PDF(Pubmed)
Abstract：
UNASSIGNED: The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals.
UNASSIGNED: The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic.
UNASSIGNED: This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system\'s Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse.
UNASSIGNED: Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity.
UNASSIGNED: Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.
UNASSIGNED: The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic.
UNASSIGNED: This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system\'s Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse.
UNASSIGNED: Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity.
UNASSIGNED: Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.
摘要：
■COVID-19大流行加速了远程医疗和移动应用程序的使用，有可能改变我们产妇护理的历史模式。MyChart是一种广泛采用的移动应用程序，用于医疗保健环境，特别是其在安全的患者门户中的消息传递功能促进医疗保健提供者和患者之间的通信。然而,先前分析产科人群门户使用的研究表明，在门户注册和消息传递方面存在显著的社会人口统计学差异，特别显示低收入和非西班牙裔黑人的患者，西班牙裔,没有保险的人不太可能使用患者门户。
■该研究旨在评估大流行前和期间患者门户使用和产前护理强度的变化，并确定大流行期间持续的社会人口统计学和临床差异。
■这项回顾性队列研究使用了来自我们卫生系统的企业数据仓库的电子病历（EMR）和管理数据。从2018年1月1日至2021年7月22日在芝加哥的大型城市学术医疗中心，获得了在8个学术附属诊所接受产前护理的所有患者的第一次妊娠记录。伊利诺伊州。所有患者年龄均为18岁或以上，在使用EMR门户的实践中，在怀孕期间参加了≥3次临床治疗。根据怀孕期间发送的安全消息的数量将患者分类为非用户或不频繁（≤5条消息）。中等（6-14条消息），或频繁(≥15条消息)用户。每月门户使用率和强度率是在2018年至2021年之前的43个月内计算的，during,在COVID-19大流行关闭后。估计了一个逻辑回归模型来识别患者的社会人口统计学和临床亚组，这些亚组的门户使用率最高。
■在12,380名患者中，2681（21.7%）从未使用过门户，和2680（21.6％），3754（30.3%），和3265（26.4%）是罕见的，中度,和频繁的用户，分别。在研究期间，门户的使用和强度显着增加，特别是在大流行之后。2018年至2021年期间，未使用患者的数量从2018年的3522人中的996人（28.3%）下降到2021年前7个月的1743人中的227人（13%）。相反，15条或更多信息的患者数量增加了一倍，从2018年的3522人中的642人（18.2%）到2021年的1743人中的654人（37.5%）。最年轻的病人,非西班牙裔黑人和西班牙裔患者，and,特别是,非英语患者继续不使用的可能性显著较高.先前存在合并症的患者，妊娠高血压疾病，糖尿病,精神健康病史均与较高的门户使用和强度显著相关.
■缩小信息使用方面的差异需要向低使用率患者群体提供外展和帮助，包括针对健康素养的教育，并鼓励适当和有效地使用信息传递。
■该研究旨在评估大流行前和期间患者门户使用和产前护理强度的变化，并确定大流行期间持续的社会人口统计学和临床差异。
■这项回顾性队列研究使用了来自我们卫生系统的企业数据仓库的电子病历（EMR）和管理数据。从2018年1月1日至2021年7月22日在芝加哥的大型城市学术医疗中心，获得了在8个学术附属诊所接受产前护理的所有患者的第一次妊娠记录。伊利诺伊州。所有患者年龄均为18岁或以上，在使用EMR门户的实践中，在怀孕期间参加了≥3次临床治疗。根据怀孕期间发送的安全消息的数量将患者分类为非用户或不频繁（≤5条消息）。中等（6-14条消息），或频繁(≥15条消息)用户。每月门户使用率和强度率是在2018年至2021年之前的43个月内计算的，during,在COVID-19大流行关闭后。估计了一个逻辑回归模型来识别患者的社会人口统计学和临床亚组，这些亚组的门户使用率最高。
■在12,380名患者中，2681（21.7%）从未使用过门户，和2680（21.6％），3754（30.3%），和3265（26.4%）是罕见的，中度,和频繁的用户，分别。在研究期间，门户的使用和强度显着增加，特别是在大流行之后。2018年至2021年期间，未使用患者的数量从2018年的3522人中的996人（28.3%）下降到2021年前7个月的1743人中的227人（13%）。相反，15条或更多信息的患者数量增加了一倍，从2018年的3522人中的642人（18.2%）到2021年的1743人中的654人（37.5%）。最年轻的病人,非西班牙裔黑人和西班牙裔患者，and,特别是,非英语患者继续不使用的可能性显著较高.先前存在合并症的患者，妊娠高血压疾病，糖尿病,精神健康病史均与较高的门户使用和强度显著相关.
■缩小信息使用方面的差异需要向低使用率患者群体提供外展和帮助，包括针对健康素养的教育，并鼓励适当和有效地使用信息传递。
