Repeated Access to Patient Portal While Awaiting Test Results and Patient-Initiated Messaging.

Importance: Patients have immediate access to test results in the patient portal, which can cause worry. Identifying behaviors associated with worry while awaiting results may allow health systems to support patients and reduce message volumes. Objective: To describe characteristics of patients who refresh their portal while awaiting test results and measure the association between refresh behavior and patient-initiated messaging. Design, Setting, and Participants: This retrospective cross-sectional study was performed at Vanderbilt University Medical Center, which uses a MyChart-based patient portal. All adult patients (aged ≥18 years) who received outpatient test results between January 1, 2022, and December 31, 2023, were included. Exposures: Use of the patient portal to review test results. Main Outcomes and Measures: The primary outcome was the proportion of patients who refreshed the portal while awaiting test results. Tests were stratified into low-sensitivity (eg, basic metabolic panel) and high-sensitivity (eg, tissue biopsy) groups using validated categories based on each test's likelihood of being misinterpreted or causing distress. Portal access logs were used to identify refresh behaviors, in which patients accessed the portal seeking new results. Secondary outcomes included the association between patient characteristics and refresh behavior and between refresh behavior and messaging as measured using multivariable logistic regression. Results: A total of 968 774 results were reviewed by 290 349 patients (mean [SD] age, 47.8 [18.0] years; 66.3% female). Patients refreshed their portal for 25.9% of results. Patients more commonly refreshed for high-sensitivity results (25 280 of 64 356 [39.3%]) compared with low sensitivity results (225 516 of 904 418 [24.9%]) (P < .001). Patients who enabled notifications had higher odds of refreshing for high-sensitivity results (odds ratio, 1.11; 95% CI, 1.06-1.17) and low-sensitivity results (odds ratio, 1.54; 95% CI, 1.49-1.59). Each refresh for high-sensitivity results was associated with a lower increase in the probability of messaging within 24 hours (mean marginal effect, 0.41; 95% CI, 0.34-0.49) compared with refreshing for low-sensitivity results (mean marginal effect, 1.03; 95% CI, 0.96-1.11). Conclusion and Relevance: This cross-sectional study found an association of patients' refresh activity for low-sensitivity results with patient-initiated messaging after review. These findings suggest that refresh behavior, a potential measure of worry, may be a characteristic of patient attitudes and preferences rather than the test.