Patient Portal Enrollment, Use, and Care Utilization among Hospitalized Children

Patient portals are designed to enhance patient and caregiver engagement by providing access to health information, communication with care teams, and telehealth services, yet their impact on health care utilization among hospitalized children is not well understood. In this cross-sectional study, we examined associations between patient portal enrollment and use and hospitalization outcomes among 40,377 children admitted to an urban quaternary or suburban tertiary pediatric hospital between 2022 and 2024. Portal activity was defined by enrollment and any use (login, messaging, or telehealth) within specified periods before or during hospitalization. Using multivariable regression models adjusted for sociodemographic factors, neighborhood opportunity, insurance type, language, medical complexity, hospital site, and year, we evaluated associations with critical care admission, hospital length of stay (LOS), and 30-day readmissions. Portal enrollment and use in the year prior to hospitalization were associated with significantly lower odds of critical care admission and shorter LOS, with average reductions of 1.56 days for enrollment and 1.21 days for use. Neither portal enrollment nor use was significantly associated with 30-day readmissions. Future research should explore any potential mechanisms facilitating lower acuity at admission and shorter hospitalizations for those engaged with digital health.