Arthur J Davidson

Curt Straub

Forrest D Pugh

Henry H Fischer

Jeffrey D Berschling

Julia Dorado-Cole

Susan Becker

Susan L Moore

Tracy Johnson

Implementation Science

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MEETING ABSTRACT Open Access
Texting for health in the safety net: Improving
health promotion and outreach
Susan L Moore1,2*, Henry H Fischer1,2, Arthur J Davidson1,2,3, Julia Dorado-Cole1, Forrest D Pugh1, Susan Becker4,
Curt Straub4, Jeffrey D Berschling1, Tracy Johnson1,3
From 7th Annual Conference on the Science of Dissemination and Implementation in Health
North Bethesda, MD, USA. 8-9 December 2014
Research Objective
Medically underserved groups, such as the uninsured,
racial and ethnic minorities, and people with multiple
chronic conditions, experience barriers in accessing
health care. However, 91% of people in the United States
use cell phones and 81% of cell phone users send and
receive text messages. Based on evidence that reminder/
recall improves adherence to clinical encounters, three
text-message based initiatives were implemented in an
integrated urban safety net healthcare system, with the
aims of improving access to care, improving health care
utilization, and improving patient satisfaction.
Methods
A software platform was used to automate sending and
receiving text messages. Questions about text messaging
were added to CAHPS patient satisfaction surveys,
which were fielded by a certified vendor. Clinical and
process outcomes were assessed through examining text
message response rates and rates of seasonal flu immu-
nization, well child check visits attended, and primary
care appointments kept, cancelled, or for which patients
did not show among program participants as compared
to non-participants.
Summary of Findings
Over 15,000 patients chose to enroll across the three pro-
grams, together receiving almost 125,000 text messages
as of May 31, 2014. Patients enrolled in appointment
reminders at 5 times the rate of the other two programs
combined. Statistically significant improvements were
observed in primary care visit outcome rates and in
adherence to well child check guidelines. HIPAA
Omnibus Rule and Telephone Consumer Protection
Act legislative and regulatory changes substantially influ-
enced consent processes, allowable message content, and
operational practices. Variation in clinic practices were
discovered during implementation, resulting in process
refinements.
D&I impact
Text messaging represents a potentially low-cost way to
improve between-visit engagement and population
health. The results of this project describe how a low-
cost, high-access technology solution can be effectively
implemented in a safety net setting that predominantly
cares for underserved populations.
Acknowledgements
This presentation was made possible by Grant Number 1C1CMS331064 from
the Department of Health and Human Services, Centers for Medicare &
Medicaid Services.
The contents of this publication are solely the responsibility of the authors
and do not necessarily represent the official views of the U.S. Department of
Health and Human Services or any of its agencies.
Authors’ details
1Denver Health and Hospital Authority, Denver, CO 80204, USA. 2Department
of Medicine, University of Colorado Denver School of Medicine, University of
Colorado Denver, Aurora, CO 80045, USA. 3Colorado School of Public Health,
University of Colorado Denver, Aurora, CO 80045, USA. 4EMC2 Consulting,
EMC Corporation, Hopkinton, MA 01748, USA.
Published: 20 August 2015
doi:10.1186/1748-5908-10-S1-A82
Cite this article as: Moore et al.: Texting for health in the safety net:
Improving health promotion and outreach. Implementation Science 2015
10(Suppl 1):A82.
* Correspondence: susan.moore@dhha.org
1Denver Health and Hospital Authority, Denver, CO 80204, USA
Full list of author information is available at the end of the article
Moore et al. Implementation Science 2015, 10(Suppl 1):A82
http://www.implementationscience.com/content/10/S1/A82
Implementation
Science
© 2015 Moore et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/
zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Texting for health in the safety net: Improving health promotion and outreach

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Texting for health in the safety net: Improving health promotion and outreach

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