Texting for Health – text4baby Outcomes (11/21/11)

Reader Todd Edwards pointed me to a Joint Commission link that addresses texting in healthcare, specifically for providers and order. This is their stance: "No, it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting." That’s pretty clear.

Reader Chris Wasden commented, "You should check out Atlantic Healthcare. They have done some very sophisticated texting that is very tailored to change beliefs and behaviors around drug adherence." I looked and was unable to find anything specific. Can somebody please send me a link or some data? Thanks.

I wrote two posts recently on texting for health (Part 1 and Part 2). In both posts I mentioned text4baby. The reason for using text4baby is that it is national program with support from HHS as well as several other organizations concerned with maternal and fetal health. I’ve always assumed this makes it the largest texting program for health in the US with about 250,000 registrations from recent data.

In both posts, I questioned the efficacy of text4baby in influencing pregnancy outcomes and providing HHS with a return on investment. The main funder of the program, Johnson & Johnson, doesn’t need better outcomes for a return on what is likely a marketing investment, but I imagine HHS is trying to solve a specific problem in healthcare, and hopefully that is outcomes.

Text4baby is currently being assessed. I think the outcomes will influence other texting programs, especially those from HHS. I’m anxious to see the kinds of results that text4baby is getting and apparently I missed the recent news about preliminary text4baby data from University of California, San Diego (UCSD). Thank you to Voxiva for contacting me to point me to the data and press.

Below are the high level findings from the White House press release (based on interviews with 150 text4baby participants, mostly by phone):

  • 81% have an annual household income under $40,000
  • 65% are either uninsured or enrolled in California’s Medicaid program
  • 63% said the service helped them remember an appointment or immunization that they or their child needed
  • 75% said they learned a medical warning sign they didn’t know previously
  • 71% talked to their doctor about a topic they read on a text4baby message
  • 39% called a service or phone number they received from a text4baby message (this rose to 53% among individuals without health insurance)

At first glance, I was a bit skeptical and put off by the interpretation of the results, but that’s because I was reading this press release instead, which I think reads a little too much into the results as proving this type of texting model not only for the population intended (underserved pregnant women) but also more generally to other populations.

As I looked at the high-level stats a second time, I started to realize that they represent very positive findings and potential long term improvements in care, though the clear ROI in terms of clinical outcomes is likely to remain hard to quantify. I’ll try to explain what I mean.

In my interpretation of the stats, text4baby is overwhelmingly hitting its target population of underserved women based on income and insurance status. This might be skewed a bit by the overall population of UCSD, but text4baby is targeting community health centers, so this is probably consistent nationally.

Second, the majority of users said that the service helped them remember an appointment or immunization. This doesn’t exactly translate to improvements in adherence as some press releases are stating, but it’s still a good thing that text4baby is helping people stay connected and it’s tailored enough to be relevant.

Third, almost three out of four users talked to their doctors about a topic from a text4baby message. The content behind text4baby is backed by large partners, including HHS, so my assumption is that it is clinically accurate. That means that most text4baby users are coming to doctors with valid discussion points, not random things they learned on crazypregnancysite.com (I actually tested that link and it doesn’t go anywhere), and engaging in discussions about them. This is a very good thing for both patients and providers.

Fourth, and I think the most important stat, is that 39% of all text4baby users — and 53% of text4baby users without insurance — contacted a service that was listed in a text4baby message. This is pretty amazing to me. About half of users were engaged and trusted text4baby enough to follow-up on a lead in a text message. The trust is likely due to the fact that community health centers — and by extension, providers — are endorsing this service and patients ultimately trust providers.

HHS is trying to find ways to engage citizens, especially underserved populations, and link them with appropriate services. If text4baby is helping in this process, that’s a very big positive for the program and for HHS.

All of these results are linked to increased engagement in health — a big part of the future of health, but also one of the most challenging aspects. In this sense, text4baby is a huge success according to this data, albeit from a very small sample.

But I wouldn’t say this proves that similar texting services will work well for other areas of health, mostly because pregnant women are already some of the most engaged patients in the health system. It does help show that targeting interested patients with ongoing education can produce positive results in terms of patient education. Maybe similar messaging services for cancer patients and parents of kids with special needs would bring similar benefits? Again, underserved groups are likely to benefit the most across all these different conditions.

I was on vacation and unable to speak with a representative from Voxiva about the data, but I hope to this week and provide an update when I do. In terms of quantifying results, I was informed that text4baby is adding in messaging specifically to increase rates of flu vaccination, something that is discretely quantifiable. Until then, or some other results come out from the national research on text4baby, Voxiva has to feel very good about the results of its first national SMS program.

Travis Good is an MD/MBA involved with HIT startups.

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