Implementation and Evaluation of a Virtual Transitional Care Intervention Using Automated Text Messaging and Virtual...

Area of Science:

• Health Services Research
• Digital Health Interventions
• Transitional Care

Background:

• Emergency department (ED) overcrowding and patient revisits are significant healthcare system challenges.
• Approximately 20% of patients return to the ED within 30 days, indicating a need for improved post-discharge care.
• ED-based transitional care, including automated SMS text messaging, offers potential for scalable and cost-effective follow-up, but evidence is limited.

Purpose of the Study:

• To evaluate a transitional care intervention combining SMS text messaging and virtual visits.
• To assess the intervention's impact on reducing ED revisits within 90 days.
• To determine the effect on outpatient follow-up rates and time to first outpatient evaluation.

Main Methods:

• Retrospective observational cohort study of patients discharged from 4 EDs.
• Intervention group: patients engaging with SMS text messaging and virtual transitional care visits (completed vs. noncompleted).
• Primary outcome: unplanned ED revisits within 90 days; secondary outcomes: outpatient follow-up and time to first outpatient visit.

Main Results:

• The noncompleted group had nearly double the 90-day ED revisits compared to the completed group (29% vs. 18.7%, P=.04).
• The completed group showed higher rates of outpatient follow-up (49% vs. 30.4%, P=.01).
• Patient engagement with the program was low, with only 2.9% accessing the scheduling link.

Conclusions:

• A combined SMS text messaging and virtual transitional care program can decrease 90-day ED revisits and improve outpatient follow-up.
• Low patient engagement (2.9%) necessitates optimization of care delivery and strategies to increase reach.
• Future research should focus on enhancing intervention accessibility and effectiveness for the broader ED discharge population.