Using Personalized Text Messages To Improve Heart Failure Hospital Readmission Rates

Abstract

<h3>Purpose</h3> Would personalized text messages to patients after heart failure hospitalizations help reduce readmission? <h3>Background</h3> Patients with managed Medicare and some private insurances have triggers for an established telephonic hospital follow up within the health system. But patients with managed Medicaid, "straight" Medicare (part A and B only), and some patients under 65 with private insurance do not have formal follow up by the health system entity after discharge. Through system indicator reports, patients were identified who did not have a following agency. As the phone contacts began, a trend emerged that a phone call was not always an effective way to reach patients. It was hypothesized that a personalized text message might make a better connection with patients after discharge to mitigate transition of care issues and in turn decrease readmission risk. Heart Failure team members have met with the patients during the hospital stay and had established some rapport already. <h3>Method</h3> Patients received a call from the Heart Failure Program, but if the patient was not reached, a text message was sent to their phone. The text message included a personalized message specific to what was discussed during their heart failure education visit while in the hospital. <h3>Results</h3> : There were 29 patients identified and texted from June to December 2020. 86% were male and 14% were female with ethnic breakdown of 66% white, 28% Hispanic/Latino, 3% Asian, 3% Middle Eastern. The mean age was 53 years old. Six patients (21%) of 29 texted replied back to text or called directly to the program office to speak to the Heart Failure Coordinator. Three (10%) patients texted instantly returned calls to program office after text was delivered. There were no 30-day readmissions for the 29 patients. <h3>Conclusion/Discussion</h3> Personalized texting appeared to help reduce heart failure readmissions with this group of patients that did not have other formal entities following hospitalization. The group observed was small, but it is beneficial when even one or two patients can be navigated away from the acute care setting. Additionally, although there wasn't a high number of direct responses, the chances of patients seeing the text were still high. A message with content that is simple and personalized may have been a helpful reminder of engagement of some level of heart failure self-care. The text message may also have served as a reminder that there was a reasonably easy way to communicate with a member of the care team without navigating through the healthcare call center. The quick replies that were received appeared to be prompted by an urgent need for help connecting with their primary provider or with problems related to medications. The text messages further highlighted structural problems patients encounter after discharge, specifically medication disruptions and physician follow up. These identified problems helped direct further readmission reduction work.