The Doctor Won’t See You Now: Examining Drivers of Care Team Response to Patient Portal Messages

With Ariel D. Stern, Lisa Rotenstein, Rebecca G. Mishuris, and Michael L. Barnett

Patient portal messages have become an important channel for patient-provider communication. However, there are well documented disparities in rates of portal use. Additionally, prior work has shown that even when minority and Medicaid patients send portal messages, they are less likely to receive responses from attending physicians, seemingly driven by lower prioritization in message triage. Using natural language processing, we analyze the text of patient portal messages from a large academic health system to understand what drives these differences, enabling us to separate three potential mechanisms: differences in the underlying request of the message (e.g., medication question, referral request), differences in the way the messages are written, and non-clinical bias. We find that, while the category of message request is a significant predictor of care team response, it cannot explain observed differences across demographic groups. On the other hand, the way the message is written – including message characteristics such as length and formality – accounts for nearly half of the observed differences in care team response. Our findings identify a clear mechanism underlying disparities in care team response, highlighting avenues for mitigating them and deepening our understanding of care disparities broadly.