Improving Outpatient Safety of Older Adults through Electronic Patient Portals
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DESCRIPTION (provided by applicant): The overall objective of this study is to assess whether providing caregivers of older adults proxy access to an Electronic Patient Portal improves the outpatient medication safety and communication between caregivers and health care providers. Many older adults rely on caregivers to maintain their health and remain in their own home. It is estimated that there are over 46 million caregivers nationally, with 83% providing care for relatives. Caregivers are frequently responsible for health-related tasks such as medication reminding and communicating condition updates with physicians. However, the support that caregivers receive is limited. Electronic Patient Portals (EPPs) securely linked to electronic health records (EHR) offer a means of personalized support for caregivers. EPPs allow access to appointment information, current medications, and also facilitate physician-health care team communication through secure messaging. Online patient portals are available 24 hours a day, 7 days a week, which potentially improves accessibility for busy caregivers. No studies have examined how EPP usage by caregivers can improve the home-based care of older adults or what factors impact EPP usage by caregivers. The aims of this feasibility study are: Aim 1: Investigate whether Electronic Patient Portal usage by caregivers facilitates the accuracy of outpatient medication reconciliation and health care provider communication. Aim 2: Identify caregiver and older adult characteristics that correlate with usage and non-usage of Electronic Patient Portals (e.g. patient lives in different residences during the year, complex medical history. Aim 3: Determine barriers to EPP usage among caregivers and potential means of improving EPP usability. This study will be the first to examine whether providing caregiver access to an EPP can improve care. We will recruit 100 caregivers from the Northwestern Medical Faculty Foundation General Internal Medicine and Geriatrics clinics which currently uses the EPIC MyChart EPP with patients (but not caregivers). The senior/POA must agree to allow a caregiver access to their chart prior to enrollment. Caregivers will be recruited who (1) provide care to community-dwelling seniors > 64 years, (2) are responsible for medications and physician communication, and (3) have internet access. Following recruitment, a research assistant will teach the caregiver how to use the EPP. One week later, a research nurse will perform a home visit to directly assess medication reconciliation and EPP usage. Four months following recruitment, data will be collected from the EHR on EPP usage and caregivers will be sent an internet-based survey eliciting level of satisfaction, perceived barriers, and means for improving EPP use. Results from this study will provide the foundation for future interventions using EPPs to improve the safety and quality of seniors' outpatient care.
