Department of Radiation Oncology, University of California, San Francisco, California.
Department of Epidemiology and Biostatistics and Department of Medicine, Division of Cardiology, University of California, San Francisco, California.
Int J Radiat Oncol Biol Phys. 2024 Nov 1;120(3):627-638. doi: 10.1016/j.ijrobp.2024.05.003. Epub 2024 May 8.
The shift to electronic health records has led to both patient portal messaging and large amounts of digital, real-world data for research. The objective of this study was to examine the association between portal messaging and survival among radiation oncology patients, using real-world data.
This retrospective cohort study included patients at least 21 years old and seen by radiation oncology providers between January 14, 2014, and April 23, 2023, at the University of California, San Francisco. We developed Cox proportional hazards models for the outcome of death and examined factors associated with portal messaging using logistic regression models.
Among 25,367 patients, the median age was 64 (interquartile range [IR], 54-72), 13,175 (52%) were White, and 14,389 (57%) were male. Overall, as the first message in a thread, 8986 (35%) patients sent messages to radiation oncology providers, and 4218 (17%) patients were sent messages from radiation oncology providers. Patients with head and neck or genitourinary malignancies were more likely than those with other diagnoses to send portal messages to and be sent portal messages from radiation oncology providers. Both sending portal messages to radiation oncology providers (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.84-0.96; P = .001) and being sent messages from radiation oncology providers (HR, 0.77; CI, 0.70-0.84; P < .001) as the first message in a thread were associated with patient survival after adjusting for socioeconomic, disease, and treatment characteristics. There were disparities among patients sending portal messages to radiation oncology providers, including for Black versus White patients (odds ratio [OR], 0.60; CI, 0.51-0.69; P < .001) and for Medicaid versus Medicare patients (OR, 0.70; CI, 0.62-0.79; P < .001). There were also disparities among patients being sent portal messages by radiation oncology providers, including for Black versus White patients (OR, 0.77; CI, 0.64-0.91; P = .003), for Medicaid versus Medicare patients (OR, 0.76; CI, 0.65-0.89; P < .001), and for patients with female versus male providers (OR, 1.47; CI 1.34-1.62; P < .001).
Sending portal messages to and being sent portal messages from radiation oncology providers were associated with better survival. Future studies should elucidate how best to support patient and provider engagement.
电子健康记录的转变带来了患者门户消息传递和大量的数字真实世界数据，可供研究使用。本研究的目的是使用真实世界的数据，研究放射肿瘤患者门户消息传递与生存之间的关联。
本回顾性队列研究纳入了 2014 年 1 月 14 日至 2023 年 4 月 23 日期间，在加利福尼亚大学旧金山分校接受放射肿瘤学治疗的至少 21 岁的患者。我们为死亡结局开发了 Cox 比例风险模型，并使用逻辑回归模型检查了与门户消息传递相关的因素。
在 25367 名患者中，中位年龄为 64 岁（四分位距[IQR]，54-72），13175 名（52%）为白人，14389 名（57%）为男性。总体而言，作为线程中的第一条消息，8986 名（35%）患者向放射肿瘤学提供者发送了消息，4218 名（17%）患者收到了放射肿瘤学提供者的消息。与其他诊断相比，头颈部或泌尿生殖系统恶性肿瘤患者更有可能向放射肿瘤学提供者发送门户消息，并收到放射肿瘤学提供者发送的门户消息。向放射肿瘤学提供者发送门户消息（风险比[HR]，0.90；95%置信区间[CI]，0.84-0.96；P =.001）和作为线程中的第一条消息收到放射肿瘤学提供者的消息（HR，0.77；CI，0.70-0.84；P <.001）与调整社会经济、疾病和治疗特征后的患者生存相关。向放射肿瘤学提供者发送门户消息的患者存在差异，包括黑人和白人患者之间（比值比[OR]，0.60；CI，0.51-0.69；P <.001）和医疗补助与医疗保险患者之间（OR，0.70；CI，0.62-0.79；P <.001）。放射肿瘤学提供者向患者发送门户消息也存在差异，包括黑人和白人患者之间（OR，0.77；CI，0.64-0.91；P =.003）、医疗补助与医疗保险患者之间（OR，0.76；CI，0.65-0.89；P <.001）以及女性提供者与男性提供者之间（OR，1.47；CI，1.34-1.62；P <.001）。
向放射肿瘤学提供者发送门户消息和收到放射肿瘤学提供者的消息与生存改善相关。未来的研究应阐明如何最好地支持患者和提供者的参与。
