Impact of a Wellness Portal on the delivery of patient-centered preventive care.

BACKGROUND The objective of this study was to determine the impact of the Wellness Portal--a novel, web-based patient portal that focuses on wellness, prevention, and longitudinal health--on the delivery of patient-centered preventive care by examining the behavior and experiences of both patients and primary care clinicians and the degree to which recommended services were individualized and provided. METHODS We conducted a 3-year, systematic portal development and testing study, which included a 6-month feasibility and acceptability pilot in 2 primary care practices followed by a 12-month cluster randomized controlled trial in 8 clinician practices (4 in each study group). Descriptive and bivariate analyses were conducted to compare service delivery between intervention and control arms. RESULTS Ninety percent of patients in the pilot study found the portal easy to use, 83% found it to be a valuable resource, and 80% said that it facilitated their participation in their own care. The cluster randomized controlled trial included 422 adults 40 to 75 years of age and the parents of 116 children 2 to 5 years of age. Seventy three percent of patients used the portal during the study. Both patient activation (measured via the 13-item Patient Activation Measure) and participants' perception of patient-centeredness of care (measured via the Consumer Assessment of Healthcare Providers and Systems instrument) increased significantly in the portal group compared with control (P = .0014 and P = .037, respectively). A greater proportion of portal users received all recommended preventive services (84.4% intervention vs 67.6% control; P < .0001); took low-dose aspirin, if indicated (78.6% intervention vs 52.3% control; P < .0001); and received Pneumovax because of chronic health conditions (82.5% vs 53.9%; P < .0001) and age (86.3% vs 44.6%; P < .0001), despite having fewer visits over the study period compared with those in the control group (average of 2.9 vs 4.3 visits; P < .0001). Children in the intervention group received 95.5% of all recommended immunizations compared with 87.2% in the control group (P = .044). CONCLUSIONS A comprehensive patient portal integrated into the regular process of primary care can increase the patient-centeredness of care, improve patient activation, enhance the delivery of both age- and risk factor-appropriate preventive services, and promote the utilization of web-based personal health records.