Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2024 Apr 1;7(4):e243701. doi: 10.1001/jamanetworkopen.2024.3701.
Postdischarge outreach from the primary care practice is an important component of transitional care support. The most common method of contact is via telephone call, but calls are labor intensive and therefore limited in scope.
To test whether a 30-day automated texting program to support primary care patients after hospital discharge reduces acute care revisits.
DESIGN, SETTING, AND PARTICIPANTS: A 2-arm randomized clinical trial was conducted from March 29, 2022, through January 5, 2023, at 30 primary care practices within a single academic health system in Philadelphia, Pennsylvania. Patients were followed up for 60 days after discharge. Investigators were blinded to assignment, but patients and practice staff were not. Participants included established patients of the study practices who were aged 18 years or older, discharged from an acute care hospitalization, and considered medium to high risk for adverse health events by a health system risk score. All analyses were conducted using an intention-to-treat approach.
Patients in the intervention group received automated check-in text messages from their primary care practice on a tapering schedule for 30 days following discharge. Any needs identified by the automated messaging platform were escalated to practice staff for follow-up via an electronic medical record inbox. Patients in the control group received a standard transitional care management telephone call from their practice within 2 business days of discharge.
The primary study outcome was any acute care revisit (readmission or emergency department visit) within 30 days of discharge.
Of the 4736 participants, 2824 (59.6%) were female; the mean (SD) age was 65.4 (16.5) years. The mean (SD) length of index hospital stay was 5.5 (7.9) days. A total of 2352 patients were randomized to the intervention arm and 2384 were randomized to the control arm. There were 557 (23.4%) acute care revisits in the control group and 561 (23.9%) in the intervention group within 30 days of discharge (risk ratio, 1.02; 95% CI, 0.92-1.13). Among the patients in the intervention arm, 79.5% answered at least 1 message and 41.9% had at least 1 need identified.
In this randomized clinical trial of a 30-day postdischarge automated texting program, there was no significant reduction in acute care revisits.
ClinicalTrials.gov Identifier: NCT05245773.
初级保健实践的出院后随访是过渡性护理支持的一个重要组成部分。最常见的联系方式是电话，但电话耗费大量劳动力，因此范围有限。
测试 30 天自动短信程序是否可以减少急性护理就诊。
设计、地点和参与者：这是一项 2 臂随机临床试验，于 2022 年 3 月 29 日至 2023 年 1 月 5 日在宾夕法尼亚州费城的一个单一学术健康系统的 30 个初级保健实践中进行。参与者在出院后 60 天内接受随访。研究人员对分配情况进行了盲法，但患者和实践工作人员未进行盲法。参与者包括研究实践的已建立患者，年龄在 18 岁或以上，从急性护理住院中出院，并且通过健康系统风险评分被认为存在中到高的不良健康事件风险。所有分析均采用意向治疗方法进行。
干预组患者在出院后 30 天内，根据递减时间表，从他们的初级保健实践中收到自动签到短信。自动消息传递平台识别出的任何需求都将通过电子病历收件箱升级为实践工作人员进行后续跟进。对照组患者在出院后 2 个工作日内从他们的实践中收到标准的过渡性护理管理电话。
主要研究结果是出院后 30 天内的任何急性护理就诊（再次入院或急诊就诊）。
在 4736 名参与者中，有 2824 名（59.6%）为女性；平均（SD）年龄为 65.4（16.5）岁。指数住院时间的平均（SD）为 5.5（7.9）天。共有 2352 名患者被随机分配到干预组，2384 名患者被随机分配到对照组。对照组中有 557 名（23.4%）在出院后 30 天内发生急性护理就诊，干预组中有 561 名（23.9%）（风险比，1.02；95%CI，0.92-1.13）。在干预组中，有 79.5%的患者至少回复了 1 条消息，有 41.9%的患者至少有 1 个需求得到识别。
在这项针对 30 天出院后自动短信程序的随机临床试验中，急性护理就诊没有显著减少。
ClinicalTrials.gov 标识符：NCT05245773。
