Automated Texts Reduce Readmissions

What’s the Claim?

While these weren’t orthopaedic patients, we think you’ll want to see this one. An automated texting program to check on medical patients after hospital discharges resulted in a number of benefits, the most dramatic one being a 55% reduction in the odds of readmission to the hospital within 30 days, compared to patients in a control group who got a follow-up phone call after discharge.

How’s It Stack Up?

There are a few important reasons — apart from the exciting top-line finding — why this study is worth sharing with CORRelations readers who want to run efficient practices. First, it shows us that key concerns about the generalizability of telehealth interventions can be overcome. Most of the patients in this experiment were in their 60s, urban, and demographically and racially diverse. Despite that, most of the eligible patients participated. Second, although there are a few papers on texting-based interventions after surgery to give us context, there aren’t any quite like this one — a prospective, experimental study of a simple, practical intervention that worked really well. That said, what’s out there in surgery does tend to support our sense that the finding here will apply to our patients — a few preliminary but positive studies after colorectal surgery, one randomized controlled trial after arthroplasty that looked more at remote monitoring than texting but with similarly reduced readmissions, and a complex RCT about remote monitoring that probably is too resource-intensive for most practices (but it also worked). Finally, the authors confirmed that the groups in this study were not just well-matched but that they also consumed healthcare resources similarly prior to the start of the study.

What’s Our Take?

For all of those reasons, the take-home finding here seems both trustworthy and applicable. Automated texting integrates well into typical EMR environments. This study group used Epic, and it seemed to accommodate nicely what authors called “escalations” (patients who replied to texts saying that they were not doing well), by forwarding them to a monitored inbox in the EMR. As an increasing number of quality metrics will penalize physicians and hospitals for readmissions after surgery, this looks like an implementable step that, once in place, can decrease office workloads and reduce hospital readmissions.

Source

Bressman E, Long JA, Honig K, et al. Evaluation of an Automated Text Message–Based Program to Reduce Use of Acute Health Care Resources After Hospital Discharge. JAMA Netw Open. 2022;5:e2238293.