JMIR Publications

ABSTRACT

Background:

Online patient portals enable patients access to, and interaction with, their personal electronic health records. Although there is increasing adoption of patient portals in many healthcare systems, little is known about the impact of patient portals on quality of care.

Objective:

The aims of this study were i) to evaluate patients’ perceptions of the impact of an online patient portal on the six domains of quality of care and ii) to identify which segments of the population perceive improved overall quality of care and greater satisfaction with care with portal use.

Methods:

A cross-sectional web-based survey study was undertaken to understand patients’ experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured by the eHEALS tool). Patients with experience of using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine’s six domains of quality of care. Patients’ responses were examined to understand their perceptions of the impact of portal use on overall quality of care, the six domains of care quality, and patient’s satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with i) perceived improvements in overall care quality, and ii) greater satisfaction with care, with CIE use.

Results:

Of 445 respondents, 38.7% (n=172) reported that the overall quality of their care was better with CIE; only 3.2% of patients (n=14) said their care was worse. In the patient-centredness domain, 61.2% (n=273) of patients felt more in control of their healthcare and 53.9% (n=240) felt able to play a greater role in decision-making. Regarding timeliness of care, 40.2% of patients (n=179) reported they could access appointments, diagnoses, and treatment more quickly with CIE use. Around thirty percent of patients perceived that CIE use had led to improvements in the quality of their care across the following domains: effectiveness (27.6% of patients; n=123), safety (31.0%; n=138), and efficiency (28.6%; n=174). Regarding equity, patients from ethnic minority groups (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.35-3.80, P<.002) and those with higher digital health literacy (OR 2.61, 95%CI 1.18-5.78, P=.02) were more likely to perceive improvements in overall care quality with CIE use. Patients from ethnic minority groups (OR 2.40, 95%CI 1.39-4.16, P=.002), males (OR 1.65, 95%CI 1.07-2.55, P=.02), and those with higher digital health literacy (OR 2.68, 95%CI 1.26-5.70, P=.01) were also more likely to be satisfied with their care because of CIE.

Conclusions:

A large proportion patients report improvements in overall quality of care with use of an online patient portal. Patient-reported improvements were identified across all six domains of care quality with the most favourable in the domain of patient-centredness. Patient from ethnic minority backgrounds and those with higher digital health literacy were more likely to report that CIE had improved the overall quality of their care. With national policy directed towards addressing health disparities, online patient portals could be valuable in improving care quality for at-risk patients in ethnic minority groups. Further research should determine which interventions are effective in enabling digitally disempowered patients to benefit from online patient portals.