A recent study from the Perelman School of Medicine at the University of Pennsylvania and Accelerate Health Equity found that sending text messages to emergency department (ED) patients is more effective than distributing paper flyers when connecting them to public benefits programs. The research, published in JAMA Health Forum, showed that 25 percent of eligible ED patients who received a text message referral called a public benefits navigator, and 18 percent enrolled in at least one benefit. In contrast, none of the patients who received information on paper made calls or enrolled.
“Patients are understandably focused on their medical care while in the ED, and information about other programs that could benefit them are not going to be top of mind, especially if it's just another piece of paper on top of their discharge and follow up instructions, which are commonly also printed papers,” said study author Austin Kilaru, MD, MSHP, assistant professor of Emergency Medicine. “But if we text them even one day afterwards, then they have the brain space to look into these helpful resources.”
Previous research has shown that text messaging after ED discharge can help with medication adherence, symptom monitoring, and follow-up appointment attendance. It has also been used to encourage healthy behaviors such as exercise and weight loss.
In this study, researchers identified patients at two Philadelphia EDs who were less likely to have severe illness and were enrolled in Medicare or Medicaid. Patients living outside Philadelphia or without cell phone access were excluded. A total of 160 participants completed an online survey to determine eligibility for programs like Supplemental Nutrition Assistance Program (SNAP), Property Tax and Rent Rebate Program (PTRR), or Low Income Home Energy Assistance Program (LIHEAP).
While in the ED but not receiving medical care, participants learned about available assistance resources from a research coordinator and received flyers with a hotline number for benefits navigators. Half of the participants later received automated text messages with prompts and the hotline number on days one, three, seven, and fourteen after discharge. Participants could opt out at any time.
Among those who received texts (79 participants), 20 called within 14 days to explore benefits; 11 enrolled in at least one program. After 30 days, 24 had called the hotline compared to only two from the control group—both after receiving a follow-up survey via text.
“The success of the text messages confirms that we should use different strategies to improve communication after a person leaves the hospital,” said Kilaru. “The barrier is sometimes awareness that benefits exist, but it can also be the friction that prevents people from taking the next step. We can use an ED visit as an opportunity to find people who are eligible for benefits but not enrolled and support that next step.”
Each year in Philadelphia, an estimated $450 million in federal and state benefits go unclaimed by eligible residents. These programs provide support for food, housing, healthcare, and economic needs but face barriers such as lack of awareness about eligibility criteria or complicated application processes.
Emergency departments often serve patients with limited access to healthcare providers or social services. Many already screen for health-related social needs such as transportation access or food insecurity and may collaborate with social service organizations.
“This isn’t about replacing human support—it’s about making that support easier to reach,” said Kilaru. “When health systems pair existing community resources with simple digital tools, we can and help more patients actually access the assistance they qualify for.”
The study was supported by funding from the National Institutes of Health.
