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Dr. Melissa O’Connor is first Doyle Research Fellow at VNSNY

Her groundbreaking study targets new area of decision support for home health discharge


Assistant Professor Melissa O’Connor, PhD, MBA, RN, Villanova University College of Nursing, has been named the first Eugenie and Joseph Doyle Research Fellow at the Visiting Nurse Service of New York (VNSNY), thus making the College a new academic partner of VNSNY. Dr. O’Connor, an expert in geriatric nursing and home health care, will be conducting a pilot study titled “Identifying Critical Factors in Determining Readiness for Discharge from Skilled Home Health Services.”

The purpose of her study is to garner interdisciplinary home health clinician and physician knowledge about the factors considered important to determine readiness for discharge from home health among older adults vulnerable for poor outcomes. After synthesizing her data from nurses, physical therapists, occupational therapists, speech-language pathologists, medical social workers and physicians, she will begin to build a decision model associated with experts’ recommendations for discharge from skilled home health services. Decision support in nursing is an understudied but emerging area of science that can have great impact.

“Today, there are no national, empirically derived decision support tools to assist in making these important decisions regarding determining readiness for discharge,” notes Dr. O’Connor, “As evidence-based practice develops, research based methods to support decision making will become more common.”

The numbers are staggering. According to Dr. O’Connor, in 2011, 3.4 million Medicare beneficiaries received approximately 6.9 million skilled home health episodes costing Medicare $18.4 billion. Medicare relies upon home health clinicians and physicians to evaluate beneficiary needs and to decide to discharge from skilled home health or recertify patients for an additional 60-day episode of care.

Appropriate decisions are critical for the patient, family and payers. More than 145 million people suffer from at least one chronic condition. Chronic illness is a serious problem especially among older adults as 20% of all Medicare beneficiaries suffer from five or more chronic conditions.  Older adults, who are often managing multiple co-morbidities, are frequently managed poorly, making them vulnerable for poor outcomes. A lack of readiness for discharge from home health could also result in poor outcomes such as hospitalization, emergency department use, increased physician visits, potential for medical errors, shorter time to death, decline in functional status and reduced quality of life.

“Home health discharge decision support could play a key role in improving the care and health of these vulnerable adults by developing a systematic, evidence-based mechanism to identify patients who are ready for discharge from home health services versus those who require one or more additional home health episodes,” explains Dr. O’Connor.