Background: The recent passage of the 21st Century Cures Act “open notes” mandate underscores the central role of patient portals in the healthcare system. Additionally, the use of patient portals such as MyChart has been associated with greater patient engagement and improved health outcomes[1]. At our institution, we aimed to characterize the patient demographics associated with MyChart status upon discharge and to investigate the relationship between MyChart status, readmissions, and completion of outpatient follow-up visits.
Methods: A retrospective analysis of patients (n = 1195) discharged from a general medicine inpatient unit between November 1, 2020 and October 1, 2021 was performed. The primary variables assessed were patient age, gender, race, language, MyChart status on admission and at discharge, outpatient visit status, and readmission within 30 days. Race was divided into the categories of Asian, Non-Hispanic White, Non-Hispanic Black, Hispanic, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Other Race. Patients were divided into age groups by decile. Language was categorized as English, Spanish, or other. Pearson’s Chi Square and Fisher’s Exact Test were employed, and multivariate analyses were conducted using logistic regression.
Results: MyChart status differed significantly according to self-identified race (P < 0.001) and age (P < 0.005), whereas MyChart status was not significantly associated with language. 63% of Non-Hispanic Black patients had an active MyChart status upon discharge, the lowest proportion among all racial groups. In comparison, 77% of Non-Hispanic White patients had an active MyChart. A multivariate logistic regression for MyChart status including age, gender, and race revealed that age (P < 0.05), Non-Hispanic White race (P < 0.001), and Asian race (P < 0.001) were significantly associated with an active MyChart status. Multivariate regression analysis of 30-day readmission based on age and MyChart status at discharge revealed only age as a significant risk-factor (P < 0.05). As seen in Figure 1, the proportion of patients who attended an outpatient visit after discharge was significantly greater among patients with an active MyChart status than patients with an inactive MyChart status (P < 0.0001). Outpatient visit completion was also statistically different according to race (P < 0.01) and age (P < 0.0005). Patients aged 90 to 100 years old and Non-Hispanic Black patients demonstrated the lowest outpatient visit completion rates: 35% and 49%, respectively.
Conclusions: Significant differences in MyChart status exist based on age and race. These differences may be related to disparities in post-discharge outpatient visit completion, negatively impacting patient outcomes. Further research is warranted to determine how to better engage older and minority patients through the MyChart portal to promote more equitable transitions of care.
