High Tech and High Touch (HT2): Transforming Patient Engagement Through Portal Technology at the Bedside

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02943109

Enrollment

3782

Registered

2016-10-24

Start date

2016-12-31

Completion date

2020-04-30

Last updated

2024-07-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Electronic Health Records, Inpatient Facility Diagnoses, Outpatient, Physician-Patient Relations

Keywords

patient portal, Health Information Technology, Electronic Health Records, Inpatient Care, Outpatient Care, Patient Engagement

Brief summary

A large-scale randomized control trial (RCT) of the impact and use of an inpatient tablet-based patient portal embedded in a larger mixed methods study to examine changes in patient experiences and outcomes, and subsequent ambulatory patient portal usage.

Detailed description

The appropriate use of technology to actively engage with patients who suffer from multiple chronic conditions, called multimorbidity, is one of the frontiers of both research and practice. For multimorbid patients, engagement in disease management activities is particularly critical, and evidence shows that enhanced patient self-management can lead to better control of chronic illness. One tool finding increasing use is the patient portal, and its pervasiveness is supported by virtue of its role as a component of the Meaningful Use criteria. A patient portal is a tethered personal health record (tPHR) that links to the patient's electronic health record, facilitating communication and engagement activities with healthcare providers. While most tPHRs have been focused on outpatient activities, a new class of tools focused on the inpatient experience has begun deployment in 2014. In response, this study supports the conduct of the first, large-scale randomized control trial (RCT) of the impact and use of an inpatient tablet-based patient portal embedded in a larger mixed methods study to examine changes in patient experiences and outcomes, and subsequent ambulatory patient portal usage. The investigators aim to study how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by improving patients' perception of the process of care while in the hospital (patient experience), increasing patients' self-efficacy for managing their chronic conditions (patient engagement), and facilitating use of a patient portal for care management activities after discharge (patient engagement). The study site is a world-class healthcare facility with the ability to provide access to a patient portal designed specifically for the inpatient experience, bridging to outside the hospital after discharge. Currently, this inpatient technology exists in only one other hospital in the US, but the investigators expect that as inpatient PHRs become more readily available, the need for clarity on this issue will only increase. The investigator's evaluation is a mixed-methods design consisting of primary data collection through surveys and interviews throughout the study period, and secondary data collection from the electronic health record and health system metadata. This study will offer insight into a potentially important mechanism to facilitate patient self-management.

Interventions

OTHERHigh Touch

Participants receives an in person visit from an technology navigator who helps to explain the technology to the patient.

OTHERLow Touch

Participants receives a visit from a patient navigator who helps to explain how to navigate the hospital system (active control).

OTHERHigh Tech

Patient receives full-suite access to an inpatient patient portal with bi-directional communication enabled.

OTHERLow Tech

Patient receives a limited access version of the inpatient patient portal with bi-directional communication disabled.

Study design

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE (Subject)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* patient accepted MyChart Bedside tablet * patient available in their room * capable of providing informed consent

Exclusion criteria

* Patient in a pilot unit where Full Tech was available prior to study start * Patient was less than 18 years of age

Design outcomes

Primary

Measure	Time frame	Description
Patient Involvement With Care - Tablet's Activities	15 days after discharge.	Questions from the involvement with care domain of the 15-day Post-discharge surveys were used to assess patient involvement with their care. Answers to the following multiple-choice survey item were explored: What kind of activities did you use the table for? (mark all that apply).
Patient Satisfaction With Care - Interactions With Healthcare Professionals	15 days after discharge	Questions from the satisfaction and experience domains of the 15-day Post-discharge surveys were used to assess patient satisfaction with their care. Answers to the following 5-point Likert scale survey item were explored: In your most recent hospital experience, how satisfied were you with the interactions you had with your healthcare professionals? . Responses were dichotomized to one most positive response versus all other responses.
Patient Involvement With Care - Questions About Health Management	15 days after discharge.	Questions from the involvement with care domain of the 15-day Post-discharge surveys were used to assess patient involvement with their care. Answers to the following 5-point Likert scale survey item were explored: All of my questions about managing my health, including my medications, were addressed before I left the hospital.. Responses were dichotomized to one most positive response versus all other responses.
Patient Involvement With Care - Finding Answers to Health Management Questions	15 days after discharge.	Questions from the involvement with care domain of the 15-day Post-discharge surveys were used to assess patient involvement with their care. Answers to the following multiple-choice survey item were explored: If you had a question about your care while you were in the hospital, what steps did you take to find an answer? (mark all that apply).
Patient Satisfaction With Care - Responses From Healthcare Professionals	15 days after discharge	Questions from the satisfaction and experience domains of the 15-day Post-discharge surveys were used to assess patient satisfaction with their care. Answers to the following 5-point Likert scale survey item were explored: In your most recent hospital experience, how satisfied were you with how well your healthcare professionals responded to your concerns? . Responses were dichotomized to one most positive response versus all other responses.
Inpatient Portal Use Frequency	At hospital discharge.	The count of MyChart Bedside (inpatient portal) sessions for the admission associated with study enrollment.
Inpatient Portal Comprehensiveness of Use	At hospital discharge.	Based on the use of all available MyChart Bedside (inpatient portal) functions, a comprehensive inpatient portal user was one who used all three functions - for patients in the low tech assignment - or used eight or more functions - for patients in the high tech assignment.
Inpatient Portal Functions Proportion of Use	At hospital discharge.	For each MyChart Bedside (inpatient portal) function available to patients assigned to high tech, a proportion of total use is calculated for each patient as the sum of actions in a given function divided for the total sum of user actions during the hospital admission associated with study enrollment.

Secondary

Measure	Time frame	Description
Outpatient Portal Frequency of Use	3 months post-discharge	Count of MyChart (outpatient portal) sessions (based on log file analysis).
Self-Efficacy	Baseline	5-point Likert scale built on the participant responses to 6 self-efficacy-related items from the admission survey. Self-efficacy measures the belief in one's capacity to complete a task, rather than the relevant skills possessed. Scale developed on the basis of Bandura, A. (2006). Guide for constructing self-efficacy scales. In F. Pajares & T. Urdan (Eds.). Self-Efficacy Beliefs of Adolescent. Greenwich, CT: Information Age Publishing, pp. 307-337. Self-Efficacy scale: * min value: 1; * max value: 5; * higher scores are better outcomes.
Outpatient Portal Adoption	3 months post-discharge	MyChart (outpatient portal) accounts activated by participants after their enrollment in the study (based on log file analysis).

Countries

United States

Participant flow

Pre-assignment details

Of the 3,782 enrolled participants, 2,892 met the study inclusion criteria and were randomized to one of the four study arms. Of those excluded: * 734 had an enrollment admission \< 3 days; * 17 had no inpatient portal use on record; * 139 switched Tech assignment.

Participants by arm

Arm	Count
High Tech, High Touch Patient receives the full version of MyChart Bedside. Patient receives training/intervention from technology navigator High Touch: Participants receives an in person visit from an technology navigator who helps to explain the technology to the patient. High Tech: Patient receives full-suite access to an inpatient patient portal with bi-directional communication enabled.	1,242
Low Tech, High Touch Patient receives the non-interactional version of MyChart Bedside. Patient receives training/intervention from technology navigator High Touch: Participants receives an in person visit from an technology navigator who helps to explain the technology to the patient. Low Tech: Patient receives a limited access version of the inpatient patient portal with bi-directional communication disabled.	470
High Tech, Low Touch Patient receives the full version of MyChart Bedside. Patient receives online training, only Low Touch: Participants receives a visit from a patient navigator who helps to explain how to navigate the hospital system (active control). High Tech: Patient receives full-suite access to an inpatient patient portal with bi-directional communication enabled.	905
Low Tech, Low Touch Patient receives the non-interactional version of MyChart Bedside. Patient receives online training, only Low Touch: Participants receives a visit from a patient navigator who helps to explain how to navigate the hospital system (active control). Low Tech: Patient receives a limited access version of the inpatient patient portal with bi-directional communication disabled.	275
Total	2,892

Baseline characteristics

Characteristic	High Tech, High Touch	Low Tech, High Touch	High Tech, Low Touch	Low Tech, Low Touch	Total
Age, Continuous	46 years	48 years	47 years	48 years	47 years
Charlson Comorbidity Index	1 units on a scale	1 units on a scale	2 units on a scale	2 units on a scale	1 units on a scale
Race/Ethnicity, Customized Black	225 Participants	81 Participants	186 Participants	58 Participants	550 Participants
Race/Ethnicity, Customized Other	41 Participants	21 Participants	44 Participants	15 Participants	121 Participants
Race/Ethnicity, Customized White	976 Participants	368 Participants	675 Participants	202 Participants	2221 Participants
Sex: Female, Male Female	709 Participants	256 Participants	521 Participants	155 Participants	1641 Participants
Sex: Female, Male Male	533 Participants	214 Participants	384 Participants	120 Participants	1251 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk	EG003 affected / at risk
deaths Total, all-cause mortality	0 / 0	0 / 0	0 / 0	0 / 0
other Total, other adverse events	0 / 0	0 / 0	0 / 0	0 / 0
serious Total, serious adverse events	0 / 0	0 / 0	0 / 0	0 / 0

Outcome results

Primary

Inpatient Portal Comprehensiveness of Use

Based on the use of all available MyChart Bedside (inpatient portal) functions, a comprehensive inpatient portal user was one who used all three functions - for patients in the low tech assignment - or used eight or more functions - for patients in the high tech assignment.

Time frame: At hospital discharge.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
High Tech, High Touch	Inpatient Portal Comprehensiveness of Use	697 Participants
Low Tech, High Touch	Inpatient Portal Comprehensiveness of Use	292 Participants
High Tech, Low Touch	Inpatient Portal Comprehensiveness of Use	253 Participants
Low Tech, Low Touch	Inpatient Portal Comprehensiveness of Use	104 Participants

Primary

Inpatient Portal Functions Proportion of Use

For each MyChart Bedside (inpatient portal) function available to patients assigned to high tech, a proportion of total use is calculated for each patient as the sum of actions in a given function divided for the total sum of user actions during the hospital admission associated with study enrollment.

Time frame: At hospital discharge.

Arm	Measure	Group	Value (MEAN)	Dispersion
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Dining on Demand	0.20 Proportion of total use	Standard Deviation 0.17
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Tutorial	0.16 Proportion of total use	Standard Deviation 0.18
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	To Learn	0.02 Proportion of total use	Standard Deviation 0.04
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	My Health	0.11 Proportion of total use	Standard Deviation 0.15
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Happening Soon	0.39 Proportion of total use	Standard Deviation 0.23
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Notes	0.00 Proportion of total use	Standard Deviation 0
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Messages	0.03 Proportion of total use	Standard Deviation 0.04
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	I Would Like	0.00 Proportion of total use	Standard Deviation 0.01
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	MyChart	0.03 Proportion of total use	Standard Deviation 0.04
High Tech, High Touch	Inpatient Portal Functions Proportion of Use	Taking Care of Me	0.05 Proportion of total use	Standard Deviation 0.04
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	I Would Like	0.00 Proportion of total use	Standard Deviation 0.01
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Dining on Demand	0.22 Proportion of total use	Standard Deviation 0.2
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Notes	0.00 Proportion of total use	Standard Deviation 0
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Tutorial	0.19 Proportion of total use	Standard Deviation 0.22
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	To Learn	0.01 Proportion of total use	Standard Deviation 0.05
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Taking Care of Me	0.04 Proportion of total use	Standard Deviation 0.05
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Messages	0.03 Proportion of total use	Standard Deviation 0.05
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	My Health	0.10 Proportion of total use	Standard Deviation 0.17
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	MyChart	0.03 Proportion of total use	Standard Deviation 0.04
Low Tech, High Touch	Inpatient Portal Functions Proportion of Use	Happening Soon	0.37 Proportion of total use	Standard Deviation 0.25

Primary

Inpatient Portal Use Frequency

The count of MyChart Bedside (inpatient portal) sessions for the admission associated with study enrollment.

Time frame: At hospital discharge.

Arm	Measure	Value (MEAN)	Dispersion
High Tech, High Touch	Inpatient Portal Use Frequency	29 Inpatient portal sessions	Standard Deviation 31
Low Tech, High Touch	Inpatient Portal Use Frequency	21 Inpatient portal sessions	Standard Deviation 18
High Tech, Low Touch	Inpatient Portal Use Frequency	29 Inpatient portal sessions	Standard Deviation 36
Low Tech, Low Touch	Inpatient Portal Use Frequency	20 Inpatient portal sessions	Standard Deviation 26

Primary

Patient Involvement With Care - Finding Answers to Health Management Questions

Questions from the involvement with care domain of the 15-day Post-discharge surveys were used to assess patient involvement with their care. Answers to the following multiple-choice survey item were explored: If you had a question about your care while you were in the hospital, what steps did you take to find an answer? (mark all that apply).

Time frame: 15 days after discharge.