
College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States.
J Med Internet Res. 2020 Oct 29;22(10):e19477. doi: 10.2196/19477.
The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes.
To examine associations between patients' and clinicians' message content and changes in patients' health outcomes.
We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff-generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension.
Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=-.30; 95% CI -0.56 to -0.04), as were staffs' action responses (β=-30; 95% CI -0.58 to -0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients' complaints (β=-4.03; 95% CI -7.94 to -0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19).
This is the first research to find associations between message content and patients' health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.
在过去十年中，临床医务人员与患者之间安全传递的电子信息数量急剧增加。许多研究探讨了患者发送的信息量是否与结果相关。然而，这些研究都没有检查信息内容本身是否与结果相关。由于安全消息传递是患者和临床医务人员之间的一种重要沟通形式，因此评估沟通的背景对于了解其对患者健康结果的影响至关重要。
研究患者和临床医生信息内容与患者健康结果变化之间的关联。
我们应用了专门为安全消息制定的分类法，对 14394 条患者和临床工作人员生成的消息进行了分析，这些消息来自患者发起的消息线程。我们的研究人群包括 1602 名患者，其中 50.94%（n=816）的患者发起了消息线程。我们进行了线性回归分析，以确定消息代码是否与糖尿病患者的血糖（A1C）水平变化以及高血压患者的收缩压（SBP）和舒张压（DBP）变化相关。
与未发起线程的患者相比，发起线程的患者 A1C 下降幅度更大（P=.01）。临床人员未回复与 SBP 降低相关（β=-.30；95% CI -0.56 至 -0.04），工作人员的行动回复也与 SBP 降低相关（β=-30；95% CI -0.58 至 -0.02）。患者生成的感谢和表扬消息以及工作人员的鼓励与 A1C 水平升高（效果量范围为 0.51（A1C）至 5.80（SBP））相关。我们发现，患者的投诉与 SBP 的改善相关（β=-4.03；95% CI -7.94 至 -0.12）。临床工作人员延迟信息共享与 SBP 升高相关（β=1.29；95% CI 0.4 至 2.19）。
这是第一项研究信息内容与患者健康结果之间的关联。我们的研究结果表明，患者消息内容与患者结果之间存在混合关联。需要进一步研究以了解这项工作的影响；在此期间，医疗保健提供者应该意识到他们的消息内容可能会影响患者的健康结果。
