Electronic Patient-Provider Communication in Diabetes Care

Thesis (Ph.D.)--University of Washington, 2012Diabetes is a chronic illness of increasing public health importance affecting one in five Americans over the age of 65. Nearly half of all individuals with diabetes do not meet recommended guidelines for blood sugar control, sharply elevating their risk for long-term complications. Effective diabetes management requires a competent, engaged care team, but the difficult work of maintaining day-to-day glycemic control is primarily done by the patient between clinic visits. Web-based health services may help to improve the quality of diabetes care by strengthening the patient-provider relationship and bridging the gap between home and clinic. These new tools can enable patients to access their lab results or medical records, schedule appointments, and securely communicate with care providers between visits. Little is known about the use of electronic patient-provider communication in diabetes care, and how use of this technology may impact care processes and health outcomes. In this dissertation, I address three issues related to use of secure patient-provider messaging within a shared electronic medical record. All studies included adults with diabetes receiving care at a large integrated delivery system. The goal of the first study was to evaluate differences in diabetes care quality and outpatient utilization associated with secure messaging. Second, I studied age-related differences in use of the electronic record and secure messaging. Finally, I used longitudinal data to reexamine the relationship between secure messaging and process and outcome measures of care. I found that a quarter of all adults with diabetes used secure messaging when available over a three-year period. Older adults were less likely to use electronic messaging and placed a higher value on in-person interactions. The majority of patients who used secure messaging had relatively modest levels of use (1-3 threads per year) and slightly more frequent clinic visits. The most active users tended to have more complex medical histories and higher outpatient utilization. Results of the longitudinal study suggest that secure messaging may have a small, positive, effect on glycemic control and adherence to glycated hemoglobin (HbA1c) testing recommendations. These findings provide a justification and framework for further research, and may be informative to providers and payers who are considering broader implementation of electronic patient-provider communication in the future