--- title: "E-messages and QoC in pts with DM and HTN | Sutter Health" description: "Patient-initiated e-messaging may increase the likelihood of completing recommended tests, but may not be sufficient to improve clinical outcomes for most patients with diabetes or hypertension without additional interventions." url: "https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. E-messages and QoC in pts with DM and HTN # Patient-initiated electronic messages and quality of care for patients with diabetes and hypertension in a large fee-for-service medical group: results from a natural experiment. McClellan SR, Panattoni L, Chan AS, & Tai-Seale M. _Med Care. \[Epub ahead of print\]_ 2016-01-12 ## Abstract BACKGROUND: Few studies have examined the association between patient-initiated electronic messaging (e-messaging) and clinical outcomes in fee-for-service settings. OBJECTIVE: To estimate the association between patient-initiated e-messages and quality of care among patients with diabetes and hypertension. DESIGN: Longitudinal observational study from 2009 to 2013. In March 2011, the medical group eliminated a $60/year patient user fee for e-messaging and established a provider payment of $3-5 per patient-initiated e-message. Quality of care for patients initiating e-messages was compared before and after March 2011, relative to nonmessaging patients. Propensity score weighting accounted for differences between e-messaging and nonmessaging patients in generalized estimating equations. SETTING: Large multispecialty practice in California compensating providers' fee-for-service. SUBJECTS: Patients with diabetes (N=4232) or hypertension (N=15,463) who had activated their online portal but not e-messaged before e-messaging became free. MEASURES: Quality of care included HEDIS-based process measures for hemoglobin (Hb) A1c, blood pressure, low-density lipoprotein (LDL), nephropathy, and retinopathy tests, and outcome measures for HbA1c, blood pressure, and LDL. E-messaging was measured as counts of patient-initiated e-message threads sent to providers. Patients were categorized into quartiles by e-messaging frequency. RESULTS: The probability of annually completing indicated tests increased by 1%-7% for e-messaging patients, depending on the outcome and e-messaging frequency. E-messaging was associated with small improvements in HbA1c and LDL for some patients with diabetes. CONCLUSION: Patient-initiated e-messaging may increase the likelihood of completing recommended tests, but may not be sufficient to improve clinical outcomes for most patients with diabetes or hypertension without additional interventions. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/26759978) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Pharmacist-led medication management program within a patient-centered medical home.](https://www.sutterhealth.org/research/publications/pharmacist-led-medication-management-in-pcmh-1055312959) Romanelli RJ, Leahy A, Jukes T, Ishisaka DY. Am J Health Syst Pharm. 72(6):453-9. doi: 10.2146/ajhp140487. 2015 Mar 15 - Publication ### [Patients' medication-related experience of care is associated with adherence to cardiometabolic disease therapy in real-world clinical practice.](https://www.sutterhealth.org/research/publications/pt-experience-of-care-associated-with-cmd-tx-adherence-1055312299) Romanelli RJ, Huang Q, LaMori J, Doshi D, Chung S. Popul Health Manag. doi: 10.1089/pop.2017.0163. \[Epub ahead of print\] 2018 Mar 12 - Publication ### [Cost estimates for designing and implementing a novel team care model for chronically ill patients.](https://www.sutterhealth.org/research/publications/cost-estimates-to-design-implement-chronic-care-model-1055312334) Panattoni L, Dillon E, Hurlimann L, Durbin M, Tai-Seale M. J Ambul Care Manage. doi: 10.1097/JAC.0000000000000209. \[Epub ahead of print\] 2017 Sep 25 - Publication ### [Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental study.](https://www.sutterhealth.org/research/publications/std-workflow-team-care-model-improve-chronic-care-1055312331) Panattoni L, Hurlimann L, Wilson C, Durbin M, Tai-Seale M. BMC Health Serv Res. 2017 Apr 19;17(1):286. doi: 10.1186/s12913-017-2240-1. 2017 Apr 19 - Publication ### [Using unlicensed health coaches to improve care for insured patients with diabetes and hypertension: patient and physician perspectives on recruitment and uptake.](https://www.sutterhealth.org/research/publications/using-health-coaches-dm-htn-1055312462) Dillon E, Panattoni L, Meehan A, Chuang J, Wilson C, Tai-Seale M. Popul Health Manag. \[Epub ahead of print\] 2015 Dec 16 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"E-messages and QoC in pts with DM and HTN"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360#medicalscholarlyarticle","name":"Patient-initiated electronic messages and quality of care for patients with diabetes and hypertension in a large fee-for-service medical group: results from a natural experiment.","headline":"E-messages and QoC in pts with DM and HTN","abstract":"BACKGROUND: Few studies have examined the association between patient-initiated electronic messaging (e-messaging) and clinical outcomes in fee-for-service settings. OBJECTIVE: To estimate the association between patient-initiated e-messages and quality of care among patients with diabetes and hypertension. DESIGN: Longitudinal observational study from 2009 to 2013. In March 2011, the medical group eliminated a $60/year patient user fee for e-messaging and established a provider payment of $3-5 per patient-initiated e-message. Quality of care for patients initiating e-messages was compared before and after March 2011, relative to nonmessaging patients. Propensity score weighting accounted for differences between e-messaging and nonmessaging patients in generalized estimating equations. SETTING: Large multispecialty practice in California compensating providers' fee-for-service. SUBJECTS: Patients with diabetes (N=4232) or hypertension (N=15,463) who had activated their online portal but not e-messaged before e-messaging became free. MEASURES: Quality of care included HEDIS-based process measures for hemoglobin (Hb) A1c, blood pressure, low-density lipoprotein (LDL), nephropathy, and retinopathy tests, and outcome measures for HbA1c, blood pressure, and LDL. E-messaging was measured as counts of patient-initiated e-message threads sent to providers. Patients were categorized into quartiles by e-messaging frequency. RESULTS: The probability of annually completing indicated tests increased by 1%-7% for e-messaging patients, depending on the outcome and e-messaging frequency. E-messaging was associated with small improvements in HbA1c and LDL for some patients with diabetes. CONCLUSION: Patient-initiated e-messaging may increase the likelihood of completing recommended tests, but may not be sufficient to improve clinical outcomes for most patients with diabetes or hypertension without additional interventions.","description":"Patient-initiated e-messaging may increase the likelihood of completing recommended tests, but may not be sufficient to improve clinical outcomes for most patients with diabetes or hypertension without additional interventions.","keywords":["Cardiovascular Diseases","Diabetes, Insulin Resistance and Metabolic Syndrome","Disease Management","Health Services","Medical Informatics"],"datePublished":"2016-01-12","url":"https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26759978"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26759978/"],"isPartOf":{"@type":"Periodical","name":"Med Care"},"author":[{"@type":"Person","name":"McClellan SR"},{"@type":"Person","name":"Panattoni L"},{"@type":"Person","name":"Chan AS"},{"@type":"Person","name":"Tai-Seale M"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Diabetes, Insulin Resistance and Metabolic Syndrome","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360#breadcrumblist"}}} ```