A program that sends secure text messages every day to help at-risk patients manage their conditions resulted in a 22% decrease in 30-day readmissions and a 46% improvement in 90-day readmissions for Sharp Rees-Stealy Medical Group patients who received the messages.
The organization developed the text message coaching program in collaboration with a vendor as a way to connect with the growing population of patients who need support and to improve performance on the CMS quality improvement programs, such as the readmission reduction program. Sharp designed the program content and partnered with a vendor to implement it.
“Our case management department budget did not have funds to increase the staff so we could provide one-on-one coaching by telephone to patients who need support. We looked at mobile technology as a way to expand our case management capabilities and to send messages to patients who need support,” says Janet Appel, RN, MSN, CCM, director of population health for the medical group.
Sharp Rees-Stealy Medical Group is part of San Diego-based Sharp Healthcare, one of the biggest health systems in California, with four acute care hospitals, three specialty hospitals, and three affiliated medical groups.
In the past, case managers would identify people who needed support, try to contact them, and explain what assistance they could provide. Usually, only about half of the calls resulted in patient engagement, Appel reports.
“We were unable to provide care management services to a segment of the growing population with the staffing resources allocated,” Appel says. “The mobile texting program has allowed us to increase case management capabilities by 44%.”
Texting allows the nurses to support more patients over a longer period of time than they could with traditional outreach, Appel says. “Through our texts, we provide guidance and tools to help them through the recovery process. It also allows us to be there when they need it if they encounter setbacks,” she says. The text messages help patients with their discharge instructions, identify early signs and symptoms of potential issues, and promote behavioral change, Appel says.
The text messages include alerts, reminders, and tips for managing each condition. Among the topics available by texting are diabetes, pre-diabetes, medication adherence, weight management, hypertension, healthy living, and post-hospital discharge.
“We’re always making changes, adding more topics, and more messages to each topic,” Appel says.
Patients can choose to receive messages at the frequency they desire, Appel says.
“We tweak the program to meet the needs and preferences of the patient,” she says.
The texts are perfect for patients who don’t want to spend a lot of time on the phone talking to a case manager, but who can benefit from care coordination, Appel says.
The text messages include information and reminders that patients can read quickly. They remind patients to take their medicine at scheduled times, describe symptoms and signs that mean patients should call the physician office, remind them to schedule follow-up visits with their physicians, provide tips on staying healthy, and offer information on fitness activities and local support groups.
For instance, patients in the medication management program receive messages like “Take your medicine as prescribed even if you feel good” and “Your medication is needed to prevent serious complications.”
Examples of the healthy living program texts include reminders for the patients to eat vegetables, fruit, and lean meats and fish, and to stick to the outside aisles at the supermarket where the fresh foods are.
The messages sent to post-hospital patients remind them to schedule a follow-up appointment and to follow their medication regimen and include information on a nurse line in case the patients have questions.
The system also allows patients with a question or a concern to reply with a text message that goes to a dashboard monitored by a Sharp case management assistant who can contact the patient with an answer or escalate the message to a nurse if the question is clinical.
The diabetes texting program lasts six months, but patients can sign up again. Healthy living and hypertension are open-ended.
Patients are identified for the program in a variety of ways, including data mining and referrals from physicians or other providers. For instance, potential participants in the diabetes program include patients with a new diagnosis of diabetes, patients with uncontrolled diabetes, and referrals from physicians.
Community health workers contact many of the patients and sign them up for the program. Others may be recruited by the entire clinical staff, including nurse case managers embedded in the physician office who see the patients when they come for their post-hospital follow-up visit.
Whenever staff members talk to patients who need support, they try to get the patients to enroll in the appropriate program, Appel says. The patients receive a text message asking if they want to be part of the program while they are still on the telephone with the community health worker or other member of the population health team. If they agree to sign up, they text back the word “yes.”
More than 3,000 people participated in the texting program last year.