URGENT UPDATE: A groundbreaking study from UCSF Health has revealed that integrating texting with live outreach can significantly enhance follow-up care for discharged patients, particularly those hard to reach. This innovative approach is crucial as hospitals strive to support patient recovery after discharge.
New findings published in the Journal of General Internal Medicine show that a combination of automated SMS messages, live phone calls, and outreach efforts can improve patient engagement by as much as 13.5%. The study highlights the challenges hospitals face in keeping patients connected to their treatment plans, particularly after they leave the hospital.
Patients discharged from hospitals often require ongoing care, including medications and community-based services. However, many struggle to follow these plans due to inadequate communication. Lena Compton, RN and Care Transitions Outreach coordinator at UCSF Health, stated, “Patients are often overwhelmed after discharge and don’t realize what they’re missing until we ask the right questions.” This proactive approach ensures that patients understand their care instructions and have access to essential resources.
In a notable finding, the study indicated that standard automated phone calls were less effective in reaching African American patients, achieving a reach of only 70% compared to 80% for other demographics. Meg Wheeler, RN, highlighted this disparity, stating, “We realized that we weren’t supporting certain populations effectively, and that meant they weren’t getting the help they needed.”
To address this gap, UCSF Health’s nursing team shifted to an integrated approach that included automated SMS messages for all patients, supplemented by personal phone calls for those not reachable by text. This strategy resulted in an increased engagement rate for African American patients, climbing to 76.4%. Overall outreach improved for all patients, with the reach rate rising from 80.2% to 83.7%.
The implications of this study are profound. By employing a multi-faceted outreach strategy, UCSF Health not only bridges the gap in patient care but also enhances health equity among diverse populations. As this model gains traction, it could reshape follow-up care practices across healthcare systems globally.
Healthcare providers are now urged to consider similar integrated outreach methods to ensure that all patients receive the ongoing support they need after leaving the hospital. The impact of this study is poised to influence patient care strategies moving forward, making it vital for hospitals to adapt and improve their communication practices immediately.
For more details, refer to the study, “Closing the Equity Gap in Hospital-to-Home Care Transitions with Automated Post-Discharge Calls, Text Messages, and Focused Nursing Outreach,” authored by Margaret Wheeler et al, in the Journal of General Internal Medicine (November 2025).
