Abstracts

Rationale: Patient activation (PA) refers to a patient's willingness to manage his or her own health and care. Increasing PA is one strategy to achieve the 'triple aim' of improved health outcomes, better patient care, and lower costs, particularly in chronic conditions. There is limited knowledge about interventions to increase PA in epilepsy. One way to indirectly measure PA is patient engagement (PE) in their own electronic health medical record. PE through patient portals have been shown to improve outcomes and improve quality care in chronic diseases. We aimed to identify clinical and social predictors of lack PE as a first step to identify opportunities for quality improvement in an academic epilepsy center. Methods: This was a prospective cohort study, enhanced with retrospective review of additional electronic health data. Six participant providers aimed to collect standardized clinical data (e.g., standardized epilepsy diagnosis, seizure type, and frequency classification) as part of routine clinical care for all (n=279) adult patient-encounters from 01/20/2019 to 05/11/2019 (16 weeks) in a tertiary-referral, epilepsy clinic. We linked the clinical data to electronic health data on social determinants of health (e.g., race, gender) as well as the outcome of interest (lack of PE). Lack of PE, defined as never using the patient’s online portal, which was designed to enable patient’s access to healthcare (communication) and to electronic medical record (information). We used multivariable logistic regression models through a stepwise forward variable selection process with minimum AIC model selection criteria to identify predictors for lack of PE within our study time-frame. Results: We analyzed information from 262 (94% of target sample) unique patient-encounters from which we had complete information. 193 (74%) of these had confirmed epilepsy, 110 (42%) of these had at least one seizure over the recent 12 months (active epilepsy), and 101 (39%) were never users of our patient portal (lack of PE). Those who were male, non-English-speakers, and who had active epilepsy (all p<0.05) were less likely to ever use the patient’s online portal within the study time frame (Tables 1 and 2). Conclusions: This work identifies subgroups for targeted interventions based on social and clinical characteristics (male, non-English-speaking patients, and patients with poorly controlled epilepsy), which provides great potential for improving health outcomes. Funding: No funding