Mobile health and patient engagement in the safety net: a survey of community health centers and clinics.

Patient-centered technologies have emerged as a way to actively engage patients in care. The reach and potential of cell phones to engage diverse patient populations is great. Evidence of their effectiveness in improving health-related outcomes is limited. Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net. Organizations identify chronic disease management as an area where cell phones offer considerable potential to effectively engage patients. To promote widespread adoption and use, technical assistance to support the implementation and management of interventions, evidence-based or best practice models that highlight successful implementation strategies in care delivery, and the introduction of new payment or reimbursement policies will be essential. OVERVIEW Cell phones and other consumer digital technologies have emerged as potentially powerful tools to engage patients in health care. They can strengthen the efficacy of safetynet health systems by improving providers’ capacity to reach vulnerable populations and actively engage them in their care. In the United States, minority and low-income people have a high level of cell phone adoption,1,2 and often use features such as text messaging3,4 and mobile Internet.5,6,7 Mobile health interventions frequently involve the use of text messaging to provide concise, timely, and customized care-related information in the form of reminders and motivational and educational messages. These notifications can promote self-management practices for chronic conditions, educate consumers about preventive care and personal wellness, and improve patients’ adherence with recommended treatment. Providers have the opportunity to enhance care delivery and strengthen patient engagement using these new forms of interactive health services that facilitate greater connectedness between patients and their care team.8 Safety-net communities, in particular, are at greater risk for chronic, preventable diseases. Perhaps more important, text messaging represents a desirable, low-cost means to amplify and reinforce patient-empowerment strategies among the populations they serve given the high penetration of cell phones, high literacy with text messaging, and low costs of implementation. Recent research with low-income patients in California found that continuity To learn more about new publications when they become available, visit the Fund’s website and register to receive email alerts. Commonwealth Fund pub. 1813 Vol. 9 The mission of The Commonwealth Fund is to promote a high performance health care system. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. For more information about this brief, please contact: Andrew Broderick, M.A., M.B.A. Codirector Center for Innovation and Technology in Public Health Public Health Institute andrew.broderick@gmail.com 2 The Commonwealth Fund and connectedness are key predictors of patient empowerment and efficacy.9 Although few patients can currently communicate with their providers by text or e-mail, a majority of those who currently can find it useful, while many of those who can’t are interested in doing so.10 This brief presents findings from an online survey of community health centers and clinics to assess how safetynet providers are using cell phones to support patient engagement. We surveyed approximately 200 leaders at urban and rural community health centers and clinics that offer health care services to low-income people, including those without insurance, between June and October 2013. This survey represents a first step in assessing the current status of the use of mobile health in engaging patients in care, and of health centers’ organizational experience in selecting, adopting, and implementing mobile health as a tool for patient engagement. Survey respondents also identified barriers to deployment and actions that can advance mobile health within safety-net communities. The survey findings provide an emerging evidence base that can begin to inform the design of strategies and policies that will support safety-net providers in implementing mobile health more broadly across the system.