NextStep

Social support is a critical component of individual wellbeing. However, during pandemics, healthcare professionals’ ability to provide these resources to patients is compromised, leaving patients with less support than ever before. NextStep is a SMS platform that aims to remotely provide patients with resources in times that limit in-person interaction. In doing so, it protects healthcare workers by minimizing their exposure during patient visits and allows them to reach a greater population of individuals. Our research shows that patients who report using social resources have lower odds of returning to the emergency department and higher odds of attending follow-up appointments in a 90 day period. Thus, in incorporating NextStep into the developing telemedicine infrastructure, it provides an accessible way to provide these critical community resources and information to patients. In testing different survey formats, we can determine how best to provide social resources to local, national, and global populations.

In a survey of UK doctors by the Doctors’ Association UK (DAUK), 61% said that their hospital was facing a shortage of scrubs. Nationally, nearly 75,000 healthcare workers have been infected and PPE demand continues to rise. Additionally, patients from underserved and underprivileged communities are suffering from the socioeconomic implications of the pandemic. Particularly, Houston’s Harris County suffers from poverty rates that are double the national average, with more than 20 percent of the population falling below the poverty line. With the effects of COVID-19 shedding light on the broad disparities within our societies, mitigating social determinants—such as improved housing, reduced overcrowding, and improved access to food—has the potential to mitigate the social and economic effects of the pandemic. We mustn’t miss this critical opportunity to address social determinants of health, so providing patients with the necessary social resources while ensuring the safety of healthcare workers is a priority. NextStep is a platform that allows healthcare workers to safely provide patients with social resources that they can continually access at their convenience. As many healthcare centers begin shifting temporarily and permanently to remote care formats, NextStep will complement their work, ensuring that patients’ medical and social needs are addressed.

NextStep is an SMS-based system for patients to receive information on pandemic relief resources and social support services. Using a Twilio interface, patients are enrolled in the system during their discharge and text responses to survey questions that filter matching resources based on the user’s need and other parameters. Based on their answers, patients are sent a personalized list of social resources and receive consistent reminders and tips on using and accessing support. By enrolling patients in the system during their discharge, providers are able to connect patients to social resources without needing prolonged contact, which no longer compromises their own health. Beyond connecting patients with resources, NextStep’s technology intends to incorporate user interactions managed through REDCap to improving and iterating upon the technology itself. The major component of this is incorporating survey randomization so we can study which survey format is most effective for the user. We also plan to implement an interface where patients, volunteers, and healthcare workers can communicate and send reminders. In using user feedback to modify the NextStep platform, we will cater to creating an accessible platform for patients and healthcare professionals.

NextStep will begin at Ben Taub County Hospital. With over 89,000 emergency patients every year, Ben Taub primarily serves low-income residents of Harris County who demonstrate great need for social resources. Of the patients contacted by volunteers in a post-ED visit follow-up telephone call, 51.2% reported successfully utilizing a social resource received from the intervention. These patients had significantly lower odds of returning to the ED 90 days after discharge. Additionally, patients who received a medical or social resource had higher 90-day follow-up appointment attendance, and those who received both types of resources had lower odds of returning to the ED after 30 days. In implementing NextStep, we will employ survey randomization and user feedback to measure how well our system is addressing patients’ concerns, and allow us to compare the efficacy of two different survey interaction formats. As we conduct field testing at Ben Taub, we will study user retention and randomization results to better understand the patient population’s needs and how they respond to remote delivery of resources. This will guide us in modifying our platform and eventually broadening it to be used beyond a local scale. 

NextStep helps protect healthcare workers and helps prevent, slow, and track the pandemic by mitigating health disparities. NextStep ensures that healthcare workers provide patients with resources, despite limited in-person interactions. The resources and patients’ increased access to social work also help bridge healthcare disparities, and thus assist in informing patients. Moreover, our current model can connect patients with online and in-person symptom trackers or testing locations that otherwise might be difficult for patients to access themselves, helping moderate disease spread. Additionally, as resources are matched to users based partially on geography, NextStep indicates which communities need what social support, specifically.