Automated texting after hospital stay associated with fewer returns to hospital
A cohort study found that ED visits and readmissions were less common among patients who received check-in texts from their primary care practice for 30 days postdischarge compared with those who did not.
Patients who received automated check-in texts from their primary care practice for 30 days after hospital discharge used significantly less acute care resources, according to a recent cohort study.
Researchers used a difference-in-differences approach at two academic primary care practices in Philadelphia from Jan. 27 through Aug. 27, 2021, to examine whether a 30-day automated texting program to support patients after hospital discharge was associated with reduced use of acute care resources. Established adult patients who were discharged from an acute care hospitalization and received the usual telephone call for transitional care management were eligible for the study. Patients at the intervention practice received automated check-in texts on a tapering schedule in the 30 days after discharge. Care needs identified by the automated messaging platform were escalated to practice staff, who followed up via the electronic medical record. The study's primary outcome was any ED visit or readmission within 30 days of discharge, while secondary outcomes were either of these variables analyzed separately along with 30- and 60-day mortality. The results were published Oct. 26 by JAMA Network Open.
Overall, 1,885 patients with 2,617 discharges were included in the analysis. Mean age was 63.2 years, and 58.4% were women. Of the discharges, 1,051 were from the intervention practice (447 before the intervention and 604 afterward) and 1,566 were from the control practice (613 before the intervention and 953 afterward). Most patients receiving the intervention (82.8%) responded to the introductory text message or the first check-in message. The 30-day rate of use of acute care resources was 15.2% before the intervention and 19.8% afterward for the control practice versus 20.3% and 16.5% for the intervention practice. Adjusted odds ratios (aORs) for the intervention practice versus the control practice were 0.59 (95% CI, 0.38 to 0.92; P=0.02) for any use of acute care resources, 0.77 (95% CI, 0.45 to 1.30; P=0.33) for an ED visit, and 0.45 (95% CI, 0.23 to 0.86; P=0.01) for a readmission. For death within 30 and 60 days of discharge, aORs were 0.92 (95% CI, 0.23 to 3.61; P=0.91) and 0.63 (95% CI, 0.21 to 1.85; P=0.40), respectively.
Patients were not randomized, and the study took place during the COVID-19 pandemic, which may have influenced the results, the authors noted. “The findings of this cohort study suggest that an automated texting program to support care management for primary care patients after hospital discharge is highly feasible and acceptable,” they wrote. “The program was associated with significant reductions in the use of acute care resources during the 30 days after discharge.” Automated texting may have been effective because it offered more frequent check-ins and an easy way for patients to initiate outreach, leading to earlier identification of care needs and a higher likelihood of escalation to primary care rather than to a more acute setting, the authors said.