Abstract
Background/Aims Patient use of web portals to interact with their healthcare delivery system and healthcare providers could improve the quality and safety of care. Among patients with diabetes in a large integrated delivery system (IDS), we examined the association between patient use of the web portals and cholesterol test results.
Methods The health system implemented a web-based tool for all patients who registered to use the website in November 2005, allowing members to securely access a personal health record, as well as e-mail their physicians, and view their lab results. In this study, we defined patients as web-portal users when patients emailed their physicians or viewed lab results at the first time. We examined the association of patient web-portal use and low-density lipoprotein cholesterol (LDL) level using linear regression with fixed effect at patient level, adjusting for medical center electronic health record (EHR) implementation, quarter for seasonality, and year for temporal trend.
Results The 169,711 patients in the IDS diabetes registry at the start of 2004 were followed through 2009. The number of patients who had used patient web-portal increased dramatically from 16% in 2006 to 35% in 2009. During 2004–2009, a total number of 1,070,856 LDL tests were performed among the study subjects and 18% of the tests were done after patients used the web-portal. Overall patient web-portal use was associated with reduction of LDL value by 0.81 mg/dL (95% CI: 0.64–0.97). Further examination among patients stratified by their baseline LDL (last value in 2003) showed that the largest reduction in LDL was found among those with worst control: on average, LDL level dropped by 0.36 mg/dL (95% CI: 0.14–0.57) among those with baseline LDL <100 mg/dL, 0.90mg/dL (95% CI: 0.63–1.18) among those with baseline LDL 100- <130mg/dL, and 2.04 mg/dL (95% CI: 1.59–2.50) among those with baseline LDL >130 mg/dL.
Conclusions Patient use of a web-based portal to review laboratory results or email their clinicians increased substantially between 2006 and 2009. Patient use of web portals was associated with improvement of LDL level, with greater improvement among patients in worse control.
