title: Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study.
abstract: Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established.
  
  
  
  We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success.
  
  
  
  We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework.
  
  
  
  We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success.
  
  
  
  Although use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children.
  
  
  
  Clinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3).
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, United States. fiks@email.chop.edu.
authors.forename: Alexander G
authors.identifier: 0000-0001-6525-8764
authors.initials: AG
authors.lastname: Fiks
authors.forename: Nathalie
authors.identifier: 0000-0002-8414-8197
authors.initials: N
authors.lastname: DuRivage
authors.forename: Stephanie L
authors.identifier: 0000-0003-1674-9537
authors.initials: SL
authors.lastname: Mayne
authors.forename: Stacia
authors.identifier: 0000-0002-3376-6147
authors.initials: S
authors.lastname: Finch
authors.forename: Michelle E
authors.identifier: 0000-0002-7750-6451
authors.initials: ME
authors.lastname: Ross
authors.forename: Kelli
authors.identifier: 0000-0001-7424-8509
authors.initials: K
authors.lastname: Giacomini
authors.forename: Andrew
authors.identifier: 0000-0001-5593-3973
authors.initials: A
authors.lastname: Suh
authors.forename: Banita
authors.identifier: 0000-0002-3281-5613
authors.initials: B
authors.lastname: McCarn
authors.forename: Elias
authors.identifier: 0000-0001-8798-7706
authors.initials: E
authors.lastname: Brandt
authors.forename: Dean
authors.identifier: 0000-0003-0554-5715
authors.initials: D
authors.lastname: Karavite
authors.forename: Elizabeth W
authors.identifier: 0000-0002-6485-5804
authors.initials: EW
authors.lastname: Staton
authors.forename: Laura P
authors.identifier: 0000-0003-2717-5794
authors.initials: LP
authors.lastname: Shone
authors.forename: Valerie
authors.identifier: 0000-0002-8910-3377
authors.initials: V
authors.lastname: McGoldrick
authors.forename: Kathleen
authors.identifier: 0000-0002-3465-9896
authors.initials: K
authors.lastname: Noonan
authors.forename: Dorothy
authors.identifier: 0000-0002-2650-1036
authors.initials: D
authors.lastname: Miller
authors.forename: Christoph U
authors.identifier: 0000-0001-9559-4646
authors.initials: CU
authors.lastname: Lehmann
authors.forename: Wilson D
authors.identifier: 0000-0003-1699-5471
authors.initials: WD
authors.lastname: Pace
authors.forename: Robert W
authors.identifier: 0000-0002-8290-5588
authors.initials: RW
authors.lastname: Grundmeier
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D003142:Communication; D005260:Female; D017144:Focus Groups; D006801:Humans; D016015:Logistic Models; D008297:Male; D010290:Parents; D010347:Patient Care Planning; D000072638:Patient Portals; D000071066:Patient Reported Outcome Measures; D010372:Pediatrics; D011320:Primary Health Care; D011368:Professional-Family Relations; D018582:Sick Leave; D011795:Surveys and Questionnaires
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma; electronic health records; health information technology