A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills

Failure to timely transfer patients to adult care is associated with increased demand on pediatric providers untrained in adult medicine, gaps in healthcare access, and an increase in emergency department visits and hospital admissions for preventable causes, in the young adult population.1, 2, 3, 4, 5 In their 2011 clinical report, the American Academy of Pediatrics, Family Physicians, and American College of Physicians issued a report outlining steps to support a structured healthcare transition (HCT) process to adult care.1,2 However, in practice, the implementation of large-scale HCT intervention has not been successful. According to the 2016 National Survey on Children's Health, approximately 85 % of youth ages 12-17 living in the US do not receive transition preparation, regardless of their health conditions.6,7 And youths without special health care needs (SHCN) tend to be less prepared to transfer care than youths with SHCN (14 % vs. 17%, respectively).6,7 To date, most HCT interventions have focused on care coordination for AYA with SHCN. Still, very few focused on patient outcomes, such as self-management skills toward transition readiness that addresses the broader AYA population HCT needs.6,7 Yet, AYAs – especially those from historically marginalized populations – are at risk of worsening pre-existing morbid or emerging new health conditions. Many forgo preventive health services due to socio-economical constraints and rely on acute care services by default for preventable health concerns.3,8, 9, 10 Therefore, interventions aimed at promoting AYA active engagement in their own health, as early as developmentally appropriate, are critical to gain health care utilization skills necessary to navigate adult care and improve health outcomes in the young adult population.2,7, 8

With the ability to manage appointments, message providers, and access protected health information (PHI), patient portal applications have been associated with increased medication adherence, better disease management among youths with chronic illness, and decreased disease complications and hospitalization.10, 11, 12, 13, 14, 15 These types of electronic health applications carry the potential to leverage healthcare utilization skills for the broader AYA population, given their wide smartphone ownership and tech-savviness.15,16

The purpose of this study was to examine whether an educational intervention aimed at improving awareness and utilization of the MyChildren's patient portal is associated with an increase in patient portal use and promotion of self-management skills toward transition readiness in an AYA population with low-level of healthcare utilization skills and portal awareness as indicated by previous interventions we conducted.17,18

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