参与患者门户网站的肿瘤患者在患者门户网站消息传递方面的差异。
Disparities in Patient Portal Messaging Among Oncology Patients Enrolled in the Patient Portal.
作者信息
Alexander Jes, Beatty Alexis L
机构信息
Department of Radiation Oncology and Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Department of Epidemiology and Biostatistics and Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
出版信息
JCO Clin Cancer Inform. 2025 Jul;9:e2400234. doi: 10.1200/CCI-24-00234. Epub 2025 Jul 9.
PURPOSE
Previous studies have consistently reported disparities in electronic health record portal enrollment. Among patients enrolled in a portal, it is less clear whether there are disparities in usage. We investigated whether disparities existed in portal usage among enrolled oncology patients regarding both sending portal messages to and receiving messages from oncology providers.
METHODS
This retrospective cohort study included patients ≥18 years old with cancer who were seen at an urban academic cancer center between January 2011 and February 2025 and enrolled in the patient portal. We developed Cox proportional hazards models for the outcomes of patients sending portal messages to and receiving messages from oncology providers as the first message in a thread. Time measurement began with the first cancer center visit or portal enrollment, whichever was later. Models were adjusted for demographic, socioeconomic, disease, and administrative visit variables.
RESULTS
Among 101,678 patients, the median age was 62 years (IQR, 51-71), and 68,527 sent and 42,242 received messages. After adjustment, age ≥50 versus 18-29 years, Latinx and Pacific Islander versus White, single and widowed versus partnered, non-English preferred language, and Medicaid and Medicare versus private insurance were associated with reduced likelihood of sending and receiving messages. Black and American Indian/Alaska Native were associated with reduced likelihood of sending messages. Female provider was associated with increased likelihood of sending and receiving messages. Women were more likely to send messages.
CONCLUSION
Among oncology patients enrolled in the patient portal, disparities existed in sending and receiving portal messages. Given the association of messaging with better survival among oncology patients in previous studies, future studies should determine how best to minimize messaging disparities beyond just addressing disparities in portal enrollment.
目的
既往研究一致报道了电子健康记录门户注册方面的差异。在注册门户的患者中，使用情况是否存在差异尚不清楚。我们调查了已注册的肿瘤患者在向肿瘤学提供者发送门户消息和接收来自肿瘤学提供者的消息方面，门户使用情况是否存在差异。
方法
这项回顾性队列研究纳入了2011年1月至2025年2月期间在一家城市学术癌症中心就诊且注册了患者门户的18岁及以上癌症患者。我们针对患者向肿瘤学提供者发送门户消息和接收来自肿瘤学提供者的消息作为线程中的第一条消息这两种情况，建立了Cox比例风险模型。时间测量从首次癌症中心就诊或门户注册开始，以较晚者为准。模型针对人口统计学、社会经济、疾病和行政就诊变量进行了调整。
结果
在101,678名患者中，中位年龄为62岁（四分位间距，51 - 71岁），68,527名患者发送了消息，42,242名患者接收了消息。调整后，年龄≥50岁与18 - 29岁相比、拉丁裔和太平洋岛民与白人相比、单身和丧偶与有伴侣相比、偏好非英语语言以及医疗补助和医疗保险与私人保险相比，发送和接收消息的可能性降低。黑人以及美洲印第安人/阿拉斯加原住民发送消息的可能性降低。女性提供者与发送和接收消息的可能性增加有关。女性更有可能发送消息。
结论
在注册了患者门户的肿瘤患者中，发送和接收门户消息存在差异。鉴于既往研究表明消息传递与肿瘤患者更好的生存率相关，未来研究应确定如何最好地最小化消息传递差异，而不仅仅是解决门户注册方面的差异。
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