O3196: Reducing Disparities in Patient Portal Activation Rates for Pediatric Patients and Families with Spanish as Preferred Language: A Quality Improvement Initiative

Purpose/Objectives: Despite patient portals (PP) having significant potential to improve patient engagement, little is known about disparities in PP adoption in pediatrics, especially by preferred language, and whether they are associated with portal platform design and patient/staff workflows. Our quality improvement (QI) initiative aims to improve PP offer and activation rates for pediatric families with Spanish as their preferred language (PSPL) at Stanford Medicine Children’s Health (SMCH) ambulatory care.

Design/Methods: This QI initiative was initiated in February 2022 at Stanford Medicine Children’s Health (SMCH) ambulatory care. MyChart is the electronic PP associated with the Epic electronic health record (Epic Systems, Verona, WI). Our interdisciplinary team consists of parents, parent mentors, providers, front desk staff, data analysts, MyChart Team specialists, members and leaders of the marketing, digital health, and clinic operations teams. The current state was assessed through qualitative interviews of stakeholders and retrospective data analysis of SMCH MyChart activation audit data for patients (0-21 years old) who completed 1+ ambulatory visits September 2021-2022 without prior active portals. We evaluated their offer and activation status during this time. Key drivers and interventions were developed through rapid process improvement sessions. The primary outcome is monthly percentage of patients with active MyChart accounts by preferred language (English vs. Spanish).

Results: Overall, PSPL consistently have the lowest activation rates (55%) than patients with English (PEPL) (86%) and any other preferred language. Our retrospective analysis (Table 1) showed that PEPL were more likely to be offered (82.7% vs. 64.9%,p < 0.001) and activate (55.2% vs 22.7%,p < 0.001) the portal than PSPL. Specifically, PSPL (20.2%) were associated with fewer codes being sent via Instant Activation via email/text (the most effective activation method) compared to PEPL (75.0%,p < 0.001). Our qualitative interviews highlighted several barriers to PP access; activation interface being too complicated to navigate, significant low patient digital health literacy, discomfort in activation at the front desk versus the patient room or at home where patients have more privacy. We identified 3 key drivers with several sub-interventions: optimizing staff workflows to complete activation in patient rooms (PDSA Cycle 1 starting March 2023), optimizing the MyChart activation user interface to be low-literacy friendly (Cycle 2 starting May 2023), incorporating patient perceived value of MyChart into marketing strategies and tools (Cycle 3 starting August 2023). Preliminary results post-Cycle 1 initiation are show small improvement in activation rates (Figure 1). We intend to have further results for Cycles 1&2 by August 2023.

Conclusion/Discussion: Significant disparities in PP offer and activation rates by preferred language are prevalent and may be associated with the platform and patient/staff workflows, previously little explored in pediatrics. Our work highlights the need for multi-faceted optimization of portal functionality and activation processes to ensure more equitable access to PP.