Cancer patients’ portal usage during hospitalization.

400 Background: Patients’ engagement with their health information during hospitalization is crucial for a successful transition to home post-discharge, especially for cancer patients who often have complex treatment plans. Patient portals are an important mechanism for accessing such information. However, little is known about cancer patients’ use of portals during hospitalization, particularly whether there are disparities in access to this valuable resource. This study’s purpose was to identify potential inequities in portal use during cancer patients’ hospital stays. Methods: This retrospective analysis at Memorial Sloan Kettering Cancer Center in New York City assessed portal usage across 28,386 patients admitted in 2022 or 2023 and discharged by December 31, 2023. For each patient, we assessed when they activated their portal account and the number of hospital days during which they logged into the portal (adjusted for total length of stay). We also assessed portal usage during Intensive Care Unit (ICU) admissions. Multivariate logistic and Poisson regression models evaluated relationships between patients’ demographic and care characteristics and their inpatient portal usage. Results: Of a total of 28,386 patients, most were female (15,107, 53%); a majority were non-Hispanic (24,177, 91%) and white (20,643, 77%); the median age was 65 years (IQR 54-75), the median number of admissions was 1 (IQR 1-2), and the median length of stay was 4 days (IQR 2-8). Nearly all patients (26,031, 92%) activated their portal accounts prior to their first admission. 65% (18,588) logged in at least once during any hospitalization. While modest usage differences emerged for primary language, ethnicity, sex and age, larger disparities appeared around race, insurance type, and marital status. Patients who were Black (OR=0.68, 95% CI (0.62, 0.74), p<0.001; IRR=0.68, 95% CI (0.62, 0.73), p<0.001), single (OR=0.80, 95% CI (0.75, 0.86), p<0.001; IRR=0.88, 95% CI (0.83, 0.93), p<0.001), or insured by Medicaid insurance (OR=0.79, 95% CI (0.71, 0.87), p<0.001; IRR=0.86, 95% CI (0.8, 0.94), p<0.001) were, respectively, 32%, 20%, and 21% less likely to use the portal, and logged in 32%, 12%, and 14% less, compared to white, partnered, and commercially insured patients, respectively. In our sub analysis of the 1,782 patients with ICU admissions, 971 (55%) logged in at least once during hospitalization. Black patients were 41% (OR=0.59, 95% CI (0.43, 0.80), p<0.001) less likely to use the portal and logged in 41% less (OR=0.59, 95% CI (0.48, 0.74) p<0.001) than white patients. Conclusions: This analysis uncovered significant disparities in cancer patients’ portal usage during hospitalization, most notably by race, insurance type, and marital status. Future work should explore the underlying reasons and leverage these insights so that portal onboarding processes and interface designs address the needs of all patients.