Primary Care Practice Reengineering and Associations With Patient Portal Use, Service Utilization, and Disease Control Among Patients With Hypertension and/or Diabetes

Ochsner J. 2017 Spring;17(1):103-111.


Background: We describe the role of primary care reengineering in the Ochsner Health System (OHS) patient portal implementation strategy and compare subsequent trends in service utilization and disease control among portal users vs nonusers within this context.

Methods: This retrospective cohort study includes 101,019 patients with hypertension or diabetes who saw an OHS primary care provider (PCP) between 2012 and 2014. Inverse probability treatment weighting was used to reduce case-mix differences between study groups. We used generalized estimating equation modeling to compare changes in encounter rates (PCP, telephone, specialty services, emergency department [ED], inpatient hospitalization), blood pressure (BP), and hemoglobin A1c (HbA1c).

Results: Age, sex, race, comorbidities, insurance, preindex utilization, and portal use were associated with changes in utilization, BP, and HbA1C; however, the strength and direction of these differences varied. An adjusted analysis comparing portal users to nonusers showed an increase in PCP (rate ratio per patient per year of 1.18, 95% confidence interval [CI] 1.14-1.22) and telephone encounter rates (1.15, 95% CI 1.08-1.22; both P<0.001) but no significant differences in specialty, ED, or inpatient hospitalization encounters. Among patients with preindex systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, portal users compared to nonusers had a greater decline in their BP, although the between-group difference was small (mmHg [SE], -1.1 [0.42] and -1.2 [0.34], respectively; both P<0.01). Portal users with diabetes compared to nonusers with diabetes also had greater decreases in HbA1c (all patients, % [SE], -0.13 [0.06]; patients with a preindex HbA1c ≥8, -0.43 [0.13], both P<0.05).

Conclusion: Our findings may reflect patient factors and system-level portal implementation strategies that focused heavily on accessibility to care.

Keywords: Diabetes mellitus; health care quality, access, and evaluation; hypertension; patient portals; primary health care; utilization.