Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor


Second Advisor


Third Advisor

Christie Laming M.D.

Academic Year



Background: Patient portals are available through many healthcare offices. They offer the opportunity to improve patient engagement and quality of patient care, but few patients enroll. At a small rural primary care office, less than 20% of the patients were enrolled in the patient portal.

Objective: The purpose of this quality improvement project was to address the barriers reported by patients at this clinic and determine whether changes in portal enrollment volume occurred. Reported barriers included a lack of knowledge about the portal and difficulties with the sign-up process.

Methods: Over three months, strategies included the development of a website with an educational video on a dedicated patient portal page, an educational brochure, and in-office promotion. Data regarding the overall percentage of patients enrolled in the portal, and the rate of enrollment 12 weeks before the project started was obtained. The project was implemented, and the overall enrollment percentage and enrollment rate for 12 weeks post-implementation were compared with the pre-implementation data. The inclusion criteria for this project entailed patients over age 18 who presented to this primary care office for an appointment. Patients 17 and under and telemedicine appointments were excluded. To determine the impact of the education available on the webpage, participants were asked to complete a survey both before and after watching the educational video. This was accomplished by convenience sampling of website visitors. Interest in education was determined by comparing the number of visits to the website to the number of times the video was viewed.

Results: 1,076 patients met criteria. The percentage of patients invited increased by 16.3% and enrollment increased by 11.7% over the project time. There was a significant difference in the percentage of patients that enrolled in the portal before and after interventions occurred (t2.1962 = 7.38, p=0.0137). The average percentage of patients enrolled post-intervention was over 19% greater than the average percentage of individuals enrolled pre-intervention (95% confidence interval 12.3344, 26.9989). Due to the low sample size, the planned t-test to evaluate education effectiveness could not be performed. Of 495 website visitors, 14 viewed educational videos (2.82%).

Conclusion: Portal enrollment did significantly increase at this small rural primary care clinic; however, it is unlikely that this was due to education. Factors that may have increased enrollment include in-office promotion and in-person point of contact, increased patient awareness of the portal, and an increased number of invitations sent to patients. Factors that may have resulted in the low response rates for the educational component include low patient interest, small target audience, patient population, minimal promotion, inconsistent implementation, and limited project timeframe.

Key Words: Adult, Education, Health Information Technology, Patient Portal, Primary Health Care, Quality Improvement, Rural Population