1. Sullivan, Veronica H. DNP, MSN, RN
  2. Hays, Mary M. DSN, MSN, RN
  3. Alexander, Susan DNP, ANP-BC, ADM-BC


Purpose/Objectives: The purpose of this program was to provide health coaching to patients with a primary or secondary diagnosis of Type 2 diabetes mellitus (T2DM) to increase self-management skills and reduce 30-day readmissions.


Primary Practice Setting: The setting was a 273-bed, acute care not-for-profit hospital in the southern region of the United States.


Findings/Conclusions: Health coaching that emphasized self-management, empowered patients to set healthy goals, and provided support through weekly reminders to improve self-management for patients with T2DM in this pilot program. The majority of patients reported accomplishment of goals with 16 out of 20 patients who did not require inpatient stay 30 days after discharge from the acute care facility.


Implications for Case Management Practice: The T2DM piloted program can easily be modified to fit other chronic illness that require routine monitoring and complex regimens to remain healthy. Case managers have the opportunity to coach on the importance of lifestyle modification and self-management support for patients with chronic illness with follow-up interactive phone visits after hospital discharge. Motivation and confidence through coaching may increase self-efficacy and better management of self-care and reduce the burden of unplanned hospital readmissions.