Company
Yale New Haven Health System
Company Size
Large-size
Commure Products Used
About the Company
Yale New Haven Hospital (YNHH) is a 1,541-bed hospital located in New Haven, Connecticut. It is the second-largest hospital in the United States[2] and one of the largest in the world. It is the primary teaching hospital for the Yale School of Medicine and the Yale School of Nursing. Owned and operated by the Yale New Haven Health System, YNHH includes the 168-bed Smilow Cancer Hospital at Yale New Haven, the 201-bed Yale New Haven Children's Hospital, and the 76-bed Yale New Haven Psychiatric Hospital.
Situation
Pre-Appointment Texting for Breast Exams: Improving Patient Engagement and Screening at Yale New Haven Health
Ensuring consistent adherence to breast cancer screening appointments remains challenging, with common barriers to care access and patient participation including ethnicity, language, socioeconomic status, or anxiety and fear related to the screening. This often stems from poor pre-appointment understanding of what to expect and how to navigate the healthcare facility.
Digital health programs in medicine have been successful in reducing missed care opportunities, but many programs provide only simple appointment reminders. Current research shows that no-shows for imaging exams can cost a radiology department $1 million in lost revenue per year. The downstream impact of these delays in care are multifactorial, including financial losses and delays in patient care.
Action
Automated and personalized patient outreach on improving patient engagement.
To address the critical issue of ensuring adherence to screening appointments, YNHH and Commure Engage collaborated to develop a novel, automated, pre-appointment communication program in mammography and breast ultrasound offered in both English and Spanish to engage patients and optimize the completion rates of scheduled breast imaging exams. This pre-appointment communication program incorporated appointment reminders, exam preparation information, and wayfinding for easy onsite navigation.
The program sought to determine whether together, these tools can significantly increase patient engagement and decrease the no-show and same-day cancel rates, thereby reducing missed opportunities for breast cancer screening and diagnostic exams and enhance department productivity.The primary mode of engagement was through text messaging (SMS), with an interactive voice response (IVR) option for patients who prefer alternative communication channels. The SMS/IVR messages include appointment reminders, allowing patients to confirm or cancel their exams in real-time, with direct integration into the EHR (Epic).
The communications include exam preparation information and detailed directions to guide patients from home, to parking, to the reception desk.Program FormatTo create a robust pre-appointment communications program, the study methodology included a multidisciplinary team composed of quality improvement and patient experience experts, mammography technologists, and a digital health team. The Commure Engage platform and its workflows are all HIPAA compliant.
Touch points over the course of the screening process include:
Initial message to patients when the appointment is made, with the ability to add the appointment to their calendar, and a phone number to call if needed.
Appointment reminder seven days before the appointment, with a repeated reminder at four days if there was no response. The patient can confirm their appointment by text or by secure link. If the patient confirms the appointment, the confirmation can be seen on the scheduler and the technologist worklist.
Two days before the scheduled exam, the patient receives a text with a hyperlink to a web page that provides testing information and wayfinding. Pretest content varies by exam type. Wayfinding includes facility photos, written driving instructions, and walking directions from the parking area.
Result
Reduced No-Shows and Same-Day Cancellations
In partnership with Commure Engage, YNHHS quickly and dramatically reduced patient no-shows and same-day cancellation rates, while achieving strong patient engagement rates. Engagement is defined as the number of patients responding to the reminders by either confirming or canceling their appointments.
54% improvement in no-shows and cancellations for breast ultrasound and mammography, driving patient compliance and improving the overall care experience. Mean no-show / same-day cancel rates declined from 13% to 6% (54% relative reduction, p<0.001).
49% engagement rate, with 19,103 reminders sent and 9,435 responses.
3% cancel rate, with any cancellations made ahead of the visit, giving the department the ability to open that slot to urgent add-ins.
59% response rate via texting, greater than the response rate with interactive voice response calls which had a 21% response rate.
As a result of this program, YNHHS has reduced missed care opportunities for breast imaging— underscoring the positive impact of personalized and timely patient outreach.
Similar programs are running at multiple clinical sites for service lines such as ambulatory, radiology, gastrointestinal and endoscopy. These programs have shown similar success rates.
