JMIR Publications

ABSTRACT

Background:

Hospital readmissions are a key indicator of care quality, and the emergency department (ED) often serves as an entry point in the readmission cycle. To reduce avoidable acute care use, many health systems have adopted ED-based transitional care interventions (TCIs). Among the most scalable and cost-effective strategies is automated text messaging outreach, which facilitates timely follow-up scheduling and reinforces discharge instructions. Despite its promise, evidence supporting this approach remains limited.

Objective:

The objective of our study was to (1) describe the design, implementation, and outcomes of a novel post-ED TCI utilizing automated text messaging and virtual care follow-up visits, and (2) assess its effect on unplanned ED revisits for the same presenting complaint as well as subsequent ambulatory follow-up engagement.

Methods:

This retrospective observational cohort study included patients discharged from four EDs within a single U.S. health system between September 2023 and September 2024. Patients were categorized into two groups based on their engagement with the intervention: (1) the Completed Virtual Visit group (requested, scheduled, and completed a visit) and the (2) Noncompleted Virtual Visit group (requested, scheduled, but did not complete a visit). The primary outcome was spontaneous, unplanned ED revisits within 90 days. Secondary outcomes included outpatient follow-up and time to first outpatient evaluation. Between group differences were assessed using descriptive statistics and multivariable regression models (P < 0.05).

Results:

Of the 68,115 discharged patients during the study period, 42.7% (29,100/68,115) received an automated text message and 2.9% (853/29,100) accessed the scheduling link. Among these, 56.5% (482/853) requested a virtual follow-up visit, 49.8% (240/482) scheduled an appointment, and 70.0% (168/240) completed the visit (Completed group). Among the 72/Noncompleted patients, 56.9% no-showed, 31.9% canceled, and 11.1% scheduled two appointments but completed neither. Nearly half (48.6%) of the Noncompleted group completed an outpatient follow-up visit, indicating variable engagement. Demographics, comorbidities, and clinical acuity were similar between groups. The Noncompleted group was nearly twice as likely to return to the ED within 90 days (27.8% vs 15.5%; χ²₁=4.20, P=0.04; OR=2.11, 95% CI 1.02–4.33) while the Completed group was more likely to complete outpatient follow-up (48.6% vs 30.0%; χ²₁=6.60, P=0.01; OR=2.17, 95% CI 1.23–3.83). Time to first outpatient visit did not differ significantly between groups (mean = 15.7 days vs. 19.8 days; Δβ = –1.93; 95% CI: –10.09 to 6.42; P = 0.65).

Conclusions:

A TCI combining automated text messaging with virtual follow-up visits was associated with reduced 90-day spontaneous ED revisits and increased outpatient follow-up. These findings support the potential of scalable, low-cost digital interventions to improve post-ED care transitions, though engagement bias may have influenced outcomes.