SMS-Based Follow-Ups to Improve Post-Discharge Surgical Outcomes

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Primary Outcome Measures:

  • Medication adherence assessed with patient responses to medication reminders [ Time Frame: Month 3 ]

    Overall patient response rates to SMS reminders will be used to assess medication compliance. Participants are asked to reply to the reminders when they have taken the dose of medication.

  • Medication adherence assessed by Morisky Medication Adherence Scale (MMAS-8) [ Time Frame: Month 3 ]

    The Morisky Medication Adherence Scale (MMAS-8) is an 8-item survey asking respondents about whether or not they take their medication as prescribed and factors that contribute to medication compliance. Participants select from “yes” or “no” to each question. The scale is scored in a way so that answers indicating medication adherence are scored as “1” and non-adherence is scored as “0”. The total score ranges from 0 to 8 with higher scores indicating increased medication compliance.

  • Participant Satisfaction [ Time Frame: Month 1 through Month 3 ]

    Patient satisfaction with the SMS tool will be assessed using a 7-item survey administered at the conclusion of the study. Participants will rate the message reminders on a scale from 1 (very poor) to 5 (very good): helpfulness, ease of use, ease of understanding, frequency of messages, quality of messages, likelihood of continuing to use message reminders, and willingness to recommend message reminders to a friend.

Secondary Outcome Measures:

  • Early detection of surgical site infection (SSI) [ Time Frame: Month 3 ]

    Participants will be allowed to intermittently provide pain scores and pictures of their surgical sites to help increase early detection of surgical site infection (SSI) post-discharge. The value of these images in early detection of SSIs will be measured through physician reporting of SSIs.

  • Early intervention of surgical site infection (SSI) [ Time Frame: Month 3 ]

    Participants will be allowed to intermittently provide pain scores and pictures of their surgical sites to help increase early detection of surgical site infection (SSI) post-discharge. The number of incidents of early intervention for SSIs will be determined as a method of measuring early detection of SSIs.

  • Care Transitions Measure (CTM-15) Score [ Time Frame: Day 1, Month 3 ]

    Care Transitions Measure (CTM-15) is a 15-item survey asking respondents to indicate their degree of agreement with statements relating to the quality of care transition from being hospitalized to being discharged. Respondents select from: 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree. Missing responses and selections of “Don’t Know/Don’t Remember/Not Applicable” do not contribute to the total score. A mean score is obtained and higher scores indicate a better transition during hospital discharge.

  • Number of visits with provider [ Time Frame: Day 1, Month 3 ]

    Responses to the question “In the last 3 months, how many times did you visit this provider to get care for yourself?” will be compared between study groups.

  • Number of appointments for routine care [ Time Frame: Day 1, Month 3 ]

    Responses to the question “In the last 3 months, did you make any appointments for a check-up or routine care with this provider? (1 = yes, 2 = no)” will be compared between study groups.

  • Satisfaction with time spent by provider on care [ Time Frame: Day 1, Month 3 ]

    Responses to the question “In the last 3 months, did the provider spend enough time on your care?” will be compared between study groups. Participants rate their satisfaction with the amount of time their provider spent on their care on a 5-point scale where 1 = strongly agree and 5 = strongly disagree.

  • Overall rating of provider [ Time Frame: Day 1, Month 3 ]

    Responses to the question “Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?” will be compared between study groups.

  • 30-Day Readmission [ Time Frame: Day 30 ]

    Readmission to the hospital within 30 days of hospital discharge will be obtained through Electronic Health Records. Any hospital admissions will be analyzed to determine if they are related to the recent procedure.

Post-operative follow up with patients is critical to providing high quality and cost effective care. In the current standard of care, patients receive verbal instructions from their physician along with discharge paperwork that outlines best practices for self-care. Unfortunately, difficult instructions can be miscommunicated or be overwhelming, and patients often leave confused, resulting in poor patient care post-discharge and high 30-day readmission rates. Medication adherence represents a crucial area for follow-up, as it is a major determinant of high-quality outcomes for post-operative care. Specifically, over 50% of patients in the U.S. either forget to or don’t correctly take their prescription medications. Non-adherence causes nearly 10% of all hospital admissions in the U.S. and 125,000 annual deaths.

In a survey of 10,000 patients, the most common reported reason for missing medications was forgetfulness (24%), followed by perceived side effects (20%), high drug costs (17%), and perception that a prescribed medication would have little effect on their disease (14%). The majority of the factors contributing to non-adherence could therefore be resolved by longitudinally addressing forgetfulness and misconceptions about medication effectiveness, options for treatment, and side effects.

An SMS patient engagement case-management platform (Memora Health, Boston, MA) has been created that enables providers to input a new medication regimen into a web-based, HIPAA compliant app that then sends text message reminders to the patient to take their medication. Communication is two-way, therefore not only helping to improve adherence and self-management for the patient, but also providing care staff with more data on the post-discharge behavior and care satisfaction of their patients. While the value of SMS-based interventions on health outcomes is abundant in the literature, there is a paucity of data evaluating the impact of SMS follow-up on improving surgical outcomes through improved medication adherence and early detection of SSI. The purpose of this study is to utilize Memora Health, a platform that leverages mobile messaging as a medium for advancing preventive care, to improve the quality of post-operative care delivered to patients, and thereby improve patient satisfaction as well as reducing readmissions.