Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records
BackgroundBariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their us...
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JMIR Publications
2024-12-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2024/1/e56573 |
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| author | Xinmeng Zhang Kaidi Kang Chao Yan Yubo Feng Simon Vandekar Danxia Yu S Trent Rosenbloom Jason Samuels Gitanjali Srivastava Brandon Williams Vance L Albaugh Wayne J English Charles R Flynn You Chen |
| author_facet | Xinmeng Zhang Kaidi Kang Chao Yan Yubo Feng Simon Vandekar Danxia Yu S Trent Rosenbloom Jason Samuels Gitanjali Srivastava Brandon Williams Vance L Albaugh Wayne J English Charles R Flynn You Chen |
| author_sort | Xinmeng Zhang |
| collection | DOAJ |
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BackgroundBariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post–bariatric surgery weight loss remains unclear.
ObjectiveThis study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery.
MethodsThis retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients’ portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient’s age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage.
ResultsThe study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI –0.55% to –0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI –0.69 to –0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05).
ConclusionsHigher patient portal engagement within 3 months after surgery—suggestive of stronger adherence to postoperative instructions and improved communication with care teams—is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality. |
| format | Article |
| id | doaj-art-d0f959de114f478dbd5ce661e51ef329 |
| institution | Kabale University |
| issn | 1438-8871 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj-art-d0f959de114f478dbd5ce661e51ef3292024-12-09T14:00:53ZengJMIR PublicationsJournal of Medical Internet Research1438-88712024-12-0126e5657310.2196/56573Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health RecordsXinmeng Zhanghttps://orcid.org/0000-0001-7876-0753Kaidi Kanghttps://orcid.org/0000-0003-0922-5727Chao Yanhttps://orcid.org/0000-0002-6719-1388Yubo Fenghttps://orcid.org/0009-0003-9214-4991Simon Vandekarhttps://orcid.org/0000-0002-7457-9073Danxia Yuhttps://orcid.org/0000-0002-1710-9382S Trent Rosenbloomhttps://orcid.org/0000-0001-7455-2260Jason Samuelshttps://orcid.org/0000-0001-5427-3117Gitanjali Srivastavahttps://orcid.org/0000-0002-8326-3089Brandon Williamshttps://orcid.org/0000-0002-7802-1317Vance L Albaughhttps://orcid.org/0000-0002-5267-8951Wayne J Englishhttps://orcid.org/0000-0001-9663-5761Charles R Flynnhttps://orcid.org/0000-0002-3749-0598You Chenhttps://orcid.org/0000-0001-8232-8840 BackgroundBariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post–bariatric surgery weight loss remains unclear. ObjectiveThis study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. MethodsThis retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients’ portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient’s age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. ResultsThe study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI –0.55% to –0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI –0.69 to –0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05). ConclusionsHigher patient portal engagement within 3 months after surgery—suggestive of stronger adherence to postoperative instructions and improved communication with care teams—is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality.https://www.jmir.org/2024/1/e56573 |
| spellingShingle | Xinmeng Zhang Kaidi Kang Chao Yan Yubo Feng Simon Vandekar Danxia Yu S Trent Rosenbloom Jason Samuels Gitanjali Srivastava Brandon Williams Vance L Albaugh Wayne J English Charles R Flynn You Chen Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records Journal of Medical Internet Research |
| title | Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records |
| title_full | Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records |
| title_fullStr | Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records |
| title_full_unstemmed | Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records |
| title_short | Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records |
| title_sort | association between patient portal engagement and weight loss outcomes in patients after bariatric surgery longitudinal observational study using electronic health records |
| url | https://www.jmir.org/2024/1/e56573 |
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