How outcomes are achieved through patient portals: a realist review
Open Access
- 6 February 2014
- journal article
- review article
- Published by Oxford University Press (OUP) in Journal of the American Medical Informatics Association
- Vol. 21 (4), 751-757
- https://doi.org/10.1136/amiajnl-2013-002501
Abstract
Objective To examine how patient portals contribute to health service delivery and patient outcomes. The specific aims were to examine how outcomes are produced, and how variations in outcomes can be explained. Methods We used a realist review method, which aims to describe how ‘an intervention works, for whom, and in what circumstances' by analyzing patterns between context, mechanism, and outcomes. We reviewed 32 evaluation studies of patient portals published since 2003. Results The reviewed evaluations indicate that as a complement to existing health services, patient portals can lead to improvements in clinical outcomes, patient behavior, and experiences. Four different mechanisms are reported to yield the reported outcome improvements. These are patient insight into personal health information, activation of information, interpersonal continuity of care, and service convenience. The vast majority of evaluations were conducted in integrated health service networks in the USA, and we detected no substantial variation in outcomes across these networks. Discussion and conclusions Patient portals may impact clinical outcomes and health service delivery through multiple mechanisms. Given the relative uniformity of evaluation contexts, we were not able to detect patterns in how patient portals work in different contexts. Nonetheless, it appears from the overwhelming proportion of patient portal evaluations coming from integrated health service networks, that these networks provide more fertile contexts for patient portals to be effective. To improve the understanding of how patient portals work, future evaluations of patient portals should capture information about mechanisms and context that influence their outcomes.Keywords
This publication has 38 references indexed in Scilit:
- Internet portal use in an academic multiple sclerosis centerJournal of the American Medical Informatics Association, 2012
- The Association Between Personal Health Record Use and Diabetes Quality MeasuresJournal of General Internal Medicine, 2011
- Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHRJournal of General Internal Medicine, 2011
- Personal health records: a scoping reviewJournal of the American Medical Informatics Association, 2011
- Randomized Trial of Depression Follow-Up Care by Online MessagingJournal of General Internal Medicine, 2011
- Patient Web Portals to Improve Diabetes Outcomes: A Systematic ReviewCurrent Diabetes Reports, 2010
- Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension ControlJAMA, 2008
- Realist review to understand the efficacy of school feeding programmesBMJ, 2007
- Potential of electronic personal health recordsBMJ, 2007
- Diffusion of Innovations in Service Organizations: Systematic Review and RecommendationsThe Milbank Quarterly, 2004