Background: The decision to use patient portals can be influenced by multiple factors, including individuals’ perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied. Objective: This study aims to understand how patients’ use of an inpatient portal is influenced by outpatient portal use. Methods: This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers. Results: Compared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60). Conclusions: Patients’ use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.

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中文翻译：

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门诊门户用户状态对住院门户使用的不同影响：观察性研究

背景：使用患者门户的决定可能受到多种因素的影响，包括个人对该工具的看法，这些因素基于他们的个人技能和经验。以前使用过一种类型的门户可能会使个人更习惯使用较新的门户技术。特别是有经验的门诊门户用户可能对他们使用具有类似功能的住院门户的能力充满信心。在实践中，门诊和住院门户技术的使用可以为患者提供跨护理环境访问其健康信息的连续性，但尚未研究一种门户使用对其他门户使用的影响。目的：本研究旨在了解患者对住院门户网站的使用如何受到门诊门户网站使用的影响。方法：该研究包括来自学术医疗中心的患者，这些患者在 2016 年至 2018 年期间住院期间可以访问住院门户（N = 1571）。我们分析了住院门户日志文件，以通过使用 3 类门诊门户用户（先前用户、新用户和非用户）来调查住院门户使用情况的变化。结果：与之前使用门诊门户的用户 (695/1571, 44.24%) 相比，新用户 (214/1571, 13.62%) 使用一组精选的住院门户功能（消息功能：发生率比 [IRR]） 1.33，95% CI 1.06-1.67；通过住院门户提供访问门诊门户的功能：IRR 1.34，95% CI 1.13-1.58）。与之前的用户相比，非用户 (662/1571, 42.14%) 的总体住院门户使用率较低（所有活动功能：IRR 0.68，95% CI 0.60-0。78) 和特定功能的使用较少，其中包括查看生命体征和实验室结果的功能 (IRR 0.51, 95% CI 0.36-0.73) 和访问门诊门户的功能 (IRR 0.53, 95% CI 0.45-0.62)。与之前的用户相比，非用户成为综合用户（定义为使用 8 个或更多独特门户功能；优势比 [OR] 0.57，95% CI 0.45-0.73）或复合用户（定义为启动的综合用户）的几率也较低住院门户的第 75 个或更高百分位的门户会话）（OR 0.42，95% CI 0.29-0.60）。结论：患者在住院期间使用住院门户似乎受到多种因素的影响，包括先前使用门诊门户。对于新用户来说，住院本身是一个可以激发行为改变的重大事件，可能影响了门户网站的使用。相比之下，非用户在使用技术来管理自己的健康方面的自我效能感可能较低，从而导致他们较少使用门户网站。了解门诊和住院门户使用之间的关系可以帮助指导有针对性的实施策略，鼓励个人使用这些工具来更好地管理他们在不同护理环境中的健康。

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