Dr Melissa O'Connor on Development of Decision Support Tool For Discharge in Home Health

More funding and research leveraging real-world data is required to create a standardized discharge decision support tool in home health, said Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group.

Transcript

Why is there no national standard or tool to determine when older adults are ready to be without skilled home support?

So, I'm working very hard on that. There is limited research in home health, due primarily to funding. And rigorous research takes time, as well as funding. Developing decision support in home health that is based on the evidence, and that is using real-world data is what I'm currently working on.

It's funded by a [University of California, Davis] Betty Irene Moore [School Of Nursing] fellowship for nurse leaders and innovators. But without decision support, the home health team is relying on individual clinician judgment to determine when patients are ready or when payers say they are ready rather than objective, available in real time data that will lead to the best patient outcomes.

We need to be able to identify patients who are ready for discharge vs those who are not because we don't want to just continue on with home health for everyone—we can't afford that and that doesn't make sense. But to answer your question, it's really because these things take time, they take funding, and we're working on it. So, hopefully within the next year or two, you will start to see a discharge decision support tool emerge that hopefully will be implemented nationally and embedded in the electronic health record.