Publication Date
Spring 2026
Degree Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Tamara McKinnon
Abstract
Background: Hospital readmissions are widely recognized as a key metric of quality care, reinforced by Centers for Medicare and Medicaid (CMS) incentive programs (U.S. Centers for Medicare & Medicaid Services, 2025). Despite these incentives, achieving a meaningful reduction of readmissions remains a challenge, especially for chronic conditions such as type 2 diabetes mellitus (T2DM), where readmission is fueled by gaps in medication management, patient confidence in symptom management, and access to timely follow-up care. Purpose: Evaluate the impact of a nurse-initiated post-discharge telephone outreach, conducted at 48 hours, by the outpatient endocrinology clinic, on 7- and 30-day readmission rates for adults with T2DM. Methods: The intervention consisted of a post-discharge phone call by an outpatient clinic nurse to address medication issues, symptom management, and to establish follow-up care. A retrospective pre-post-design compared 7-day and 30-day readmission rates before and after implementation. Results: The post-discharge outreach was associated with a reduction in both early (7-day) and overall (30-day) readmission rates among patients with T2DM, with a significant reduction in 7-day readmissions. Conclusion: A nurse-initiated 48-hour post-discharge telephone outreach is a simple, but effective strategy to reduce preventable readmissions in patients with T2DM, supporting CMS quality improvement goals and showcasing the value of structured post-discharge support within outpatient endocrinology care.
Recommended Citation
Kane, Sierra, "Evaluating the Effectiveness of a Nurse-initiated Post-discharge Phone Call in the Prevention of Hospital Readmissions for Type 2 Diabetes Mellitus" (2026). Doctoral Projects. 212.
DOI: https://doi.org/10.31979/etd.564e-qyb6
https://scholarworks.sjsu.edu/etd_doctoral/212
