实时患者门户在急诊科患者中的使用：一项开放结果研究。
Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study.
机构信息
Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States.
Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States.
出版信息
Appl Clin Inform. 2022 Oct;13(5):1123-1130. doi: 10.1055/a-1951-3268. Epub 2022 Sep 27.
OBJECTIVES
We characterized real-time patient portal test result viewing among emergency department (ED) patients and described patient characteristics overall and among those not enrolled in the portal at ED arrival.
METHODS
Our observational study at an academic ED used portal log data to trend the proportion of adult patients who viewed results during their visit from May 04, 2021 to April 04, 2022. Correlation was assessed visually and with Kendall's τ. Covariate analysis using binary logistic regression assessed as a function of time accounting for age, sex, ethnicity, race, language, insurance status, disposition, and social vulnerability index (SVI). A second model only included patients not enrolled in the portal at arrival. We used random forest imputation to account for missingness and Huber-White heteroskedasticity-robust standard errors for patients with multiple encounters ( = 0.05).
RESULTS
There were 60,314 ED encounters (31,164 unique patients). In 7,377 (12.2%) encounters, patients viewed results while still in the ED. Patients were not enrolled for portal use at arrival in 21,158 (35.2%) encounters, and 927 (4.4% of not enrolled, 1.5% overall) subsequently enrolled and viewed results in the ED. Visual inspection suggests an increasing proportion of patients who viewed results from roughly 5 to 15% over the study (Kendall's τ = 0.61 [ <0.0001]). Overall and not-enrolled models yielded concordance indices () of 0.68 and 0.72, respectively, with significant overall likelihood ratio ( <0.0001). Time was independently associated with viewing results in both models after adjustment. Models revealed disparate use between age, race, ethnicity, SVI, sex, insurance status, and disposition groups.
CONCLUSION
We observed increased portal-based test result viewing among ED patients over the year since the 21 Century Cures act went into effect, even among those not enrolled at arrival. We observed disparities in those who viewed results.
目的
我们描述了急诊患者实时查看患者门户测试结果的特征，并描述了整体患者特征和在急诊到达时未注册门户的患者特征。
方法
我们在学术急诊室进行的观察性研究使用门户日志数据来趋势分析 2021 年 5 月 4 日至 2022 年 4 月 4 日期间就诊的成年患者查看结果的比例。通过视觉和 Kendall 的 τ 进行相关性评估。使用二元逻辑回归的协变量分析评估作为时间的函数，考虑年龄、性别、族裔、种族、语言、保险状况、处置和社会脆弱性指数 (SVI)。第二个模型仅包括在到达时未注册门户的患者。我们使用随机森林插补来处理缺失值，并为有多次就诊的患者使用 Huber-White 异方差稳健标准误差（=0.05）。
结果
共有 60314 次急诊就诊（31164 位独特患者）。在 7377 次就诊（12.2%）中，患者在急诊时查看了结果。在 21158 次就诊（35.2%）中，患者在到达时未注册门户使用，927 次就诊（未注册的 4.4%，总体的 1.5%）随后在急诊注册并查看了结果。视觉检查表明，从研究开始时的大约 5%到 15%，查看结果的患者比例呈上升趋势（Kendall 的 τ=0.61 [ <0.0001]）。整体和未注册模型的一致性指数（）分别为 0.68 和 0.72，整体似然比检验（ <0.0001）具有统计学意义。在调整后，时间在两个模型中都是查看结果的独立因素。模型揭示了年龄、种族、族裔、SVI、性别、保险状况和处置组之间不同的使用情况。
结论
自 21 世纪治愈法案生效以来的一年中，我们观察到急诊患者使用门户查看测试结果的比例增加，即使在到达时未注册门户的患者中也是如此。我们观察到查看结果的患者存在差异。
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