Role of Online Patient Portal Self-Scheduling and Self-Referral Pathways to Decrease Health Disparity for Screening Mammography

Ben Sadeghi; Julia Tran; Irene S Tsai; Gelareh Sadigh

doi:10.1016/j.jacr.2023.06.027

Role of Online Patient Portal Self-Scheduling and Self-Referral Pathways to Decrease Health Disparity for Screening Mammography

J Am Coll Radiol. 2023 Jul 27:S1546-1440(23)00534-3. doi: 10.1016/j.jacr.2023.06.027. Online ahead of print.

Authors

Ben Sadeghi¹, Julia Tran¹, Irene S Tsai², Gelareh Sadigh³

Affiliations

¹ Department of Radiological Sciences, University of California, Irvine, Orange, California.
² Department of Radiological Sciences, University of California, Irvine, Orange, California; Director of Breast Imaging, University of California, Irvine.
³ Department of Radiological Sciences, University of California, Irvine, Orange, California; Associate Editor, Journal of the American College of Radiology; Director of Health Services and Comparative Outcome Research, University of California, Irvine. Electronic address: gsadigh@uci.edu.

PMID: 37516158
DOI: 10.1016/j.jacr.2023.06.027

Abstract

Purpose: The aim of this study was to assess the rate of self-scheduling and self-referral for screening mammography (SM) and to assess sociodemographic factors associated with their use in an academic health care system in southern California.

Methods: Patients scheduled for SM between February 1, 2021, and September 20, 2022, were included in this retrospective study. Multivariable logistic regression models were used to assess associations among sociodemographic factors, self-referral, and online self-scheduling pathways.

Results: In total, 22,306 patients were scheduled for SM (mean age, 59 years; 66.8% white, 20.4% Asian, and 20.6% Hispanics). Overall, 3,566 (16.0%) used online self-scheduling, and 1,232 (5.5%) self-referred for SM. Patients 70 years or older (vs 50 years or younger) (OR, 0.41; 95% CI, 0.34-0.51), Spanish (vs English) speakers (OR, 0.22; 95% CI, 0.16-0.31), and those on Medicaid (vs commercially insured) (OR, 0.71; 95% CI, 0.50-0.99) were less likely to self-schedule. Hispanics (vs non-Hispanics) (OR, 1.39; 95% CI, 1.20-1.61), Asians (vs whites) (OR, 1.64; 95% CI, 1.46-1.85), and patients residing in the most (vs least) disadvantaged neighborhoods (OR, 1.16; 95% CI, 1.02-1.33) were more likely to self-schedule. Furthermore, patients 70 years or older (vs 50 or younger) (OR, 0.70; 95% CI, 0.52-0.93) and Spanish speakers (OR, 0.05; 95% CI, 0.03-0.09) were less likely to self-refer, whereas blacks (vs whites) (OR, 1.89; 95% CI, 1.30-2.75), patients on Medicaid (vs commercially insured) (OR, 3.70; 95% CI, 2.65-5.13), and patients living in the most (vs least) disadvantaged neighborhoods (OR, 1.52; 95% CI, 1.27-1.82) were more likely to self-refer.

Conclusions: Sociodemographic differences in online patient portal use and self-referral for SM suggest that the two pathways have been successful in addressing some of the existing scheduling barriers and are a step toward closing the disparity gap.

Keywords: Screening mammography; health disparity; self-referral; self-schedule.