Mostly, But Program Changes are Needed to Ensure Health Care Access for Low-Income Americans
Health Care Access & Coverage
Automated Texting Shows Promise to Reduce Hospital Readmissions
Frequent Text Check-Ins After Hospitalization Helped Patients Access Follow-Up Care
The transition from hospital to home can be a challenging period. After receiving 24-hour care in the hospital, patients must suddenly adjust to little or no clinical support at home—even as they may be struggling to regain strength, cope with new diagnoses, manage medications, and coordinate follow-up appointments.
Policymakers and payers have targeted the transition in an effort to improve patient outcomes and lower health care spending. In response, health systems have tried a combination of one-off phone calls and post-discharge follow-up visits.
In a recent JAMA Network Open study, our team reported on a different approach: a pilot program employing automated text messaging to support patients with the transition. The goal of the pilot program was to scale up patient touchpoints and decrease barriers to communicating with their primary care practice without placing significant additional burden on staff to initiate outreach. Patients received automated check-in text messages from their primary care practice during the first 30-days post-discharge. Patients could reply with a text to about any needs and receive and a follow-up phone call from a nurse.
Despite concerns that patients would find the program impersonal or staff would be overwhelmed responding to messages, the program was highly acceptable to both groups. Of the 430 patients enrolled in the program, 360 (83%) responded to the initial messages. On average, the nurses had to make an additional 1.4 calls per day to patients. Compared to a control group, in which patients received one or a series of nurse-initiated phone calls (usual care), the automated texting program was associated with less acute care use during the 30 days after discharge, with the difference driven largely by a 55% decrease in the odds of a 30-day readmission.
For primary care practices and health systems looking to provide support to their patients across the continuum of care, the findings are encouraging. They indicate that in a fragmented landscape, relatively simple applications of technology can help patients feel more connected to their care team and can help practices provide additional support in a scalable way. Our health system’s primary care practices are currently testing the approach in a larger randomized controlled trial.
Our pilot program is just one example of many new applications of virtual care and digital medicine that are shifting patient care away from the traditional, visit-based model to something more continuous with ongoing patient engagement. If there is value in these approaches—and programs like ours indicate that there is—payers and policymakers will need to find ways to reduce the following barriers:
- The current fee-for-service model deters the widespread adoption of digital and virtual methods of patient engagement. One way to overcome this barrier might be for policymakers to adopt alternative payment models, such as a statewide or national virtual care payment policy.
- Licensure rules currently restrict physician practices to specific states. The complex regulatory infrastructure that governs the use of the latest tools for patient engagement needs to be updated.
- While the Centers for Medicare and Medicaid Services has made transitional care management services a priority, traditional call-based outreach can be operationally burdensome with lower response rates. If text message-based outreach is an acceptable and effective alternative, payors may be more likely to reimburse for these services, promoting their continued use.
The study, Evaluation of an Automated Text Message–Based Program to Reduce Use of Acute Health Care Resources After Hospital Discharge, was published in JAMA Network Open on October 26, 2022 by Eric Bressman, Judith A. Long, Katherine Honig, Jarcy Zee, Nancy Mcglaughlin, Carlondra Jointer, David A. Asch, Robert E. Burke, and Anna U. Morgan.
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