The Association Between Sociodemographic Factors and Patient Portal Utilization Across Orthopaedic Subspecialties

Patient portal (PP) usage enhances patient engagement, quality of care, and clinical outcomes. However, effective utilization requires digital literacy and internet access, resulting in disparities, particularly among older, non-White, uninsured, or publicly insured patients. While prior studies have examined PP use in specific orthopaedic subspecialties, comprehensive analyses are limited. The aim of this study was to identify social determinants of health of interest (SDOH) associated with PP utilization across orthopaedic subspecialties and to assess its association with outcomes.

A retrospective cohort study of adult patients who underwent orthopaedic procedures was conducted between January 2021 and December 2022. The study included 33,143 encounters involving 28,028 patients. PP utilization was defined as activating and using the PP at least once. SDOH assessed included age, sex, race, ethnicity, language, domestic partnership status, employment status, insurance, and urbanicity. Clinical outcomes included hospital length of stay, 30-day return to the emergency department (ED), 30-day readmission, and discharge disposition. Univariable and multivariable models evaluated associations between SDOH and PP use, while mixed-effects models assessed the association between PP utilization and outcomes.

PP utilization varied across subspecialties, with the highest rates in sports medicine (93.9%) and hip preservation (92.6%) and the lowest in trauma (71.7%). Lower odds of PP use were observed among patients older than 65 years, male, non-White, non-English speaking, single, unemployed, uninsured or publicly insured, and those living in rural areas. A decrease of 1 SDOH was associated with a 2.21-fold increase in PP use (odds ratio [OR]): 2.21; 95% confidence interval [CI]: 2.14-2.29; p < 0.001). Nonusers had higher odds of 30-day ED return (OR: 1.73; 95% CI: 1.51-1.99), 30-day readmission (OR: 2.49; 95% CI: 2.12-2.93), nonhome discharge (OR: 4.63, 95% CI: 3.76-5.70), and experienced longer hospital stays (Rate Ratio: 1.61; 95% CI: 1.52-1.70).

PP utilization in orthopaedic surgery is associated with social determinants of health and varies by subspecialty. PP nonusage is associated with worse clinical outcomes, highlighting the need for targeted interventions to improve PP adoption among at-risk populations and reduce disparities in orthopaedic care.

Level III. See Instructions for Authors for a complete description of levels of evidence.