Background: Improving patient-provider communication is crucial for promoting a shared understanding of the care plan among patients and providers. Increasingly, hospitals are focusing on efforts to engage patients in establishing recovery goals and understanding their plan of care, in part by leveraging technology. We designed, developed, and implemented an acute care patient portal (Figure 1) that was integrated with our electronic health record and configured to improve communication of patient-designated recovery goals and key elements of the plan of care. We investigated the degree to which patients and key members of their care team were concordant with regard to the overall care plan, including key recovery goals as well as plan of care elements.
Methods: We conducted a pre-post study in which we modified a validated care plan assessment tool (O’Leary) to include the patient’s key recovery goal (Haberle) and interviewed a sample of hospitalized patients admitted to an oncology unit for at least 48 hours during the pre (11/13-5/14) and post (1/15-5/15) periods. The patient’s nurse and, when possible, a physician (first responder, attending) were then interviewed within 24 hours of the patient interview. Two board-certified internists independently assessed and scored all nine care plan elements in each dyad (patient-RN, patient-MD, RN-MD) for no (0), partial (0.5), or complete agreement (1). All scoring discrepancies were resolved by consensus. A mean concordance score was calculated as the average of the sum of the nine scored elements for each dyad across all patient dyads. Mean concordance scores were compared in the pre and post periods using a generalized estimating equations z-test, clustering for dyads per patient. Weighted propensity score methods were used to adjust for differences in age, sex, race, and Charlson score between the pre-post periods. In the post-intervention period, mean concordance scores among portal and non-portal users were similarly compared in an on-treatment analysis.
Results: Of 457 and 283 eligible patients admitted during the pre and post intervention periods, 55 and 46 patients (Table 1) were interviewed, respectively, along with at least one provider. There was a non-significant trend towards improvement in mean care plan concordance scores (Table 2). There was significant improvement in mean concordance scores for the ‘Haberle’ recovery goal (0.31 to 0.60, p<0.01) and main reason for hospitalization (0.59 to 0.80, p<0.05). In post-intervention on-treatment analysis, mean concordance scores were non-significantly higher among portal compared to non-portal users (0.70 vs. 0.65, p=0.26), and were significantly higher for the ‘Haberle’ recovery goal (0.74 vs 0.25, p<0.01).
Conclusions: We observed improvement in concordance regarding the patient’s recovery goal and the main reason for hospitalization among patients and key members of the care team after implementation of an acute care patient portal. Recovery goal concordance was higher among portal users. Future efforts should be directed at confirming these findings for different populations and evaluating whether improved concordance mediated by patient portals results in delivery of care congruent to stated goals during and after hospitalization.