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

Not Applicable

Completed

Conditions: Inpatient Facility Diagnoses
Electronic Health Records
Physician-Patient Relations
Outpatient

Interventions: Other: High Touch
Other: Low Touch
Other: High Tech
Other: Low Tech

Registration Number: NCT02943109

Lead Sponsor: Ohio State University

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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 3782

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Low tech, high touch	High Touch	Patient receives the non-interactional version of MyChart Bedside. Patient receives training/intervention from technology navigator
High tech, high touch	High Touch	Patient receives the full version of MyChart Bedside. Patient receives training/intervention from technology navigator
High tech, high touch	High Tech	Patient receives the full version of MyChart Bedside. Patient receives training/intervention from technology navigator
Low tech, high touch	Low Tech	Patient receives the non-interactional version of MyChart Bedside. Patient receives training/intervention from technology navigator
High tech, low touch	Low Touch	Patient receives the full version of MyChart Bedside. Patient receives online training, only
High tech, low touch	High Tech	Patient receives the full version of MyChart Bedside. Patient receives online training, only
Low tech, low touch	Low Touch	Patient receives the non-interactional version of MyChart Bedside. Patient receives online training, only
Low tech, low touch	Low Tech	Patient receives the non-interactional version of MyChart Bedside. Patient receives online training, only

Primary Outcome Measures

Name	Time	Method
Patient Satisfaction With Care - Interactions With Healthcare Professionals	6 months after discharge	Questions from the satisfaction and experience domains of the 6-month 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)".
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.
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)".
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.
Patient Satisfaction With Care - Responses From Healthcare Professionals	6 months after discharge	Questions from the satisfaction and experience domains of the 6-month 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 the past 6 months, 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.

Secondary Outcome Measures

Name	Time	Method
Self-Efficacy	6 months post-discharge	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).
Outpatient Portal Frequency of Use	3 months post-discharge	Count of MyChart (outpatient portal) sessions (based on log file analysis).