title: Retaining homeless veterans in outpatient care: a pilot study of mobile phone text message appointment reminders.
abstract: OBJECTIVE
  We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows.
  
  
  METHODS
  We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation.
  
  
  RESULTS
  Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patient-cancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI]  = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI = -0.4, 6.4; P = .08).
  
  
  CONCLUSIONS
  Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings.
authors.affiliation: D. Keith McInnes, Beth Ann Petrakis, Allen L. Gifford, Sowmya R. Rao, and Thomas K. Houston are with the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA. Steven M. Asch is with VA Palo Alto Center for Innovation to Implementation, Palo Alto, CA. Thomas P. O'Toole is with the National Center on Homelessness among Veterans, Providence VA Medical Center, Providence, RI.
authors.forename: D Keith
authors.initials: DK
authors.lastname: McInnes
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Petrakis
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001071:Appointments and Schedules; D040421:Cell Phone; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D017010:Reminder Systems; D012959:Socioeconomic Factors; D060145:Text Messaging; D014728:Veterans
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