# Linkage of Emergency Department Patients With Public Benefits Navigators via Text Messages: A Randomized Clinical Trial

## TL;DR

Text messages were more effective than paper flyers in helping emergency department patients connect with benefits navigators to apply for public benefits.

## Contribution

This study demonstrates that text messaging is a more effective method than paper referrals for encouraging patients to seek public benefits assistance.

## Key findings

- 25% of patients who received text messages contacted benefits navigators, compared to 0% who received paper flyers.
- 14% of the text message group submitted at least one public benefits application, while none in the control group did.

## Abstract

Are text messages more effective than paper referrals in encouraging emergency department patients to seek assistance in applying for unclaimed public benefits?

In this randomized clinical trial of 160 patients who were discharged from the emergency department, 25% who received text message reminders contacted benefits navigators compared with 0 who received paper flyers alone.

The trial results suggest that health system interventions that address social needs, including benefits navigation, may benefit from using text messages in their design.

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.

To determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.

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.

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.

The primary outcome was whether study participants called benefits navigators within 14 days. Secondary outcomes included whether study participants submitted any benefits application within 14 days.

Of 1778 patients screened, there were 160 participants enrolled. Participants’ mean (SD) age was 44 (17) years; 94 (59%) were women, 145 (91%) were non-Hispanic Black, and 11 (7%) were non-Hispanic White. In the intervention group, 20 participants (25%) contacted benefits navigators vs 0 in the control group (difference, 25 percentage points; 95% CI, 16%-35%). In the intervention group, 11 participants (14%) submitted at least 1 application for public benefits compared with 0 in the control group (difference, 14 percentage points; 95% CI, 6-22).

The trial results suggest that text messages were more effective than paper referrals to help eligible emergency department patients seek assistance with public benefits applications. Text messages may offer a tool to allow health systems, in collaboration with community partners, to address health-related social needs.

ClinicalTrials.gov Identifier: NCT05654220

This randomized clinical trial examines whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.