Suzanne Sullivan, PhD, MBA, RN, CHPN

Assistant Professor

Suzanne Sullivan.

School of Nursing
University at Buffalo
201 A Wende Hall
Buffalo, NY 14214-8013

As a home health and hospice nurse, I have often been distressed by how frequently people living with serious illness experience unwanted or non-beneficial treatments at the end-of-life because they have not engaged in discussions about serious illness goals for care. I hope that my research will uncover new opportunities to assist nurses in this area.

Suzanne Sullivan is an assistant professor at the School of Nursing who dedicates her research to end-of-life care. Recently, Sullivan has developed a predictive model for 12-month mortality risk among community-dwelling, older adults using a large, nationally representative dataset of 635,000 individuals receiving skilled home health care. Through her work, Sullivan demonstrates that nurse-sensitive data is a valuable resource for achieving the quadruple aim (enhancing the patient experience, improving population health, reducing costs and improving the work life of health care providers).

Currently, Sullivan is conducting a grounded theory study that explores how homecare nurses recognize serious illness in older adults and how they use decision support tools to guide transitions in care. She plans to integrate the findings of this study with the predictive model to develop an approach that assists homecare nurses in identifying older adults at risk for decline/death so that they can support patients and their families in transitioning to palliative and hospice care programs.

Additionally, Sullivan is working with a team of researchers from the School of Nursing, Jacobs School of Medicine and Biomedical Sciences, and Department of Biomedical Informatics to develop a customized training program for research scientists to use data science approaches to address the needs of individuals and their families in the context of Alzheimer’s disease and related dementias (AD/ADRD). The team focuses on predicting functional decline, mortality risk and sleep in people with AD/ADRD.


  • PhD, State University of New York at Buffalo
  • MBA, Northeastern University
  • BSN, University of Phoenix
  • AS, Nursing, Florida Keys Community College
  • AA, Liberal Arts, Florida Keys Community College

Areas of Research

  • Developing personalized approaches for supporting older adults in the community (and their families) with decision-making in serious illness
  • Supporting transitions to community-based supportive care services such as hospice and palliative care
  • Maximizing quality-of-life at the end-of-life

Teaching Responsibilities

  • NUR 472 Promoting Quality Health Outcomes and Culture of Safety
  • NUR 509 Ethics in the Health Professions
  • NUS 691 Information Technology in Healthcare Seminar & Lab
  • NUR 701 State of Nursing Science

Recent Publications

*Sullivan, S. S., Casucci, S., & Li, C. S. (2020). Eliminating the surprise question leaves homecare providers with few options for identifying mortality risk. American Journal of Hospice and Palliative Medicine, 37(7), 542-548.

Mann, C. M., Aldossary, F. R., & Sullivan, S. S. (2019). Providing palliative care: Oncology nurses' perceptions of their self-reported abilities. Clinical Journal of Oncology Nursing, 23(6), 647-654.

Romo, R. D., Carpenter, J. G., Buck, H., Lindley, L. C., Xu, J., Owen, J. A., Sullivan, S. S., Bakitas, M., Dionne-Odom, J. N., Zubkoff, L., Matzo, M., & HPNA Research Advisory Council. (2019). HPNA 2019-2022 research agenda: Development and rationale. Journal of Hospice & Palliative Nursing, 21(4). 

Sullivan, S. S. (2019). TakingAIM: A precision health framework for promoting person-centered advance care planning. (2019). Journal of Hospice & Palliative Nursing, 21(6), 502-509.

Sullivan, S. S., Hewner, S., Chandola, V., & Westra, B. (2019). A predictive model to identify mortality risk in homebound older adults using routinely collected nursing data. Nursing Research, 68(2), 156-166.

Sullivan, S. S. & Klingman, K. J. (2019). Advance care planning associated with demographics but not necessarily preferences: A cross-sectional analysis of NHATS data. Applied Nursing Research, 49, 97-103.

*Hewner, S., Sullivan, S. S., & Yu, G. (2018). Reducing emergency room visits and in-hospitalizations by implementing best practice for transitional care using innovative technology and big data. Worldviews on Evidence-Based Nursing, 15(3), 170-177.

*Klingman, K. & Sullivan, S. S. (2018). Associations between sleep disorders and comfort at end-of-life: Opportunities for improvement. Sleep Medicine Review, 9(2), 110-114.

*Hewner, S., Casucci, S., Sullivan, S. S., Mistretta, F., & Xue, Y. Q. (2017). Integrating social determinants of health into primary care clinical and informational workflow during care transitions. eGEMS (Generating Evidence & Methods to improve patient outcomes), 5(2), 2.

*Sullivan, S. S., Li, J., Wu, Y., & Hewner, S. (2017). Complexity of chronic conditions impact on end of life expense trajectories of Medicare decedents. Journal of Nursing Administration, 47(11), 545-550. doi:10.1097/NNA.0000000000000541

*Sullivan, S. S., Mistretta, F. Casucci, S., & Hewner, S., (2017). Integrating social context into comprehensive shared care plans: A scoping review. Nursing Outlook, 65(5), 597-606.

Castner, J., Klingman, K., Sullivan, S. S., Xu, W., & Titus, A. (2016). Hitting home with technology development for asthma. The Lancet Respiratory Medicine, 4, 102-103. doi:10.1016/S2213-2600(15)00525-1

*Castner, J., Sullivan, S. S., & Klingman, K. (2016). Strengthening the role of nurses in medical device development. Journal of Professional Nursing, 32(4), 300-305.

Sullivan, S. S. & Dickerson, S. S. (2016). Facing Death: A critical analysis of advance care planning in the United States. Advances in Nursing Science, 39(4), 320-332. (Editor’s Pick December 3, 2016, Palliative Care Edition)

*Porock, D., Bakk, L., Sullivan, S. S., Love, K., Pinkowitz, J., & Barsness, S. (2015). National priorities for dementia care: Perspectives of individuals living with dementia and their care partners. Journal of Gerontological Nursing. 41(8), 9-1610.3928/00989134-20150710-02 (Winner of the Edna Stilwell Writing Award)

*Sullivan, S. S., Ferreira da Rosa Silva, C., & Meeker, M. (2015). Family meetings at end of life: A systematic review. Journal of Hospice and Palliative Nursing, 17(3), 196-205.

*Denotes data-based research

Honors and Awards

  • Ruth G. Elder Excellence in Research Award, University at Buffalo, 2018
  • Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellow in Nursing Research (F31), National Institute of Nursing Research (NINR), National Institutes of Health (NIH), 2016-2018
  • Jonas Nurse Leader Scholarship Award, Jonas Center for Nursing and Veterans Healthcare/American Association of Colleges of Nursing, 2016-2018
  • Shirley DeVoe Doctoral Dissertation Research Award, University at Buffalo, 2016-2018
  • Edna Stilwell Writing Award, Journal of Gerontological Nursing, 2015 
  • Faculty Research Poster Award, Clinical and Translational Science Institute: UNYTE Scientific Session, University of Rochester, 2015
  • Top Research Award, Sigma Xi Scientific Research Society, Graduate Research Day and Poster Competition, University at Buffalo, 2014
  • Presidential Fellowship Award, University at Buffalo, 2013-2016
  • Distinguished Nursing Graduate Award, Florida Keys Community College, 2009

Professional Activities

  • Member, Hospice and Palliative Nurses Association Research Advisory Council
  • American Academy of Hospice and Palliative Medicine - eCQM Working Group
  • Clinical Data Analytics Workgroup, University of Minnesota, School of Nursing



Principal Investigator
Improving Quality of Care and Quality of Life for Persons with Alzheimer’s Disease and Related Dementias at the End-of-Life
National Institute on Aging/National Institute of Nursing Research (1R03 AG067159-01)
Award Amount: $159,500

Abstract: This study addresses Goals 2 and 3 of the National Plan to Address Alzheimer’s disease to enhance care quality and efficiency and expand support for persons with AD/ADRD by identifying factors related to poor EOL-QOL and care transitions in the context of caregiving for the future development of a personalized approach to support in the moment healthcare decision-making.

Understanding Processes Used by Homecare Patients and Families When Transitioning to Hospice and Palliative Care Services
Patricia H. Garman Award, University at Buffalo, School of Nursing
Award amount: $10,000

Abstract: Accessing hospice and palliative care is essential to quality, complex, serious illness care management. However, these services are underutilized and typically occur after hospitalization and within days of death. Patients who receive homecare have an opportunity to work with nurses to evaluate their goals for care and access these services earlier, yet little is known about the processes patients and families use when deciding to make these care transitions. This study will use grounded theory methods to triangulate data and identify the processes used by patients and families who have transitioned from cure-focused to comfort-focused care to develop a framework for use by homecare clinicians to support early transitions to hospice and palliative care.

Mecca S. Cranley Nursing Research Mentorship Award
Award amount: $10,000

Abstract: The objectives of this award are to assist new investigator faculty members in a) developing a specific plan to develop a 5-year research career trajectory, b) develop a research proposal for extramural funding, and c) receive general advice to strengthen the likelihood of success for research development.

Principal Investigator
Nurse's Perspectives on Identifying Changes in Condition and Facilitating Care Transitions Prior to Decision Support Tool Design
Patricia H. Garman Award, University at Buffalo, School of Nursing
Award Amount Requested: $10,000

Abstract: Home health nurses play a critical role in recognizing risk for decline so they may engage, support, and guide patients and families facing serious illness in transitions to palliative and hospice care programs, yet this is an understudied area. This grounded theory study explores the process that home health nurses use to identify risk in serious illness and how they support transitions to palliative and hospice care. The findings of this study will be used to inform the development of a of an interoperable clinical decision support tool for use by homecare nurses to guide end-of-life care transitions.


Co-Investigator (PI: P. Elkin)
Buffalo Research Innovation in Genomic and Healthcare Technology Education: Alzheimer’s and related dementias Care improvement Through Data Science Education (ACT-DSE): Custom training for Research Scientists
National Institutes of Health (NIH)/National Library of Medicine (NLM)
Award Amount: $270,000

Abstract: To customize a biomedical informatics-training program for research scientists in the context of Alzheimer's disease and related dementias (AD/ADRD). With data science approaches, we focus on predicting functional decline, mortality risk, and sleep in people with AD/ADRD.

Principal Investigator
Using the Home Health OASIS to Promote Advance Care Planning for Community-Dwelling Frail Elders.
National Institutes of Health -- National Institute of Nursing Research (NINR) Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship (F31)
Award Amount: $63,856.

Abstract: This study used data science methods to examine the potential of using the home health OASIS dataset to prognosticate death risk within a year for community dwelling frail elders receiving home healthcare as a trigger for the use of clinical decision support and to promote provider-patient advanced care planning action.

Principal Investigator
Jonas Nurse Leader Scholar Award
Jonas Center for Nursing and Veterans Healthcare/American Association of Colleges of Nursing
Award Amount: $10,000

Principal Investigator
Shirley DeVoe Doctoral Dissertation Research Award
University at Buffalo, School of Nursing, State University of New York
Award Amount: $5,000