JMIR Publications

ABSTRACT

Background:

Much attention has been drawn to patient portals as an important tool for health providers to facilitate patient engagement. However, little is known about whether the use of patient portals contributes to improved management of patients’ health, within the context of their confidence in acquiring health information and their ability to monitor and take good care of their own health, due to the lack of an observational or randomized dataset with measurements of self-efficacy outcomes both pre- and post-adoption of patient portals.

Objective:

To develop a testing framework that allows for causal inference and use it to investigate whether the exposure to patient portals, or intensively using a patient portal, will improve patients’ self-efficacy towards obtaining health information and taking care of themselves.

Methods:

This study was a secondary data analysis that used data from the National Cancer Institute’s HINTS 5 Cycle 1 data. Patient portal usage frequency was used to define the treatment, and survey items measuring self-efficacy were selected as the main outcomes, including patients’ confidence in getting health information and taking care of their own health. To enable establishing causality from survey data, we propose a novel testing framework that can identify the causal relationship using instrumental variables and conditional independent tests.

Results:

Using patient portals is shown to improve patients’ confidence of getting health information. The estimand of the weighted average causal effect from two-stage least squares regression is 0.15, with a 95% Confidence Interval (0.06, 0.23), p<0.001. It means that increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times, the expected average increase in the response score (measured on a Likert-type scale) is 0.15. However, we cannot conclude a causal effect of using patient portals on patients’ confidence in self-care.

Conclusions:

The proposed statistical method exploits the potential of national survey data for causal inference studies and the results advocate patient portals and promote the need to provide better support and education to patients. It also urges randomized controlled studies to further investigate this identified treatment effect.