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Sun, Ran (2019) PATIENT PORTAL USE AND ITS ASSOCIATION WITH CLINICAL OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: The rapid growth of type 2 diabetes mellitus (T2DM) in the United States presents significant challenges. Patient portals are promising tools that address the increasing number of individuals with T2DM and engage these people in the process of managing their chronic condition. Objectives: The purposes of this study were: 1) to describe the portal usage pattern by individuals with T2DM over the two-year study period; 2) to identify whether sociodemographic, socioeconomic, and clinical characteristics differ between portal users and non-users; and 3) to longitudinally examine the effect of portal use on glycemic control in patients with T2DM. Methods: This two-year retrospective, observational cohort study utilized data from the ambulatory electronic health records (EHR) of the University of Pittsburgh Medical Center (UPMC) Physician Services and its ancillary patient portal. The study included adults seen in an outpatient setting of UPMC between January 2015 and December 2016. We applied descriptive statistics to describe sample characteristics and portal usage patterns. Logistic regression was used to examine factors associated with portal use. A propensity score matching (PSM) technique was conducted to equate the portal user and non-user groups, and mixed modeling was performed to examine the effect of portal use on hemoglobin A1c (HbA1c) over time. Results: Nearly one-third of the individuals (n=12,615, 32.9%, 95% CI: [32.3%,33.3%]) with T2DM used the portals. An increased portal usage was observed before and after a physician visit, and on weekdays compared to weekends (p<0.001). In general, we found associations of age, race, income, and the number of chronic conditions with portal usage, and several other predictors modified these effects (ps<0.05). After PSM, both groups showed a non-linear decline of HbA1c over time (p<.001), and the portal users (n=4,924) demonstrated a greater decrease and better maintenance than the non-users (n=4,924, p<.001). Conclusions: Our findings highlight the promising effect of a patient portal on clinical glycemic control in persons with T2DM. Disparities in patient portals need to be addressed to bridge the existing gaps in diabetes outcomes. Future study should explore mechanisms through which the portal contributes to better clinical outcomes to guide evidence-based portal design and implementation.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Sun, Ranras186@pitt.eduras1860000-0002-5181-3242
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee MemberSereika, Susan M.ssereika@pitt.edussereika
Committee MemberKorytkowski, Marymtk7@pitt.edumtk7
Committee MemberSaul, Melissamis18@pitt.edumis18
Committee MemberLi, Dandal144@pitt.edudal144
Committee ChairBurke, Loralbu100@pitt.edulbu100
Date: 22 April 2019
Date Type: Publication
Defense Date: 14 January 2019
Approval Date: 22 April 2019
Submission Date: 19 February 2019
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 116
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Diabetes Mellitus; Electronic Health Record; Patient Portal; Personal Health Record
Date Deposited: 22 Apr 2019 19:07
Last Modified: 22 Apr 2020 05:15


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