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This article was written by David Brennan, MBE, Joseph Brodine, MD, Molly Daughtry, and Kristen E. Miller, DrPH, MSPH, MSL, CPPS.
Published in Frontiers in Health Services, our research demonstrates enhanced patient engagement and improved hypertension management following the implementation of a patient-generated, text-based care management system.
Sometimes, managing a chronic condition such as high blood pressure (hypertension) feels like a full-time job. But you’re not alone. Research has shown that the best health outcomes happen when patients and providers work together—and MedStar Health is committed to finding new, innovative solutions.
MedStar Health Research Institute’s study of a collaborative, innovative effort to check in with thousands of patients with unmanaged high blood pressure was recently published in Frontiers in Health Services,
Our goal was simple: to find out whether a new, two-way text messaging system could help us identify which patients still had high blood pressure and which had their blood pressure under control. Texting allowed us to reach many more people than phone calls, and more people who need our care participated. This would allow us to focus on helping the patients who need help the soonest.
Reaching 10,000 patients with one text.
Our efforts to reach people by phone took a lot of time and effort, with little success. It can be intimidating to pick up a phone call from the doctor’s office, especially when you are not expecting one.
We chose text messaging because this channel gives patients control and choice over how and when they respond. Plus, research shows that patients who have fewer in-person visits and are less engaged in their health care are more likely to respond to texts than to phone calls.
Efficiently understanding patient needs.
Our pilot study focused on the 10,753 MedStar Health patients who, based on their records, appeared to have uncontrolled high blood pressure.
As part of MedStar Health’s commitment to patient care and public health, we sent these patients a text using a secure, two-way platform called Twistle. The messages asked patients to send us a recent home blood pressure reading. If they didn’t respond, we sent a reminder two days later and another one a week after the first text.
This outreach functioned like a giant magnet. It helped us separate the patients who need our help right away from those who are effectively managing their blood pressure.
About 18% of the total group, or 1,942 patients, returned normal blood pressure readings. This showed that they’re managing their condition well, and we updated their records to confirm their care is on track.
Importantly, 49 patients sent back blood pressure readings that were identified as either dangerously high or dangerously low. Care managers immediately contacted these patients to schedule same-day appointments, possibly preventing heart attacks or strokes.
Patients who did not respond continued to get traditional outreach and clinical attention from their primary care teams. By identifying which patients had their condition under control, we were better able to focus our efforts on those who did not or did not provide information.
The text message strategy showed we could reach more than twice as many patients via text as via phone calls, using almost five times less staff time. Our research demonstrates that telehealth-enabled outreach can help engage patients, improve equity, and help more people connect with providers to improve their health.
Related reading: Mom HEART Program Helps Birthing Patients Keep Tabs on Blood Pressure at Home.
The challenge of managing high blood pressure.
High blood pressure occurs when blood pushes too much against the walls of the arteries. It is often called “the silent killer,” in part because it usually has no clear or noticeable symptoms. Yet it’s one of the leading causes of serious health problems in the U.S., including heart disease, heart attack, stroke, and kidney failure.
According to the Centers for Disease Control and Prevention, almost half of U.S. adults (48.1%) have high blood pressure, but only a quarter (22.3%) have it under control. About 34 million U.S. adults who should be taking medication either don’t have a prescription or haven’t gotten it filled.
Related reading: High Blood Pressure: Everything You Need to Know About the “Silent Killer”.
High blood pressure does not affect everyone equally. More men than women have the condition. More Black people have hypertension than non-Hispanic white, non-Hispanic Asian, and Hispanic adults.
This is due in part to challenges that often are beyond patients’ control, such as:
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Access and transportation: Getting a reliable way to get to the doctor’s office, and time off from work and other responsibilities to attend appointments.
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Cost and affordability: Medications and health foods can be expensive, and taking unpaid time off from work can make the problem worse.
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Education and trust: It’s hard to know what you need to do, and easy to feel unsure if the advice you are getting from doctors, friends, and relatives is right for you.
Social determinants of health like these can make it hard to stay on top of your care. MedStar Health uses innovative technologies and processes that are easier, faster, and more respectful of patients’ time and unique circumstances.
Related reading: New Study: Stress of Daily Racism Linked to Hypertension Among Black Young Adults.
Innovation through teamwork.
The success of this program was made possible by dedicated staff from several MedStar Health teams working together to provide patient care from every angle. It was a true team effort across the organization, including:
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MedStar Institute for Innovation: The team provided advanced technical infrastructure, introducing the two-way Twistle platform.
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Care Transformation Organization: A staff of 70 dedicated care managers worked to be the “person on the other end,” responding to messages and coordinating patient care.
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National Center for Human Factors in Healthcare: The research team analyzed the data, prepared the research manuscript, and led the dissemination of the results.
In addition, family medicine doctors and other providers care for our patients and help them manage hypertension with medications and lifestyle adjustments.
The pilot campaign was so successful that it has led to an evolution in care management at MedStar Health. This text campaign is no longer a one-time event; it’s an ongoing, evolving process to help our patients manage their health.
We’ve since used this effective technology for other texting campaigns, including reminder messages for cancer screenings and A1C checks for diabetes. The numbers tell us our new methods are working. MedStar Health is on track to send hundreds of thousands of focused text messages by 2030, helping more patients stay on top of their health.
We’re coordinating these messages with upcoming appointments, helping patients arrange necessary tests before they come in so they can have truly meaningful conversations with their doctor.
Caring for patients beyond our doors.
MedStar Health’s dedications to our patients are at the heart of this vital telehealth-enabled innovation, and the research that supports its success.
This inventive, patient-focused approach means that you have more control and choice about how you interact with your care team. Through simple texts, we are making it easier for you to partner with us to get the care you need to advance your health.
