Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity
The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined...
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| Published in: | JAMA network open Vol. 7; no. 3; p. e242618 |
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| Language: | English |
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American Medical Association
18.03.2024
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| Abstract | The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication.
To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.
In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.
Patient race and ethnicity.
Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.
A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.
The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms. |
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| AbstractList | The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication.ImportanceThe COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication.To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.ObjectiveTo examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.Design, Setting, and ParticipantsIn a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.Patient race and ethnicity.ExposurePatient race and ethnicity.Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.Main Outcomes and MeasuresRates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.ResultsA total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.Conclusions and RelevanceThe findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms. ImportanceThe COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient–care team communication.ObjectiveTo examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.Design, Setting, and ParticipantsIn a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.ExposurePatient race and ethnicity.Main Outcomes and MeasuresRates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.ResultsA total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, −5.34 to −2.57 pp;P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp;P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.Conclusions and RelevanceThe findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms. The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication. To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups. In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023. Patient race and ethnicity. Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded. A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients. The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms. This cross-sectional study assesses differences in care team response to patient portal messages by patient race and ethnicity among primary care patients in the US. |
| Author | Tang, Mitchell Mishuris, Rebecca G. Stern, Ariel D. Payvandi, Lily |
| AuthorAffiliation | 2 Harvard Business School, Boston, Massachusetts 6 Boston University School of Medicine, Boston, Massachusetts 4 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 1 Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts 3 Digital, Mass General Brigham, Somerville, Massachusetts 7 Harvard-MIT Center for Regulatory Science, Boston, Massachusetts 5 Department of Family Medicine, Boston Medical Center, Boston, Massachusetts |
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| Author_xml | – sequence: 1 givenname: Mitchell surname: Tang fullname: Tang, Mitchell organization: Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts, Harvard Business School, Boston, Massachusetts – sequence: 2 givenname: Rebecca G. surname: Mishuris fullname: Mishuris, Rebecca G. organization: Digital, Mass General Brigham, Somerville, Massachusetts, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts – sequence: 3 givenname: Lily surname: Payvandi fullname: Payvandi, Lily organization: Department of Family Medicine, Boston Medical Center, Boston, Massachusetts, Boston University School of Medicine, Boston, Massachusetts – sequence: 4 givenname: Ariel D. surname: Stern fullname: Stern, Ariel D. organization: Harvard Business School, Boston, Massachusetts, Harvard-MIT Center for Regulatory Science, Boston, Massachusetts |
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| Cites_doi | 10.2196/preprints.46939 10.1001/jama.2022.24710 10.1001/jamainternmed.2023.1838 10.1007/s11606-021-06682-z 10.1377/hlthaff.2021.01423 10.1001/jama.2021.13304 10.1093/jamia/ocab268 10.1377/hlthaff.2016.1651 10.1001/jamanetworkopen.2020.29650 10.2105/AJPH.2015.302903 10.1016/S2589-7500(23)00225-X 10.1093/jamia/ocz023 10.1126/science.aax2342 10.1186/s12889-016-3621-9 10.1287/mnsc.2017.2900 10.1111/milq.v100.3 |
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| Snippet | The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new... ImportanceThe COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a... This cross-sectional study assesses differences in care team response to patient portal messages by patient race and ethnicity among primary care patients in... |
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| SubjectTerms | Adult Aged Asian Black or African American Cross-Sectional Studies Equity, Diversity, and Inclusion Ethnicity Female Hispanic or Latino Humans Male Medical personnel Middle Aged Minority & ethnic groups Online Only Original Investigation Pandemics Patient Portals Patients Race Teams Web portals White |
| Title | Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity |
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