Factors Associated with Uptake of Patient Portals at a Federally Qualified Health Care Center.

Federally qualified health centers (FQHC) aim to improve cancer prevention by providing screening options and efforts to prevent harmful behavior. Patient portals are increasingly being used to deliver health promotion initiatives. However, little is known about patient portal activation rates in FQHC settings and the factors associated with activation. This study examined patient portal activation among FQHC patients and assessed correlations with demographic, clinical, and health service use variables. We analyzed electronic health record data from adults >18 years old with at least one appointment. Data were accessed from the electronic health records for patients seen between 1 September 2018 and 31 August 2022 (n = 40,852 patients). We used multivariate logistic regression models to examine the correlates of having an activated EPIC-supported MyChart patient portal account. One-third of patients had an activated MyChart portal account. Overall, 35% of patients with an activated account had read at least one portal message, 69% used the portal to schedule an appointment, and 90% viewed lab results. Demographic and clinical factors associated with activation included younger age, female sex, white race, English language, being partnered, privately insured, non-smoking, and diagnosed with a chronic disease. More frequent healthcare visits were also associated with an activated account. Whether or not a patient had an email address in the EHR yielded the strongest association with patient portal activation. Overall, 39% of patients did not have an email address; only 2% of those patients had activated their accounts, compared to 54% of those with an email address. Patient portal activation rates were modest and associated with demographic, clinical, and healthcare utilization factors. Patient portal usage to manage one's healthcare needs is increasing nationally. As such, FQHC clinics should enhance efforts to improve the uptake and usage of patient portals, including educational campaigns and eliminating email requirements for portal activation, to reinforce cancer prevention efforts.

The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System.

Purpose: To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Methods: Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results: Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion: Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.

MiQuit: A Study Protocol to Link Low-Income Smokers to a State Tobacco Quitline.

Purpose: To conduct a randomized controlled trial to compare 3 implementation strategies and the impact of facilitated referrals on linkage of Federally Qualified Health Center patients to the Illinois Tobacco Quitline (ITQL). Methods: This study will be a hybrid type 3 implementation-effectiveness trial guided by 2 implementation science frameworks: reach, effectiveness, adoption, implementation, and maintenance and exploration preparation implementation sustainment. We will evaluate whether sending provider messages through the patient electronic health portal increases patient linkage to the ITQL. We will (1) randomly assign all eligible patients to receive 1 of 3 messages (information about quitting, advice to quit, and advice to quit or cut down), and (2) we will offer a facilitated linkage to the ITQL. For patients who opt into a facilitated referral, we will share their contact information with the ITQL, who will contact them. Four weeks after the initial message, patients who expressed interest in services but were not reached by the ITQL will be rerandomized to 1 of 2 arms, an offer to reconnect to the ITQL or an offer to engage a peer navigator who can help them reconnect to the ITQL. We will assess the implementation strategies' reach, adoption, linkage, and sustainability with the ITQL. Discussion: This study will provide a new cost-effective and efficient model to link low-income smokers to state tobacco quitlines. Message delivery via patient health portals has important implications for addressing other tobacco-related morbidities.

G9a Promotes Breast Cancer Recurrence through Repression of a Pro-inflammatory Program.

Dysregulated gene expression is a common feature of cancer and may underlie some aspects of tumor progression, including tumor relapse. Here, we show that recurrent mammary tumors exhibit global changes in gene expression and histone modifications and acquire dependence on the G9a histone methyltransferase. Genetic ablation of G9a delays tumor recurrence, and pharmacologic inhibition of G9a slows the growth of recurrent tumors. Mechanistically, G9a activity is required to silence pro-inflammatory cytokines, including tumor necrosis factor (TNF), through H3K9 methylation at gene promoters. G9a inhibition induces re-expression of these cytokines, leading to p53 activation and necroptosis. Recurrent tumors upregulate receptor interacting protein kinase-3 (RIPK3) expression and are dependent upon RIPK3 activity. High RIPK3 expression renders recurrent tumors sensitive to necroptosis following G9a inhibition. These findings demonstrate that G9a-mediated silencing of pro-necroptotic proteins is a critical step in tumor recurrence and suggest that G9a is a targetable dependency in recurrent breast cancer.