Personal health record use for children and health care utilization: propensity score-matched cohort analysis

Abstract

Objectives: To examine the association between caregiver personal health record (PHR) use and health care utilization by pediatric patients.

Design, setting, and participants: We conducted a retrospective observational cohort study of 2286 pediatric members aged six months to 2.5 years of Kaiser Permanente Hawaii and Northwest Regions in 2007-2011, using propensity score matching methods and t and chi-square tests to examine associations between PHR use and health care utilization. We used ANOVA to examine utilization across quartiles of PHR use.

Main outcome measures: Outpatient clinic visits, telephone encounters, and emergency department visits.

Results: PHR-registered children, compared with propensity score-matched nonregistered children, had 21% (95% CI, 14-28; P < .0001) more outpatient clinic visits and 26% (95% CI, 16-37; P < .0001) more telephone encounters. Utilization differences were more pronounced with nonprimary care providers than with primary care providers. Outpatient clinic visits and telephone encounters increased among the quartile with the highest PHR use; no utilization differences occurred in the 3 lowest-use quartiles.

Conclusions: PHR use by caregivers was associated with statistically significant increases in outpatient clinic visits and telephone encounters among pediatric patients.

Keywords: ambulatory care; electronic health record; pediatrics; personal electronic health record; utilization.