Abstract
IMPORTANCE: Millions of Americans provide health and function-related help to family (broadly defined). These "care partners" provide critical support; however, they are rarely identified or supported in care delivery.
OBJECTIVES: Conduct a multi-site evaluation of a portal-based intervention designed to identify, engage, and support care partners in primary care settings.
DESIGN: Three days before a visit, patients were sent a portal notification inviting them to complete a questionnaire. Participants reporting caregiving responsibilities were provided a link to the Caregiver Intensity Index™ (CII), an assessment of caregiving intensity with local resources. In-clinic materials were available with information about accessing the CII.
SETTING: Five primary care practices at two health care organizations.
PARTICIPANTS: All patients age 18 + years of age at organization 1 and 21 + at organization 2.
MAIN OUTCOMES: Intervention reach: proportion and characteristics of patients completing the pre-visit survey. Intervention effectiveness: proportion of patients completing the CII.
RESULTS: The demonstration was implemented at 5 primary care practices between September 30, 2022, and May 31, 2024. At Organization 1, 19,407 patients received the pre-visit portal based questionnaire and 8,905 completed it at least once (response rate = 45.9%). At Organization 2, 12,047 patients received the questionnaire; 7,819 completed it at least once (response rate = 64.9%). The majority of pre-visit questionnaires were completed by patients. Patients assisted by care partners in completing the survey were older and less likely to speak English as a first language. About 1 in 5 respondents (16.9% at Organization 1 and 22.8% at Organization 2) reported caregiving responsibilities. Of these respondents, 36.9% and 27.3% completed the CII. Across both organizations, 61% of patients accessing and completing the CI through any of the available means (QR codes on in office materials, link in the pre-visit survey, link in the after-visit summary document) moderate caregiving intensity. Among all participants completing the CII 16.2% (Organization 1) and 19.5% (Organization 2) clicked on at least one resource.
CONCLUSION: To our knowledge, this pilot represents the first-of-its-kind effort to identify and support patients with caregiving responsibilities through a portal-based intervention. Our demonstration suggests a simple portal questionnaire, with the CII linked to resources, and supported with in-clinic materials, may successfully identify, engage, and support care partners, with minimal changes to clinician workflow. This approach may also offer an opportunity to digitally engage more vulnerable patients. As efforts to improve support for care partners gain traction, incorporation of this portal-based intervention offers an opportunity for widespread engagement and support.