Texting found more effective than phone calls for hospital discharge follow-ups

Primary care practices traditionally have used phone calls to check on the status of patients who’ve recently been discharged from the hospital and address any problems that might cause them to be readmitted. But automatic text messaging might be a better way to accomplish those goals, a new study finds.

The study’s authors note that while follow-up phone calls are somewhat effective in reducing unplanned readmissions, they require a significant time commitment, often go un- answered, and generally reach patients only once.

As an alternative, they designed a 30-day post-discharge intervention using automated texting, with patient needs identified by the messaging platform escalated to practice staff for follow-up. They implemented the program at a university-affiliated primary care practice for five months in 2021.

Then they compared use of acute care resources—defined as emergency department (ED) visits or hospital readmissions-- among recently discharged patients with acute care resource use at a practice with a similar patient population but without the texting intervention. In all, the study included 1,885 patients with 2,617 discharges, including 1,051 from the intervention practice and 1,556 from the control practice.

They found that after implementing the texting program, the odds of acute care resource use within 30 days of discharge were 41% lower than at the practice without the texting program. Moreover, the program integrated easily into the workflow of the practice’s care management team, for whom responding to calls from recently discharged patients was already part of the daily routine.

A further benefit of the program, researchers say, was its positive reception among patients. More than eight in 10 responded to at least one of the introductory text messages, a rate far higher than responses to post-discharge phone calls.

While the authors don’t provide any definitive reasons as to why texting reduces acute care use, they theorize that more frequent check-ins and relative ease of patient-initiated outreach result in earlier identification of potential problems and a greater likelihood that those problems can be handled by the practice rather than in an acute care setting.

The study, “Evaluation of an Automated Text Message–Based Program to Reduce Use of Acute Health Care Resources After Hospital Discharge” was published online October 26 in JAMA Network Open.