17 - Addressing Language Disparities in Pediatric Patient Portal Enrollment at an Urban Safety-Net Hospital

Poster Number: 17
Publication Number: 17.2825

Background: Electronic patient portals offer the opportunity to reduce existing barriers to healthcare access. The Zuckerberg San Francisco General Pediatric Asthma/Allergy clinic (PAAC) serves a diverse population of children, 65% of whom primarily speak Spanish. Disparities in patient portal enrollment by language have been consistently reported in the literature, and few studies have addressed this barrier with the added complexity of proxy enrollment of minors. A total of 37.6% of patients seen from March 2022-February 2023 in the PAAC were enrolled in MyChart, with Spanish-speaking patients 28% less likely to be enrolled in MyChart than English-speaking patients (Figure 1)

Objective: To raise monthly average MyChart enrollment in the PAAC, for all patients and for Spanish-speaking patients, to 50%.

Design/Methods: We interviewed PAAC staff and providers and conducted a gap analysis to identify barriers to MyChart enrollment. The main barriers were the lack of an identified role focused on enrollment, and complexities of proxy enrollment. To address this gap, we partnered with an established Health Advocate (HA) volunteer program to expand the role of the volunteer assigned to the PAAC. Our pilot volunteer was bilingual and bicultural, and focused on providing individualized support with MyChart enrollment and proxy access during PAAC visits, while screening for social needs.

Results: The intervention led to an increase in average monthly MyChart enrollment rates for all patients, from 36.8% to 50.8%, during the study period (Figure 2). Average monthly MyChart enrollment of Spanish-speaking patients increased from 33.5% to 47.3%. Monthly enrollment for all patients and Spanish-speaking patients remained above the prior 12-month baseline average for most timepoints from March-August 2023. Cumulative enrollment for all patients seen in the PAAC during the study period increased to 51% (a 36% increase from the prior 12-month period) and to 47% for Spanish-speaking patients (a 28% increase) (Figure 3).

Conclusion(s): This study demonstrates that a dedicated bilingual volunteer can effectively enhance pediatric patient portal enrollment, particularly in Spanish-speaking populations. Though Spanish-speaking patient enrollment remained slightly below target, the results nevertheless demonstrate the remarkable impact that a qualified, dedicated volunteer can have in reducing disparities. Our findings support the integration of patient portal enrollment into the job description of dedicated, permanent clinical staff to ensure equitable healthcare access for pediatric patients.