Introduction

The 21st Century Cures Act Final Rule requires that test results be released to patients through patient portals as soon as they are available.1 Findings from studies characterizing how patients engage with this expanded access have varied across settings and outcomes.2-8 Nationally representative estimates can complement existing work by isolating the specific behavior enabled by the Cures Act (viewing immediately released test results before clinician discussion) rather than general portal access, adding a comprehension outcome absent from prior work, and identifying disparities that persist beyond differential offering of access, including the potential role of patient-centered communication and digital literacy.

This study addressed 2 research questions. First, does a patient’s probability of accessing test results through a patient portal before hearing about the results from their health care practitioner vary by sociodemographic characteristics, health status, patient-centered communication, and digital health literacy and engagement? Second, among respondents reporting viewing before discussing with their clinician, does self-rated understanding of those results vary across the same factors?

This cross-sectional study was deemed exempt from review and informed consent by the New York University institutional review board because the data were deidentified and publicly available. This report followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies.

This study used the 2024 Health Information National Trends Survey (representative survey of US adults⁹ ) (eMethods in Supplement 1). The analytic sample was restricted to individuals who had been offered online access to their medical records by a health care practitioner and reported having a medical test within the past year. The outcomes were (1) viewing immediately released test results before hearing from a health care practitioner and (2) self-rated understanding of what those results showed and what they meant for the patient’s care. Self-reported sociodemographic factors from the survey instrument included age, sex, race and ethnicity, educational attainment, and annual household income. Race and ethnicity were included given documented disparities in patient portal access and use. Other independent variables included urbanicity, Census region, number of chronic health conditions, personal and family cancer history, medical care discrimination, patient-centered communication, digital literacy, and health-related social media use (eMethods in Supplement 1). Multivariable associations with each outcome were estimated using robust Poisson regression and expressed as adjusted prevalence ratios with 95% CIs.¹⁰ All statistical analyses were conducted in R version 4.5.2 (R Project for Statistical Computing), and all tests of statistical significance reflect a 2-sided α = .05.

A total of 4982 respondents were included. After weighting, the estimates generalized to 174 672 964 US adults (28.4% [95% CI, 26.3%-30.7%] aged 50 to 64 years; 51.5% [95% CI, 49.1%-53.9%] female), with 13.2% (95% CI, 11.8%-14.8%) identifying as Hispanic, 4.6% (95% CI, 3.5%-5.9%) as non-Hispanic Asian, 10.2% (95% CI, 9.0%-11.6%)as non-Hispanic Black, and 62.2% (95% CI, 60.0%-64.5%) as non-Hispanic White (Table 1). Regarding the primary outcome measure, 68.6% (95% CI, 66.4%-70.9%) of respondents viewed immediately released test results before hearing from their health care practitioner (unweighted: 3379 of 4982 respondents). Among this population, 6.6% (95% CI, 5.1%-8.1%) rated their understanding of what the immediately released test results showed and what the results meant for their care as poorly (unweighted: 210 respondents). The remaining distribution was 26.8% (95% CI, 24.3%-29.4%) understanding fairly well, 31.7% (95% CI, 29.0%-34.5%) understanding well, and 34.9% (95% CI, 32.1%-37.9%) understanding very well.