Date of Award

May 2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Biomedical and Health Informatics

First Advisor

Timothy Patrick

Committee Members

Jake Luo, Min Wu, Abdulrahman Jabour

Keywords

health literacy, patient portal, radiology report, radiology reporting type, radiology test results, summary statement

Abstract

Introduction and significance: Radiology exams are an important part of health care. To enhance the quality of health care, health care services need to be delivered in ways that meet patients’ needs and preferences. Patients were found to be interested in the timely receipt of radiology test results. One of the easiest and fastest ways to deliver radiology test results to patients is via online patient portals. It seems, however, that the method of providing radiology test results through patient portals has not reached its full maturity; it still needs a great deal of improvement. Therefore, participation of the end-readers (i.e., the patients) in the shape of radiology test results on patient portals is crucial. Moreover, making the radiology test results readily available to patients can encourage them to be more involved in their health care. To the best of our knowledge, this is the first study that covers this topic from this angle. The findings of this study can be used to improve the quality of health care services by making radiology test results on the patient portal meet patients’ needs and preferences. Objective: The aim of this study was to investigate the needs and preferences of patients regarding radiology test results delivered via patient portals. Method: This study used a cross-sectional, quantitative approach design using a questionnaire survey with close-ended questions. The distribution method used for this study was a self-administered questionnaire, on paper and online. The sample size of this study was 615 participants. There were three main research questions that this study aimed to answer: 1. Is there a relationship between patients’ level of education and how much they understand from the radiology report? 2. Does health literacy have a main role in patients’ understanding of the radiology report? 3. Does adding a statement at the end of the radiology report in lay terms summarizing the content of the report improve patients’ understanding of the report? In addition, this study also explored the following issues: 4. How much do patients understand from a typical radiology report? 5. Which type of radiology reporting do patients prefer (structured versus free-text)? 6. Do patients think that the type of radiology reporting affects their understanding of the report? Data analysis: The collected data were analyzed using the Pearson Chi-square test with Cramer's V, Spearman’s correlation test, Fisher’s exact test, and Wilcoxon signed rank test with effect size. Results: No relationship was found between patients’ level of understanding of a radiology report and health literacy or level of education. An association was found between health literacy and level of education, where people with a lower level of education tended to have limited health literacy. No correlation was found between laypersons’ level of understanding of a typical spine MRI report and gender, age, race, previous radiology exam experience, or native language. There also was no correlation between laypersons’ level of understanding of a typical brain MRI report and gender, race, native language, or previous radiology exam experience. However, there was a very weak relationship between laypersons’ level of understanding of a typical brain MRI report and age, where elderly people tended to not understand the typical brain MRI report. Most of the participants (69%) wanted to receive their radiology test results through the online patient portal. Most of the participants (61%) also preferred the structured radiology report to the free-text report. Sixty one percent of the participants thought that the type of radiology reporting affected their level of understanding, around 75% of whom preferred structured radiology reporting. Most of the participants did not understand the typical radiology reports (Mdn=2). Most of the participants understood the MRI report with the patient summary statement (Mdn=4). The vast majority of the participants (84%) thought that adding a summary statement at the end of the radiology report summarizing the content of the report in lay terms was a good method for improving their understanding of the report. The Wilcoxon signed rank test revealed that adding a summary at the end of a radiology report summarizing the content of the report in lay terms can significantly enhance the participants’ level of understanding of the reports with a very large effect size (Z = 17.271, p < 0.001, r = 0.723 for the spine MRI report and Z = 17.239, p < 0.001, r = 0.721 for the brain MRI report). Conclusions: Most patients will not understand their radiology report regardless of their level of education and their health literacy skills. Adding a summary at the end of the radiology report in lay terms summarizing the content of the report significantly improves patients’ understanding of the report. Structured radiology reporting is the preferred type of reporting for most patients, and most of them think that the type of radiology report affects their level of understanding of the report.

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