Melucci Alexa D, Flodman Kiersten, Loria Anthony, Swanson Holli L, Robinson Mary K, Hasselberg Michael J, Evans Lara, Temple Larissa K, Fleming Fergal J
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
Surgical Health Outcomes & Research Enterprise (SHORE), The University of Rochester Medical Center, Saunders Research Building, Suite 124003, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
Surg Endosc. 2023 Dec;37(12):9275-9282. doi: 10.1007/s00464-023-10478-z. Epub 2023 Oct 25.
Patient engagement technologies (PET) are an area of growing innovation and investment, but whether PET use in the setting of electronic medical record (EMR) supported patient portals are associated with improved outcomes is unknown. Therefore, we assessed PET and EMR activation among patients undergoing elective colorectal surgery on an enhanced recovery pathway.
We identified adults undergoing elective colorectal surgery between 1/2017 and 7/2021. EMR activations were assessed and patients were considered PET users if they used a proprietary PET application. Multivariable logistic regression was used to identify factors associated with PET use and determine whether the level of engagement (percentage of messages read by the patient) was associated with 30-day outcomes.
484 patients (53.5% PET users, 81.6% with an activated EMR patient portal, 30.8% ≥ 70 years of age) were included. PET users were younger, more likely to have their EMR portal activated and had decreased odds of prolonged length of stay [odds ratio (OR) 0.5, 95% confidence interval (CI) 0.4-0.8]. Among patients ≥ 70 years, PET users had reduced odds of readmissions (OR 0.2, 95% CI 0.1-0.9) compared to PET non-users. The most engaged PET users had decreased morbidity (OR 0.2, 95% CI 0.1-0.8) and readmissions (OR 0.3, 95% CI 0.1-0.8) compared to the least engaged PET users.
When controlling for EMR activation, patients who use PET, specifically those with higher levels of engagement or aged ≥ 70, have improved outcomes following elective colorectal surgery. Interventions aimed at increasing the adoption of PET among older adults may be warranted.
患者参与技术（PET）是一个创新和投资不断增长的领域，但在电子病历（EMR）支持的患者门户环境中使用PET是否与改善预后相关尚不清楚。因此，我们评估了接受择期结直肠手术且采用强化康复路径的患者的PET和EMR激活情况。
我们确定了2017年1月至2021年7月期间接受择期结直肠手术的成年人。评估EMR激活情况，如果患者使用了专有的PET应用程序，则将其视为PET用户。使用多变量逻辑回归来确定与PET使用相关的因素，并确定参与程度（患者阅读消息的百分比）是否与30天预后相关。
纳入484例患者（53.5%为PET用户，81.6%的EMR患者门户已激活，30.8%年龄≥70岁）。PET用户更年轻，EMR门户激活的可能性更大，住院时间延长的几率降低[比值比（OR）0.5，95%置信区间（CI）0.4 - 0.8]。在≥70岁的患者中，与非PET用户相比，PET用户再入院的几率降低（OR 0.2，95% CI 0.1 - 0.9）。与参与程度最低的PET用户相比，参与程度最高的PET用户发病率降低（OR 0.2，95% CI 0.1 - 0.8），再入院率降低（OR 0.3，95% CI 0.1 - 0.8）。
在控制EMR激活的情况下，使用PET的患者，特别是那些参与程度较高或年龄≥70岁的患者，在择期结直肠手术后预后改善。可能有必要采取干预措施以提高老年人对PET的采用率。
