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The surge in portal messages during the pandemic has exacerbated work overload and burnout among primary care providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To enhance primary care clinic portal message workflow efficiency by identifying barriers through surveys and interviews, then implementing interventions to address challenges and streamline processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We used a pre- and post-intervention with concurrent control design to evaluate this quality improvement project. The project was conducted at an Internal Medicine ambulatory clinic site within a large academic medical center in the Midwest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The quality improvement project involved primary care physicians, registered nurses, licensed practical nurses, medical assistants, and patient services associates managing patient portal messages in primary care clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Interviews and surveys assessed workflow practices, perceptions, and gaps. Interventions included developing \u201cBest Practice Standards\u201d and \u201cRouting Guide\u201d documents and restructuring staffing with dedicated time for message management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Measures<\/jats:title>\n                    <jats:p>The co-primary outcomes were the volume of portal messages per physician clinical full-time equivalent (cFTE) and the proportion of message encounters with physician involvement. The secondary outcome was the proportion of messages sent to multiple recipients (\u201ccarbon copy\u201d messages).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>The intervention site showed a 16% reduction in messages per physician cFTE monthly (RRR, 0.84; 95% CI, 0.75\u20130.94) and a 65% decrease in \u201ccarbon copy\u201d messages (RR, 0.35; 95% CI, 0.31\u20130.39) compared to controls. Physician involvement in messages remained unchanged at the intervention site but increased 8% at control sites. Pre-intervention interviews identified workload, process, training, and stress barriers. Post-intervention, staff noted improvements from role clarification and dedicated message time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Targeted interventions can reduce portal message burden and improve workflow efficiency in primary care by implementing standardized protocols and clarifying roles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-025-09478-7","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T11:41:55Z","timestamp":1744717315000},"page":"4022-4029","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Taming the In-Basket\u2014How Two Simple Tools Reduced Portal Message Volume in an Academic Internal Medicine Clinic"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9041-2644","authenticated-orcid":false,"given":"Nicole","family":"Hadeed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Ameling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Henderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bucala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvette","family":"Salamey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Meddings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"issue":"1","key":"9478_CR1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12875-019-0948-1","volume":"20","author":"JL Hefner","year":"2019","unstructured":"Hefner JL, MacEwan SR, Biltz A, Sieck CJ. 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