Linkage of Emergency Department Patients With Public Benefits Navigators via Text Messages: A Randomized Clinical Trial
Abstract
Importance: Enrollment in public benefits is associated with improved health outcomes, yet many eligible individuals do not claim them. Public benefit programs are important policy tools to address health-related social needs. Health systems have developed new partnerships with community organizations to assist patients with enrollment in benefits.
Objective: To determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.
Design, setting, and participants: This 2-arm, nonblinded, randomized clinical trial was conducted from November 2023 to April 2024 at 2 academic hospital emergency departments in Philadelphia, Pennsylvania, and included adult individuals in stable condition with Medicaid or Medicare insurance who were discharged from the emergency department and eligible for at least 1 of 10 public benefit programs. Individuals were excluded if they were unable to read English or did not have access to a mobile phone. Data were analyzed from May 2024 to November 2024.
Interventions: Eligible participants were randomized in a 1:1 ratio. Participants allocated to the intervention received a series of 4 automated text messages over 14 days that prompted them to contact a benefits navigator telephone line operated by a community partner; those allocated to the control group received a paper flyer.
Main outcomes and measures: The primary outcome was whether study…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 1,778 participants or records.
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