Patient-Physician Messaging by Race, Ethnicity, Insurance Type, and Preferred Language.

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Lisa S Rotenstein, Brianna Hardy, Mitchell Tang, Bryan Steitz, Robert W Turer, Emily Alsentzer, Michael L Barnett
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引用次数: 0

Abstract

Importance: Asynchronous patient-portal messaging has emerged as a central component of patient-physician communication, yet disparities in response patterns remain underexplored.

Objective: To examine variations in asynchronous messaging responses in primary care by race and ethnicity, insurance type, and primary language.

Design, setting, and participants: This cross-sectional study of messaging data included 795 170 adult patients receiving primary care at Mass General Brigham in 2021, 341 836 of whom sent an asynchronous patient portal message. Data were analyzed from April 17, 2023, to July 29, 2025.

Exposures: Race and ethnicity, insurance status, and preferred language.

Main outcomes and measures: Receipt of a response within 1 or 3 business days and time to first response from care team. Multivariable regression models adjusted for patient demographics, clinic, and time fixed effects.

Results: The analytic sample consisted of 341 836 patients, who sent a total of 3 525 905 messages comprising 1 270 662 message threads to 1113 physicians. Among these patients (mean [SD] age, 52.2 [17.3] years), 18 442 were Asian (5.4%), 14 089 were Black or African American (4.1%), 9979 were Hispanic or Latino (2.9%), 285 919 were White (83.6%), 232 661 had commercial insurance (68.1%), and 332 004 primarily spoke English (97.1%). Characteristics of patient-threads that received a response from any care team member within 1 business day were as follows: 65.7% of threads from Black participants (32 165 of 48 983), 63.9% of threads from Hispanic or Latino (21 732 of 34 014), 68.5% of threads from White participants (743 161 of 1 085 517), 70.0% of threads from patients with commercial insurance (529 803 of 756 923), 60.9% of threads from patients with dual-eligibility (40 846 of 67 045), 68.4% of threads from patients preferring English (847 489 of 1 239 768), and 58.0% of threads from patients preferring Spanish (6898 of 11 903). Similar disparities were found in the response rate from primary care physicians. After adjustment, compared with White patients, the rate of response from any care team member within 1 day was lower for Black patients (1.1 [95% CI, 0.2-2.0] percentage points; P = .01) and Hispanic patients (1.1 [95% CI, 0.3-1.9] percentage points; P = .01). Compared with patients with commerical insurance, the response rate within 1 day was lower for dual-eligible patients (4.9 [95% CI, 4.2-5.5] percentage points; P < .001), and compared with patients who preferred English, the response rate within 1 day was lower for patients who preferred Spanish (4.1 [95% CI, 2.5-5.7] percentage points; P < .001). Adjustment for clinic and time fixed effects accounted for most of the observed disparities in response rates and timing.

Conclusions and relevance: In this cross-sectional study of primary care patients in a single health system, there were significant disparities in the responsiveness of primary care teams to asynchronous patient-portal messages by race and ethnicity, insurance type, and language. These were partially attributable to slower response times at practices that treat underserved patients.

按种族、民族、保险类型和首选语言分类的患者-医生信息。
重要性:异步患者门户消息传递已成为患者-医生通信的核心组成部分,但响应模式的差异仍未得到充分探讨。目的:研究不同种族、民族、保险类型和主要语言在初级保健中异步消息传递反应的变化。设计、设置和参与者:这项信息传递数据的横断面研究包括795 170名2021年在麻省总医院接受初级保健的成年患者,341 其中836人发送了异步患者门户信息。数据分析时间为2023年4月17日至2025年7月29日。暴露因素:种族和民族、保险状况和首选语言。主要结果和措施:在1或3个工作日内收到回复,以及从护理团队收到第一次回复的时间。多变量回归模型调整了患者人口统计学、临床和时间固定效应。结果:分析样本包括341 836名患者,共向1113名医生发送了3条 525 905条消息,其中1条 270 662条消息线程。在这些患者(平均[SD]年龄52.2[17.3]岁)中,亚洲人18 442人(5.4%),黑人或非裔美国人14 089人(4.1%),西班牙裔或拉丁裔9979人(2.9%),白人285 919人(83.6%),232 661人有商业保险(68.1%),332 004人主要说英语(97.1%)。在1个工作日内收到任何护理团队成员回复的患者线程的特征如下:65.7%的线程从黑人参与者(32 165 48 983),63.9%的线程从西班牙裔或拉丁裔(21 732 34 014),68.5%的线程从白人参与者(743 161 1 085 517),70.0%的患者线程商业保险(529 803 756 923),60.9%的患者线程dual-eligibility(40 846 67 045),68.4%的线程从患者喜欢英语(847 489 239  768),和58.0%的线程从病人喜欢西班牙11 903(6898)。在初级保健医生的回复率中也发现了类似的差异。调整后,与白人患者相比,黑人患者1天内任何护理团队成员的反应率较低(1.1 [95% CI, 0.2-2.0]个百分点;P =。01)和西班牙裔患者(1.1 [95% CI, 0.3-1.9]个百分点;P = 0.01)。与商业保险患者相比,双重符合条件的患者在1天内的反应率较低(4.9 [95% CI, 4.2-5.5]个百分点);P结论和相关性:在这项针对单一卫生系统初级保健患者的横向研究中,初级保健团队对非同步患者门户信息的反应性因种族和民族、保险类型和语言而存在显著差异。这在一定程度上是由于在治疗服务不足的病人时反应时间较慢。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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