Date of Award

Spring 5-2022

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Marti Jordan

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. Carolyn Coleman, Committee Member

Committee Member 2 School

Leadership and Advanced Nursing Practice



The Centers for Medicare and Medicaid Services (CMS) continue to apply costly financial penalties for hospital readmission. Hospital readmission can stem from multiple causes which can lead to poor health outcomes or increased healthcare financial costs. However, with the use of an implemented 14-day post-hospital follow-up appointment with a primary care provider, hospital readmission could be reduced, and patient care improved. The multiple factors that can lead to hospital readmission include non-adherence to medication, socioeconomic factors, patient-related factors, condition-related factors, or health system-related factors. Through the implementation of post-hospital discharge follow-up visits within 14 days of discharge, hospital readmissions could be reduced.

The purpose of the Doctor of Nursing Practice (DNP) project was to identify factors that affect a patient’s hospital readmission in an identified hospital facility with a general nonspecific discharge patient population with multi-discharge diagnoses. To identify these factors patients had a scheduled follow-up visit completed within 14 days of discharge from the selected hospital facility. In the follow-up visit the identified provider and researcher addressed the patient's concerns, medication reconciliation, pending or needed laboratory tests, or other concerns. A post-hospital transition of care form could also be completed within one to two business days post-hospital discharge. The results of the DNP project found that due to an unforeseen stoppage of the study the limited data did not support the use of a hospital discharge follow-up visit within 14 days. The results provided no evidence of any decreased rate of hospital readmission as the data was limited with small sample size. The DNP project suggested that further research is needed to determine if follow-up visits within 14 days of hospital discharge provide decreased hospital readmissions.