313 - Disparities in Patient Portal Enrollment and Use Among Hospitalized Children

Publication Number: 1297.313

Yinlu Zhu, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Courtney Wolk, University of Pennsylvania, Philadelphia, PA, United States; Stephanie G. Menko, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Danielle Capriola, Childrens Hospital of Philadelphia, Sanatoga, PA, United States; Kate M.. Fuller, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Philip Scribano, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Chris Bonafide, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Aditi Vasan, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Michael J. Luke, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Patient portals allow caregivers of pediatric patients and adolescent patients to engage with their health care through a range of features, including scheduling appointments, viewing after visit summaries, messaging with providers, and requesting medication refills. However, there are persistent disparities in access to and comfort with using these portals. Hospitalization may represent an opportunity to identify and address these disparities. Patterns in portal use among hospitalized children are currently underexplored.

Objective: To evaluate the association of patient-, household- and population-level factors with patient portal enrollment before and during hospitalizations and portal use (measured by logins) before, during, and after hospitalization.

Design/Methods: We conducted a cross-sectional analysis of patients admitted to two children's hospitals within a single health system from 2022-2024. Periods of interest included 12 months before admission, during hospitalization, and 3 months after discharge. We calculated unadjusted rates of portal enrollment and use for these time periods, stratified by patient-level (age, race/ethnicity, insurance coverage, medical complexity), household-level (preferred language), and population-level (neighborhood opportunity via the Child Opportunity Index 3.0) factors. We then used multivariable logistic regression to identify associations between these factors and portal enrollment and use.

Results: Across 40,371 hospitalized children, 93% had enrolled in our patient portal and 88% had at least one portal login in the year prior to admission (Table 1). Patients who identified as Black or African American (compared to Asian, chosen as reference based on highest adjusted enrollment), were publicly insured, preferred a language other than English (LOE), and lived in moderate, low, or very low opportunity neighborhoods had significantly lower odds of portal enrollment (Fig. 1A) and portal use (Fig. 2) both before and after admission. Of the 7% of patients who were not enrolled in the patient portal prior to admission, those who were publicly insured, preferred a LOE, and lived in lower opportunity neighborhoods had decreased odds of being enrolled during their admission (Fig. 1B).

Conclusion(s): Despite high overall rates of portal enrollment among our patient population, we observed persistent disparities in both portal enrollment and use. Efforts to promote equitable portal use among hospitalized children may be most effective when focused on families who are publicly insured, prefer languages other than English, and live in lower opportunity neighborhoods.

Table 1: Unadjusted Rates of Portal Enrollment and Use Before, During, and After Hospitalization
"Before" represents enrollment and use before hospitalization out of the total population. "During" represents enrollment during hospitalization out of those not enrolled prior to admission, and portal use during hospitalization out of those enrolled during hospitalization. "After" represents portal use after discharge out of those enrolled by discharge. We did not measure enrollment after discharge.

Figure 1: Portal Enrollment Before (A) and During (B) Hospitalization
CCC = complex chronic conditions; COI = child opportunity index; LOE = language other than English

Figure 2: Portal Use Before (A), During (B), and After (C) Hospitalization
CCC = complex chronic conditions; COI = child opportunity index; LOE = language other than English