Text Message Patient Outreach Cuts 30-Day Hospital Readmission Risk 41%

Healthcare organizations may consider implementing text message patient outreach as part of their post-discharge patient engagement strategies, as the technology can yield a lower risk of 30-day hospital readmission, among other quality metrics, researchers wrote in JAMA Network Open.

Particularly, text message patient outreach yielded a 41 percent reduction in the risk for 30-day hospital readmission, a key clinical quality measure in many value-based care arrangements.

Patient engagement during the post-discharge process is critical. Keeping in touch with patients allows acute care providers to monitor issues and address them on an outpatient basis before symptoms deteriorate and require acute care in the ED or an inpatient setting.

Normally, this post-discharge patient engagement happens when nurses call the patient to check in.

“This approach has proven effective in some settings in reducing unplanned readmissions; however, the calls are limited in scope and present a significant operational burden,” the researchers wrote. “In our experience, the calls can be time intensive, often go unanswered, and generally connect with patients only once, early in the course of their recovery.”

But in an analysis comparing patients discharged for acute care in two separate healthcare facilities, researchers found text messaging could be a more efficient process.

The research team sent discharged patients in one facility the traditional care management phone call.

But at the other facility, patients were also able to opt into the text message program following that phone call. First, the text messages asked patients whether they had a primary care provider (PCP) visit lined up after their acute care episode. Then, patients began receiving “check-in” texts that tapered off as time wore on.

Messages were bi-directional and escalated care as needed, depending on patient answers to prompts.

This program was successful, with the researchers reporting that the text message patient engagement reduced the odds that patients would need to access any kind of acute care.

Particularly, text message engagement was linked to a 41 percent reduction in 30-day hospital readmissions. Patients getting the texts were 33 percent less likely to visit the ED 30 days after discharge, but this finding was not statistically significant, the researchers said.

“The mechanism through which this compound program prevents use of acute care is likely complex, but we theorize that more frequent check-ins and a lower friction medium for patient-initiated outreach lead to earlier identification of needs and a greater likelihood that issues will be escalated to and handled by the primary care practice than another setting,” the researchers posited.

What’s more, patients liked the text messages, and the messages prompted some level of care management. During the study period, the text messages led to 260 escalations, meaning a patient was referred to primary care or another form of healthcare as the result of one of their responses.

And although patients could opt out of the engagement text messages whenever they wanted, there was laudable retention. Around 80 percent of patients responded to either the introductory text message or the first check-in message. Of those who were responsive at the start of the campaign, 44 percent were responsive by the end of the campaign, too.

All said, only 8.6 percent of patients enrolled in the text message outreach program opted out. Meanwhile, the Net Promoter Score (NPS) for the program was +67, which the researchers said is “considered excellent.”

Text message patient outreach systems can be beneficial because they are efficient and help organizations reach patients where patients most prefer. By automating post-discharge patient engagement, healthcare organizations can circumvent the staff burden that’s often associated with high-touch patient engagement programs.

This study still employed staff members to make initial post-discharge phone calls, regardless of whether the patient would get the option for the text message campaign. Future work may investigate systems to do away with this initial phone call, the researchers said.

Text messages have proven effective for various types of patient engagement, separate studies have found.

Throughout the COVID-19 vaccine rollout, organizations across the country used text message patient outreach to notify individuals when they became eligible for the shots and to help them schedule vaccine appointments.

In June 2022, researchers found text messages were just as effective for getting patients in for vaccinations as phone calls were, but given the efficiency of automated text, that program may have the upper hand in patient engagement.

But healthcare organizations considering text message patient engagement should be careful about how they deploy the systems. Some studies have found that sending too many text message alerts could prompt patients to unsubscribe from notifications, making programs virtually useless.