Using Text Messaging to Improve Patient-Reported Outcomes
By Brandon Daniell
Patient-reported outcomes (PRO) have taken on increased importance as providers seek greater insights into the real-life impact of their treatments and services. These insights—whether used for internal measurement and improvement purposes or to support participation in a federal program (e.g., Merit-based Incentive Payment System (MIPS)) or statewide program (e.g., TexasAIM)—can empower providers to better tailor their efforts to strengthen outcomes. When successful, these efforts can decrease the need for additional, expensive, and avoidable treatments and services.
Strong PROs can also bolster patient satisfaction and engagement while aligning with value-based care models, which increasingly link reimbursement and performance metrics to patients’ perceptions of their progress toward better health.
A significant challenge concerning PROs is getting patients to share information and updates on their outcomes. Enter text messaging. To enhance their ability to collect, analyze, and then act on PROs, we are seeing providers turn to texting solutions, including those with two-way text messaging capabilities that enable interaction with patients. Organizations are leveraging texting as a patient-report outcome measures (PROM) tool to better engage with patients about their outcomes and treatment and service experiences, helping to uncover meaningful opportunities for improvement.
Value of texting as a PROM survey tool
Text messaging offers several advantages over other forms of patient communications when it comes to patients submitting their PROs. Email communication has become less reliable due to spam overload and the sheer volume of messages people receive daily. Similarly, phone calls are resource-intensive for staff and often ineffective, as consumers increasingly ignore calls from unknown numbers. Patient portals also have their limitations, with adoption and use often low. Patients can easily forget how to log in, may not want to juggle multiple portals if they see multiple providers using different systems, and may find the user experience complex and difficult to navigate.
Meanwhile, texting is a communication method increasingly preferred by patients. Most patients are on their phones or have their phones nearby throughout the day, making texting a natural communication method. Texts have a high open rate and are quick and easy to read. Patients can respond to texts at their convenience. With two-way text messaging, patients can quickly reply with a text to questions and requests concerning their outcomes.
For providers, text messaging is fast, efficient, and cost-effective. Texting allows for automated follow-ups if a patient does not respond initially. Analytics and reporting can identify who has and has not opened and/or replied to a text message, enabling providers to make data-driven decisions on how and when to follow up.
Examples of text messages for PROs
What do effective text messages for securing PROs look like? Here are some examples your organization can adapt and emulate for your own outreach PROs efforts.
30-day check-in text for discharged acute myocardial infarction (AMI) patients
Example text message: “XYZ Heart Center: To update your records, we need to know if you have required an emergency room visit or hospital admission since your discharge. Must reply YES or NO.”
For those AMI patients who reply with “YES,” the provider can work to determine the cause of the emergency room visit or hospital admission and then develop or change processes to help reduce the likelihood of such events for future AMI patients.
4-day check-in text for discharged congestive heart failure (CHF) patients
Example text message: “Hi <first name>. It is critical that you contact us if you are having trouble breathing when resting, have a dry cough that is getting worse, or have experienced weight gain in excess of 2lbs in a 24-hour period. If any of these apply to you, you can reach out to your primary care provider for direction or text CALL to receive a call back.”
This message serves multiple purposes. It reminds CHF patients not to wait to reach out to their primary care provider (PCP) if they have an experience that could indicate worsening health. It also gives patients the option to request a call from the provider, who can then work either to help the patient connect with their PCP (or a new PCP, if needed) or work with the patient address the situation.
Postpartum text campaign
Text messages: A provider can send a series of post-discharge messages to new mothers, covering topics including whether patients are experiencing infection symptoms, requesting that patients rate their pain level, and asking patients whether they have concerns about feeding their infant.
These messages enable providers to quickly identify emerging issues that could jeopardize the health of both mother and baby, allowing them to take timely action and provide necessary guidance and support. Additionally, the information gathered helps providers pinpoint areas where further education and resources could benefit future mothers in preventing similar health challenges.
Postoperative recovery text
Example text message: “XYZ Anesthesiologists: We hope your recovery is going well. Have you had any anesthesia-related complications/nausea/vomiting since your visit? Reply YES/NO.”
This message, sent by an anesthesia group, helps to assess whether the group’s providers are taking the appropriate steps to reduce the likelihood of anesthesia-related complications. Patients who respond with “YES” can receive further outreach to help the group identify the complication and assess whether changes in the delivery and management of anesthesia could help improve outcomes.
Postoperative check-in text
Example text: “XYZ Surgery Center: Thank you for choosing us for your knee replacement. We’re checking in regarding your procedure. Are you having any complications related to your procedure such as discomfort, pain, fever, bleeding, or any other issue? Please reply Yes or No.”
A simple follow-up text message like this enables the provider to engage with a patient not long after their treatment (in this case, a surgical procedure) to determine whether the patient is experiencing any symptoms of potential concern. For a patient who responds “Yes,” the provider can either call to discuss the symptom(s) or send a follow-up text requesting details about the complication(s). The patient can then be informed about when to expect a call from the provider and/or be provided with instructions on the next steps.
Powering PROs with Texting
The use of two-way text messaging as a PROMs solution can be a game-changer for healthcare organizations striving to increase both the quantity and quality of PROs. By leveraging text-based surveys, organizations can enhance patient participation while capturing valuable, real-time insights that support more informed and often proactive care decision-making.
For patients who opt into text messaging, the convenience, accessibility, and immediacy of the communication method can lead to higher response rates, better ensuring providers receive timely and relevant information. By making texting a routine component of post-discharge and follow-up care, the continuous stream of patient input will enable healthcare teams to make necessary care adjustments, implement early interventions, and take preventive measures that can reduce the risk of adverse events and readmissions, ultimately improving patient outcomes and overall care quality.
Brandon Daniell is co-founder and chief revenue officer of Dialog Health, a provider of a HIPAA-compliant, conversational two-way texting platform to organizations which they can leverage as a communication and engagement channel.