Active Use of Patient Portal Associated with Reduced Risk of Readmission, Study Finds

Jeremy Louissaint, MD

Credit: University of Texas Southwestern Medical Center

Using a patient portal to send messages may be associated with a reduced risk of 90-day and overall readmission among patients with decompensated cirrhosis, according to findings from a retrospective study.

Although the majority of study participants were enrolled in the patient portal and passive use was high at 98%, only moderately active use was associated with a reduced risk of readmission, highlighting the potential viability of this tool for addressing readmission rates related to cirrhosis.¹

“Although portal use has been characterized in multiple chronic conditions, data are lacking regarding both the patterns of patient portal use in persons with cirrhosis and whether portal activity modifies clinical outcomes,” wrote Jeremy Louissaint, MD, assistant professor of internal medicine at University of Texas Southwestern, and colleagues.¹

A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information. It can also be used to view test results, review clinical notes, and message healthcare providers. Given its apparent utility, the impact of patient portal use on clinical outcomes merits further research to explore its potential advantages for specific patient populations.²

Investigators sought to characterize patient portal use in patients with decompensated cirrhosis and evaluate its association with cirrhosis-related readmissions. To do so, they identified 131 patients with chart review–confirmed decompensated cirrhosis followed in the hepatology clinic at the University of Michigan Medical Center who had an index cirrhosis-related admission between May 1, 2018, and May 1, 2019.¹

Investigators defined decompensated cirrhosis as having a history of hepatic encephalopathy, ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatic hydrothorax, hepatopulmonary syndrome, or hepatorenal syndrome. Cirrhosis-related admission was defined as an admission related to ascites or volume management, kidney injury, infection, gastrointestinal bleeding, jaundice, and hepatic encephalopathy.¹

Patient portal enrollment and data from the 6 months preceding the study period were collected. Portal functions evaluated included sending a message, defined as active use of the portal, as well as reading a message and reading a test result, both of which were categorized as passive use of the portal. Use was further stratified as no, moderate, or frequent based on the frequency of portal function use compared to the mean among the cohort.¹

The study’s primary outcomes were 90-day and overall readmissions, adjusted for age, model for end-stage liver disease–sodium, alcohol-related cirrhosis etiology, ascites, and hepatic encephalopathy. An additional secondary outcome was the overall risk of readmission during follow-up based on active use.¹

Among the total study population, 50.4% (n = 66) of participants were female and the mean age was 58 years. The most common cirrhosis-related reasons for index admission were hepatic encephalopathy (31.3%), infection (31.3%), and ascites (18.3%).¹

Enrollment in the patient portal was 63.4% (n = 83). Investigators noted there were no significant differences in enrollment based on clinical or demographic characteristics.¹

For active use, defined by investigators as sending a message through the portal, 63.4% (n = 83) of patients were nonusers, 14.5% (n = 19) were moderate users, and 22.1% (n = 29) were frequent users. For passive use, defined as using the portal to read a message or test result, 41.2% (n = 54) and 42% (n = 55) of patients were moderate users, and 20.6% (n = 27) and 19.8% (n = 26) of patients were frequent users, respectively.¹

Investigators pointed out 97.6% (n = 81) of patients were moderate or frequent passive users for both reading a message and reading a test result. Upon analysis, moderate active users had less 90-day readmissions (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.60-1.00) and overall readmissions (subdistribution hazard ratio [sHR], 0.42; 95% CI, 0.21-0.84), compared to nonactive users.¹

Of note, there was no difference in the risk of 90-day readmission between frequent active users (OR, 0.93l 95% CI, 0.75-1.17) and nonusers. Additionally, investigators found no relationship between the frequency of passive portal use and the risk of 90-day readmission.¹

“Active use of the patient portal may be a helpful tool in addressing the inherently high readmission rates in cirrhosis. However, additional work is needed to identify possible confounders and refine key use behaviors of both patients and providers that may be protective or maladaptive in relation to the risk of readmission,” investigators concluded.¹

References:

1. Louissaint J, Gibbs J, Shenoy A, Cohen-Mekelburg S, Lok A, Tapper E. Patient Portal Use and Risk of Readmissions in Decompensated Cirrhosis: Retrospective Study. JMIR Form Res. 2023;7:e47080. Published 2023 Dec 19. doi:10.2196/47080
2. HealthIT.gov. What is a patient portal?. September 29, 2017. Accessed December 22, 2023. https://www.healthit.gov/faq/what-patient-portal