Every year, Philadelphians fail to claim approximately $450 million dollars in federal
and state benefits1. Across the United States, unclaimed benefits are estimated at
approximately $60 billion1. These benefits include support for food, housing, healthcare,
economic support, and others that can make a significant impact on well-being, upward
mobility, and financial stability. The reasons that benefits are unclaimed are numerous,
including lack of awareness about benefit programs and eligibility criteria, lack of
agency and self-efficacy in completing expansive application requirements and organizing
the necessary paperwork, and navigating the psychological costs of stigma associated with
seeking public benefits2. In accordance with incentive structures developed as a result
of the Affordable Care Act, health care systems have demonstrated value in screening for
patients' social needs and creating partnerships with public service agencies to connect
patients to social services to improve individual and population health and reduce health
care disparities3-5. Patients presenting to emergency departments are more likely to
possess unmet social needs6-8. Thus, it is critical for health care providers in
emergency departments to effectively identify patients' social needs and connect patients
to social services agencies that can provide both immediate and long-term assistance
through the connection to public benefits programs.
Benefits Data Trust (BDT), a benefits support organization based in Philadelphia, has a
long track record of success in consistently securing benefits for individuals with unmet
social needs. BDT assists individuals with the completion and submission of applications
for 19 public benefits programs (e.g., Supplemental Nutrition Assistance Program, the
Low-Income Home Energy Assistance Program, and the Pharmaceutical Contract for the
Elderly) via different channels, including web, phone, text, and in-person support
services. Trained outreach specialists are knowledgeable about the intricacies of
benefits applications and eligibility requirements, and support is available in multiple
languages. Building trust with clients and serving vulnerable underserved communities is
a central focus for outreach specialists. For services that they do not provide
assistance for, BDT is also staffed to provide warm handoffs to help connect individuals
to relevant organizations.
The focus of this proposal is to test whether patients identified in Penn Medicine
Emergency Departments (ED) randomized to receive a warm handoff text messaging
intervention are more likely to connect to study-specific BDT phone line and submit more
applications for public benefits programs in comparison to patients who only receive a
summary flyer with the BDT study-specific phone line upon discharge from the Emergency
Department.
We will first conduct a pilot study with 30 participants to assess the design efficacy
and implementation success of the text messaging intervention. After which, we will
concurrently launch a two-arm prospective intervention randomized controlled trial that
is expected to occur over 6 months in Penn Medicine Emergency Departments. The study will
use Way To Health, a research information technology platform at the University of
Pennsylvania used previously in digital health engagement clinical trials.
We propose to first survey patients to determine their eligibility for public benefits
programs. Second, patients who are eligible for at least 1 of the 21 benefits programs to
which BDT either provides direct application support or provides referrals to agency
websites to complete applications will be randomly selected to either receive a flyer
with the study-specific BDT phone number to apply for public benefits programs (active
control) or receive a text messaging intervention for two weeks after leaving the ED with
instructions to connect to the BDT study-specific phone line in addition to the flyer.
Patients randomized to the intervention arm will receive an initial text message one-day
post-discharge from the ED with instructions for connecting with BDT and will receive
subsequent reminders to connect with BDT on Days 3, 7, and 14 post-discharge. Patients
who indicate that they have successfully connected with BDT on Day 3 will not receive
intervention messages on Days 7 and 14. All patients, both those randomized to the
control and intervention groups, will receive an end-of-study survey on Day 14
post-discharge from the ED to ask patients if they connected with BDT, assess the
patient's experience in the research study, and provide a reminder about the number to
connect with BDT.
Insights from this randomized controlled trial will inform future work evaluating
benefits enrollment outcomes, the relationship between benefits enrollment and health
care outcomes, and variations in health services use among patients connected to BDT in
the ED.
