Text-based virtual care program did not improve post-discharge outcomes

A program that provided automated text messaging with escalation to clinical care, if needed, was not successful in reducing acute care revisits in the 30 days post-hospital discharge, according to a recent study.

Published in JAMA Network Open, the study assessed a post-discharge outreach program that aimed to support patients after hospital discharge. The post-discharge period is critical for hospitalized patients. The study noted that readmissions and acute care revisits are common. Thus, healthcare provider organizations employ numerous efforts to reduce these through transitional care management programs.

These programs commonly feature nurses calling patients over the telephone to identify needs post-discharge, the study stated. While phone calls are effective, they can add to nursing burdens.

Pennsylvania-based researchers decided to examine the efficacy of a less labor-intensive strategy: a 30-day automated texting program. Through the program, patients received check-in messages from primary care practice staff on a tapering schedule after hospital discharge.

The researchers conducted a two-arm study that included adult patients who received care in 30 participating University of Pennsylvania Health System primary care practices from March 29, 2022, to January 5, 2023.

The study population was assigned usual post-discharge transitional care management or usual care plus the 30-day automated text messaging program. Those in the usual care group received a phone call from a nurse within their primary care practice within two business days of discharge, while those in the intervention arm received the phone call as well as automated text messages. The messages asked if there was anything the patient needed help with and if the patient responded “yes,” they received follow-up messages to categorize their needs. If patients required a higher level of care, messages were routed to an inbox in the patient’s EHR, prompting the practice staff to call the patient.

Of 4,736 patients included in the study, 2,352 were assigned to the intervention group and 2,384 to the control group.

The primary outcome was any acute care revisit, either an emergency department (ED) visit or readmission, within 30 days of discharge. Researchers found the rate of acute care revisits was 23.4 percent in the control group and 23.9 percent in the intervention group within 30 days of discharge. There was also no significant difference in the rate of acute care revisits between the groups at seven and 60 days post-discharge.

Further, there was no significant difference in the likelihood of an ED visit or readmission at 30 days post-discharge, and the percentage of patients scheduling a primary care follow-up visit within 14 days was similar between the groups.

“The program was integrated within existing practice workflows, demonstrated high levels of engagement and satisfaction, and identified needs in a substantial number of patients,” the researchers concluded. “Nonetheless, the patients in the intervention arm were no less likely to be readmitted or need other acute care services.”

However, they noted that “there is still potential value in an automated texting approach, given that call-based programs are operationally burdensome.”

Text message-based programs have been more successful in other areas, however.

For instance, a study published in 2021 showed that an automated texting program helped the University of Pennsylvania Health System lower the risk of death for COVID-19 patients. For the study, researchers examined data from 3,488 patients who tested positive for COVID-19 between March 23 and Nov. 30, 2020.  The patients were enrolled in the health system’s COVID Watch program, which remotely monitored patients via twice-a-day, automated text message check-ins.

The study revealed that three of the COVID Watch program participants had died at 30 days as compared with 12 of the 4,377 patients who received usual care. The COVID Watch group also had 2.5 fewer deaths per 1,000 patients than the usual care group at 60 days.