In a pilot that included more than 350 chronic heart failure patients, a Philadelphia hospital was able to reduce its 30-day readmissions by 10 percent -- a 40 percent improvement over baseline -- by using email and text message reminders to get patients into follow-up appointments. Dr. Thompson Boyd, physician liaison at Hahnemann Hospital and Richard Imbimbo, the hospital's CFO, spoke at HIMSS 2015 in Chicago about their 10-month pilot, which was expanded from an initial six-month pilot, with congestive heart failure patients.
"We really want to show you that mobile technology has a role to play in readmission reduction and that patients that are more engaged tend to be readmitted less often," Boyd said. "They keep their appointments more often at higher rates, and cancel less, and also, for those folks, percentage of readmissions was down."
The pilot involved a total of 368 congestive heart failure patients and a total of 784 discharges. Patients were given the option of text message, phone, or email reminders to show up for scheduled follow-up appointments after they were discharged. Baseline readmissions prior to the pilot were at 26.7 percent.
At the end of the 10 months, 30-day readmissions for those who received messages dropped to 16 percent. Even those that didn't receive the messages saw a drop to 21.3 percent. They also tracked the average number of days until the patients attended a follow-up appointment. The messaged patients were back in 9 days on average, whereas the non-messaged were back in 14 days. Likewise, the time between discharge and readmission was longer for the patients who received messages (16 days compared to 14).
There was also a marked difference between patients who confirmed their appointment by responding to the message vs those who received the message but didn't reply. Based on data from the original six-month study, the re-admissions rate for those who confirmed was 8.8 percent, compared to 15.4 percent who didn't.
Interestingly, about 68 percent of messaged patients showed up for their follow-up appointment, whether they confirmed or not. Only 47 percent of non-messaged patients showed up. Five percent of confirmed patients cancelled their appointments, compared to 4 percent of non-confirmed patients and 11 percent of non-messaged patients. The study looked at the income level of patients, and found that it had no effect on how responsive they were to messaging.
Boyd and Imbibo also stressed that for a small number of patients, hospitals could save a lot of money by investing in outreach that goes beyond mobile messaging. Their data shows that 63 percent of readmissions came from 8.8 percent of patients, and that this small group of very-high readmission patients is disproportionately raising costs.
"Those readmitters need a greater proportion of traditional care complemented with technology," Boyd said. "I feel they need someone to come to their house every single day. ... You really need to have that close touch complementing technology."