Diabetes Quality of Care and Outpatient Utilization Associated with Electronic Patient-Provider Messaging: A Cross-Sectional Analysis

Abstract

Objective: To test the hypothesis that electronic patient-provider messaging is associated with high care quality for diabetes and lower outpatient utilization.

Research Design and Methods: We conducted a cross-sectional analysis of electronic patient-provider messaging over a 15-month period between January 1, 2004 and March 31, 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 18 or over with a diagnosis of diabetes mellitus. 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 (HbA1c, 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). In multivariate models, frequent use of electronic messaging was associated with HbA1c < 7% (RR 1.36, 95% CI 1.16 to 1.58). Contrary to our hypothesis, frequent use of electronic messaging was also associated with a higher rate of outpatient visits (RR 1.39, 95% CI 1.26 to 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 healthcare needs of this unique population. More research is necessary to assess the impact of electronic messaging on care quality and utilization.