Background: Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective: This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods: For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results: Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions: Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

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中文翻译：

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患者门户中的证据状态：总括审查

背景：患者门户已成为公认的数字健康战略。迄今为止，对患者门户网站的研究发展迅速。然而，随着时间的推移，对门户可用性、使用、临床或健康行为和结果以及门户采用的越来越多的证据的评估是有限的。目标：本文旨在使用伞状审查方法全面整合患者门户网站上的证据现状，介绍我们评估纳入系统审查中提出的定量和定性结果的证据的方法，并提出一种知识翻译工具，可用于告知患者门户采用的所有阶段。方法：对于这项研究，使用了乔安娜布里格斯研究所总括审查方法的修改版本。在多个数据库中搜索了针对患者门户的系统评价，最终样本包括 14 篇评价。我们对系统评价中报告的定量、定性和混合方法主要研究的结果进行了元级综合。我们根据临床采用元模型 (CAMM) 组织了总括审查结果。计票、GRADE（建议、评估、发展和评估的分级）和 CERQual（对定性研究审查的证据的信心）用于评估总体审查证据。结果：我们的知识翻译工具以证据图的形式总结了调查结果。该地图按 CAMM 类别组织，描述了以下影响门户采用和影响的因素：患者背景、患者 兴趣和满意度、门户设计、促进者和障碍、提供者的态度、服务利用、行为影响、临床结果和患者报告的结果。该地图列出了所包含的门户研究中认可的理论和机制，同时确定了可以为门户采用的所有阶段提供信息的商业模式和组织理论的需求。我们的 GRADE 和 CERQual 总括审查评估导致大多数证据被评为中到低，这反映了门户研究中的方法论问题、研究数量不足或特定重点领域的混合结果。具有高证据等级的 2 个发现是患者对使用门户进行交流的兴趣以及在门户中简单显示信息的重要性。在总体审查中确定了 40 多个门户功能，所有系统审查中都提到了通过安全消息传递和预约进行通信。结论：我们的总体评价提供了一个元级综合，以理解来自已发表系统评价的患者门户网站上的证据。门户功能的非系统和可变报告破坏了评估和比较门户效果的能力，并忽略了门户使用的特定上下文。需要对社会、组织、政策和时间维度敏感的研究设计，以更好地了解利用已识别因素来改进门户使用和效果的潜在机制和背景。结论：我们的总体评价提供了一个元级综合，以理解来自已发表系统评价的患者门户网站上的证据。门户功能的非系统和可变报告破坏了评估和比较门户效果的能力，并忽略了门户使用的特定上下文。需要对社会、组织、政策和时间维度敏感的研究设计，以更好地了解利用已识别因素来改进门户使用和效果的潜在机制和背景。结论：我们的总体评价提供了一个元级综合，以理解来自已发表系统评价的患者门户网站上的证据。门户功能的非系统和可变报告破坏了评估和比较门户效果的能力，并忽略了门户使用的特定上下文。需要对社会、组织、政策和时间维度敏感的研究设计，以更好地了解利用已识别因素来改进门户使用和效果的潜在机制和背景。

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