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Original research
Patient portal messaging to address delayed follow-up for uncontrolled diabetes: a pragmatic, randomised clinical trial
  1. Arielle R Nagler1,
  2. Leora Idit Horwitz2,
  3. Aamina Ahmed2,
  4. Amrita Mukhopadhyay3,
  5. Isaac Dapkins4,
  6. William King2,
  7. Simon A Jones2,
  8. Adam Szerencsy3,
  9. Claudia Pulgarin5,
  10. Jennifer Gray6,
  11. Tony Mei6,
  12. Saul Blecker2
  1. 1The Ronald O Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
  2. 2Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
  3. 3Department of Medicine, NYU Langone Health, New York, New York, USA
  4. 4Family Health Centers (FHCs) at NYU Langone Health, New York, New York, USA
  5. 5NYU Grossman School of Medicine, New York, New York, USA
  6. 6NYU Langone Health, New York, New York, USA
  1. Correspondence to Dr Arielle R Nagler; arielle.nagler@nyulangone.org

Abstract

Importance Patients with poor glycaemic control have a high risk for major cardiovascular events. Improving glycaemic monitoring in patients with diabetes can improve morbidity and mortality.

Objective To assess the effectiveness of a patient portal message in prompting patients with poorly controlled diabetes without a recent glycated haemoglobin (HbA1c) result to have their HbA1c repeated.

Design A pragmatic, randomised clinical trial.

Setting A large academic health system consisting of over 350 ambulatory practices.

Participants Patients who had an HbA1c greater than 10% who had not had a repeat HbA1c in the prior 6 months.

Exposures A single electronic health record (EHR)-based patient portal message to prompt patients to have a repeat HbA1c test versus usual care.

Main outcomes The primary outcome was a follow-up HbA1c test result within 90 days of randomisation.

Results The study included 2573 patients with a mean (SD) HbA1c of 11.2%. Among 1317 patients in the intervention group, 24.2% had follow-up HbA1c tests completed within 90 days, versus 21.1% of 1256 patients in the control group (p=0.07). Patients in the intervention group were more likely to log into the patient portal within 60 days as compared with the control group (61.2% vs 52.3%, p<0.001).

Conclusions Among patients with poorly controlled diabetes and no recent HbA1c result, a brief patient portal message did not significantly increase follow-up testing but did increase patient engagement with the patient portal. Automated patient messages could be considered as a part of multipronged efforts to involve patients in their diabetes care.

  • Ambulatory care
  • Diabetes mellitus
  • Healthcare quality improvement
  • Information technology
  • Patient-centred care

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bmjqs-2024-018249

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @leorahorwitzmd

    • Contributors AN, LIH, AA, AM, ID, WK, SAJ, AS, CP, JG, TM and SB contributed to study design and manuscript drafting and review. AN is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.