Diabetes quality of care and outpatient utilization associated with electronic patient-provider messaging: a cross-sectional analysis.
OBJECTIVE
To test the hypothesis that electronic patient-provider messaging is associated with high care quality for diabetes and lower outpatient utilization.


METHODS
We conducted a cross-sectional analysis of electronic patient-provider messaging over a 15-month period between 1 January 2004 and 31 March 2005. The study was set at Group Health Cooperative--a consumer-governed, nonprofit health care system that operates in Washington and Idaho. Participants included all patients aged >or=18 years with a diagnosis of diabetes. In addition to usual care, all patients had the option to use electronic messaging to communicate with their care providers. The primary outcome measures were diabetes-related quality-of-care indicators (A1C, blood pressure, and LDL cholesterol) and outpatient visits (primary care, specialty care, and emergency).


RESULTS
Nineteen percent of patients with diabetes used electronic messaging to communicate with their care providers during the study period (n = 2,924) (overall study cohort: 15,427 subjects). In multivariate models, frequent use of electronic messaging was associated with A1C <7% (relative risk [RR] 1.36 [95% CI 1.16-1.58]). Contrary to our hypothesis, frequent use of electronic messaging was also associated with a higher rate of outpatient visits (1.39 [1.26-1.53]).


CONCLUSIONS
Frequent use of electronic secure messaging is associated with better glycemic control and increased outpatient utilization. Electronic patient-provider communication may represent one strategy to meet the health care needs of this unique population. More research is necessary to assess the effect of electronic messaging on care quality and utilization.
Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA. ltownsen@u.washington.edu
Lynne T
LT
Harris
Sebastien J
SJ
Haneuse
Diane P
DP
Martin
James D
JD
Ralston
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D008078:Cholesterol, LDL; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000534:rehabilitation*; D055615:Electrical Equipment and Supplies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012637:Security Measures; D055815:Young Adult
D008078:Cholesterol, LDL