T. P. Robinson1, A. Dillon1, J. W. Chung1, R. P. Merkow2, K. Y. Bilimoria1, A. D. Yang1 1Indiana University School Of Medicine, Department Of Surgery, Indianapolis, IN, USA 2University Of Chicago, Department Of Surgery, Chicago, IL, USA
Introduction: New technological tools can serve as a means for greater patient engagement in their care. Patient engagement platforms have emerged that utilize the phone and internet to connect patients and providers through two-way communication, education materials, reminders, and assessment forms. Studies have demonstrated improved patient outcomes, however few large-scale studies describe what types of patients are utilizing these platforms. The objectives of this study were (1) to assess utilization of a customizable patient engagement software platform in a large healthcare system, (2) examine characteristics of patients interacting with the platform, and (3) identify factors associated with pathway completion.
Methods: Twistle is a customizable patient engagement platform that is accessible across multiple service lines. Twistle has been used to interact with patients through 61 unique disease-, clinic- or procedure-specific series of pathways in a single healthcare system since 2019. Differences in pathway completion rates(CR) were analyzed with χ2 tests. Multivariable logistic regression models identified factors associated with pathway completion of Twistle. Clusters were created based on zip code to account for non-independence among samples.
Results: Between 2019-2023, there were 1,091,576 pathways initiated with 877,307 pathways completed (CR 80.4%). Across the 10 pathways with the most total pathways started, CR ranged from 57.1-95.2%. Logistic regression analysis of a surgery-specific preoperative assessment clinic pathway found interactions involving patients age 60-79 years to have greater odds of pathway completion (CR 72.5%, OR 1.34, 95%CI 1.11-1.63) as well as females (OR 1.11, 95%CI 1.02-1.21). Across all 61 surgical and medical pathways, patients had greater odds of pathway completion if they were male (OR 1.11, 95%CI 1.09-1.13), had English language preferred (OR 1.10, 95%CI 1.01-1.20), or were older, with the greatest odds occurring in patients ≥ 80 years old (CR 88.9%, OR 2.61, 95%CI 2.42-2.82). Race/ethnicity interactions with pathway completion demonstrated increased odds of pathway completion in Asian (OR 1.09, 95%CI 1.01-1.17), White(OR 1.06, 95%CI 1.01-1.12), and Non-Hispanic (OR 1.10, 95%CI 1.05-1.16) groups, while Black race had lower odds of pathway completion (OR 0.92, 95%CI 0.87-0.97).
Conclusion: In evaluating the use of a patient engagement platform in a large healthcare system, there is variability in pathway engagement and completion rates. Contrary to common perceptions, older patients frequently engaged with, and completed, pathways on the platform. Racial and gender disparities exist in the use of the platform. Interventions targeted to these specific populations may be able to increase utilization of patient engagement platforms, improve communication between patients and their care team, reduce disparities, and potentially improve patient experience and outcomes.