Digital Discharge Planning to Improve Self-Management in Patients With Diabetes Mellitus

Overview

Diabetes mellitus is a chronic disease that requires continuous self-management to prevent complications and hospital readmissions. However, discharge planning in many hospitals is often delivered verbally and lacks structured follow-up after patients return home, which may lead to poor self-management behaviors. This study aims to evaluate the effectiveness of a digital discharge planning intervention delivered through a mobile application to improve self-management among patients with diabetes mellitus after hospital discharge. The intervention is based on the Chronic Care Model and includes educational materials, reminders, and monitoring tools related to seven dimensions of diabetes self-management. A randomized controlled trial with a parallel-group design will be conducted among patients with diabetes mellitus. Participants in the intervention group will receive digital discharge planning through a mobile application for 90 days after discharge, while the control group will receive standard discharge planning provided by the hospital. Primary outcomes include patient self-management behavior, while secondary outcomes include glycemic control and hospital readmission within 90 days.

Diabetes mellitus is one of the most prevalent chronic diseases worldwide and requires long-term self-management to maintain glycemic control and prevent complications. Effective discharge planning plays an important role in preparing patients to manage their condition independently after leaving the hospital. However, in many clinical settings, discharge planning is often delivered verbally and without structured follow-up, which may limit patients' ability to maintain appropriate self-management behaviors. This study develops and evaluates a digital discharge planning model delivered through a mobile application to support patients with diabetes mellitus after hospital discharge. The intervention is theoretically grounded in the Chronic Care Model and supported by nursing theories including Orem's Self-Care Deficit Theory, Watson's Human Caring Theory, and Pender's Health Promotion Model. The mobile application includes several features designed to support diabetes self-management based on the Diabetes Canada framework, including healthy eating, physical activity, blood glucose monitoring, medication adherence, problem solving, reducing risks, and healthy coping. The application provides educational materials, reminders, daily activity tracking, and feedback to encourage patient engagement and adherence to self-management practices. A randomized controlled trial with a parallel-group design will be conducted to evaluate the effectiveness of the intervention. Participants will be randomly assigned to either the intervention group receiving digital discharge planning through the mobile application or the control group receiving standard discharge planning provided by the hospital. The intervention period will last for 90 days following hospital discharge. The study will assess the impact of the digital discharge planning model on self-management behaviors, glycemic control, and hospital readmission among patients with diabetes mellitus.