Association Between Patient Portal Activities and End-of-Life Outcomes Among Deceased Patients in the Last 12 Months of Life.

Abstract

<b><i>Objective:</i></b> The objective of this study was to examine the association between portal use and end-of-life (EOL) outcomes in the last year of life. <b><i>Methods:</i></b> A retrospective cohort (<i>n</i> = 6,517) study at Kaiser Permanente Colorado among adults with serious illness deceased between January 1, 2016, and June 30, 2019. Portal use was categorized into engagement types: no use, nonactive, active without a provider, and active with a provider. EOL outcomes were hospitalizations in the month before death, last-year advance directive completion, and hospice use. Association between EOL outcomes and levels of portal use was assessed using χ² statistics and generalized linear models. <b><i>Results:</i></b> Higher portal engagement types were associated with higher rates of hospitalizations (<i>p</i> = 0.0492), advance directive completion (<i>p</i> = 0.0226), and hospice use (<i>p</i> = 0.0070). <b><i>Conclusion:</i></b> Portal use in the last year of life was associated with increases in a poor EOL outcome, hospitalizations, and beneficial EOL outcomes, advance directives, and hospice care.