Text Messages Linked Emergency Department Patients to Benefits Help

Key Takeaways

• Text-message referral was associated with greater short-term contact with benefits navigators than a paper referral pathway.
• Benefits application submission was observed in the text-message group, while no such activity was reported in the control group.
• Discharged adults in stable condition with Medicaid or Medicare and eligibility for at least 1 of 10 programs received four automated text messages over 14 days directing them to a benefits navigator telephone line operated by a community partner, while control participants received a paper flyer.

A text-message referral pathway outperformed a paper flyer after emergency department discharge, with 20 intervention participants, or 25%, contacting benefits navigators within 14 days and none in control. This randomized clinical trial used a 2-arm, nonblinded design at two academic emergency departments in Philadelphia, Pennsylvania. Investigators evaluated whether a digital referral improved early connection to public benefits help among discharged patients. Findings focused on outcomes measured during the first 14 days after discharge.

From November 2023 to April 2024, investigators enrolled adults in stable condition who had Medicaid or Medicare, were being discharged, and qualified for at least 1 of 10 public benefit programs. Patients were excluded if they could not read English or lacked mobile phone access, and 160 participants were enrolled after 1778 patients were screened. The intervention delivered four automated text messages over 14 days directing participants to a benefits navigator telephone line operated by a community partner, while the control group received a paper flyer. Mean age was 44 years, 59% were women, and the cohort was predominantly non-Hispanic Black. The prespecified 14-day outcomes were navigator contact as the primary end point and any benefits application submission as the secondary end point.

For the primary outcome, 20 participants (25%) in the intervention group versus 0 in control contacted benefits navigators, yielding a 25-percentage-point difference with a 95% CI of 16% to 35%. For the secondary outcome, 11 participants (14%) in the intervention group versus 0 in control submitted at least 1 public benefits application, for a 14-percentage-point difference with a 95% CI of 6 to 22. These results were observed within the same 14-day follow-up period. Across both prespecified outcomes, the short-term advantage favored the text-message pathway.

The investigators concluded that text messages were more effective than paper referrals in helping eligible emergency department patients seek assistance with public benefits applications.