---
title: "New Study Links Patient E-Messaging to Better Care | Sutter Health"
description: "A Sutter-affiliated study finds patient-initiated electronic messaging is linked to modest gains in completing recommended diabetes and hypertension tests."
url: "https://vitals.sutterhealth.org/research-innovation/patient-initiated-electronic-messages-and-quality-of-care-for-patients-with-diabetes-and"
---

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# Patient-initiated Electronic Messages and Quality of Care for Patients With Diabetes and Hypertension in a Large Fee-for-Service Medical Group: Results From a Natural Experiment.

A Sutter-affiliated study finds patient-initiated electronic messaging is linked to modest gains in completing recommended diabetes and hypertension tests.

March 12, 2016 by Sutter Health

![Patient-initiated Electronic Messages and Quality of Care for Patients With Diabetes and Hypertension in a Large Fee-for-Service Medical Group: Results From a Natural Experiment.](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/Vitals/research-and-innovation/Patient-initiated-Electronic-Messages-and-Quality-of-Care-for-Patients-With-Diabetes-and-Hy-1c8a0bd3.jpg?h=720&iar=0&w=1280 "Patient-initiated Electronic Messages and Quality of Care for Patients With Diabetes and Hypertension in a Large Fee-for-Service Medical Group: Results From a Natural Experiment.")

McClellan SR, Panattoni L, Chan AS, Tai-Seale M. _Medical Care_ . 2016;54(3):287-295.

[View the study](https://journals.lww.com/lww-medicalcare/Abstract/2016/03000/Patient_initiated_Electronic_Messages_and_Quality.10.aspx)

### ABSTRACT:

**Background:**  Few studies have examined the association between patient-initiated electronic messaging (e-messaging) and clinical outcomes in fee-for-service settings. 

**Objective:**  To estimate the association between patient-initiated e-messages and quality of care among patients with diabetes and hypertension. 

**Design:**  Longitudinal observational study from 2009 to 2013. In March 2011, the medical group eliminated a $60/year patient user fee for e-messaging and established a provider payment of $3-5 per patient-initiated e-message. Quality of care for patients initiating e-messages was compared before and after March 2011, relative to nonmessaging patients. Propensity score weighting accounted for differences between e-messaging and nonmessaging patients in generalized estimating equations. 

**Setting:**  Large multispecialty practice in California compensating providers’ fee-for-service. 

**Subjects:**  Patients with diabetes (N=4232) or hypertension (N=15,463) who had activated their online portal but not e-messaged before e-messaging became free. 

**Measures:**  Quality of care included HEDIS-based process measures for hemoglobin (Hb) A1c, blood pressure, low-density lipoprotein (LDL), nephropathy, and retinopathy tests, and outcome measures for HbA1c, blood pressure, and LDL. E-messaging was measured as counts of patient-initiated e-message threads sent to providers. Patients were categorized into quartiles by e-messaging frequency. 

**Results:**  The probability of annually completing indicated tests increased by 1%-7% for e-messaging patients, depending on the outcome and e-messaging frequency. E-messaging was associated with small improvements in HbA1c and LDL for some patients with diabetes. 

**Conclusion:**  Patient-initiated e-messaging may increase the likelihood of completing recommended tests, but may not be sufficient to improve clinical outcomes for most patients with diabetes or hypertension without additional interventions.

## Topics

[Diabetes](https://vitals.sutterhealth.org/search?facets=%5B%7B%22i%22%3A%22c_healthTopics.name%22%2C%22v%22%3A%5B%22Diabetes%22%5D%7D%5D&verticalKey=articles)[Blood Pressure](https://vitals.sutterhealth.org/search?facets=%5B%7B%22i%22%3A%22c_healthTopics.name%22%2C%22v%22%3A%5B%22Blood+Pressure%22%5D%7D%5D&verticalKey=articles)

## Diabetes care

Managing your blood sugar is key to protecting your long-term health and energy. If you're living with diabetes, our endocrinology specialists can provide personalized treatment, medication management and support to help you thrive.

[Learn more about Diabetes care](https://www.sutterhealth.org/services/diabetes)

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