JMIR Publications

ABSTRACT

Background:

The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Since a secure message thread is considered most like an in-person clinic encounter, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes.

Objective:

To examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes.

Methods:

We applied a theory-based taxonomy to 14394 patient- and clinic staff-generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 51% of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic levels (A1C) in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension.

Results:

Patients who initiated threads had larger declines in A1Cs (P=0.01) compared to patients who did not initiate threads. Clinic non-response was associated with decreased SBP (beta=-0.30; 95% CI: -0.56, -0.04), as were staffs’ action responses (beta=-0.30; 95% CI: -0.58, -0.02). Increased DBP, SBP, and A1C were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (beta=-4.03; 95% CI: -7.94, -0.12). Deferred information sharing by clinic staff was associated with increased SBP (beta=1.29; 95% CI: 0.4-2.19).

Conclusions:

This is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, healthcare providers should be aware that their message content may influence patient health outcomes.