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2019 HSR&D/QUERI National Conference Abstract

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1094 — Characterizing Secure Messaging Perceptions and Use Among Veterans with High Technology Adoption

Lead/Presenter: Bella Etingen,  COIN - Hines
All Authors: Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL ), Martinez RN (Center of Innovation for Complex Chronic Healthcare (CINCCH), , Hines VA Hospital, Hines, IL) Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL; Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL) Shimada S (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA) Richardson L (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Cao L (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL) Netherton D (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Houston TK (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA)

Objectives:
Secure messaging (SM) through VA's online patient portal can support the provision of continuous (as opposed to episodic) care. Despite its steadily increasing adoption among Veterans, our understanding of patient-level factors associated with SM use remains limited. This study examined Veteran perceptions of SM and factors associated with volume of SM use.

Methods:
The eHealth Partnered Evaluation Initiative and Office of Connected Care have developed a cohort of Veterans to provide longitudinal feedback on VA connected-care technologies and improve their integration into practice. This cohort is referred to as the "Veterans Engagement with Technology Collaborative" (VET-C), and is comprised of over 2,700 Veterans who are known technology users. These Veterans participated in a telephone survey administered in 2017 regarding demographics, technology use and perceptions of communication and access. Survey responses were supplemented with VA administrative data on participant health characteristics and SM volume. Cohort characteristics were examined using descriptive statistics. Factors associated with SM volume were identified using negative binomial regression.

Results:
Veterans had sent an average of 12 SMs to their VA healthcare teams in the prior year (range: 1-133). The majority reported that communicating with their healthcare team was easy (74.7%) and that team members encouraged them to use SM (73.3%), and made them feel cared about as a person through their SMs (88.0%). Adjusted analyses indicated older age (IRR: 1.00; CI95%: 1.00-1.01), higher education (IRR: 1.17; CI95%: 1.07-1.27), worse perceived health (IRR: 1.09; CI95%: 1.03-1.16), and having asthma (IRR: 1.13; CI95%: 1.06-1.21), osteoarthritis (IRR: 1.11; CI95%: 1.05-1.17) and depression (IRR: 1.11; CI95%: 1.04-1.18) were associated with greater SM volume, while being married was associated with decreased volume (IRR: 0.91; CI95%: 0.86-0.97).

Implications:
Veteran perceptions of SM are largely positive, and those with select chronic conditions and in poor health more frequently use SM. There may be added benefit to promoting use of SM among Veterans with certain diagnoses, and those of older age and lower educational attainment.

Impacts:
Identifying factors associated with increased SM volume can provide VA with a roadmap of initial targets to increase use of this important communication modality.