With More Patients on Prolonged Ventilation, Many Can Receive Care at Home
Nearly half a million patients receive prolonged mechanical ventilation (PMV) annually, at a cost of over $35 billion. With COVID-19 putting a substantial burden on hospitals and other health care settings, there is tremendous interest in providing care services at home whenever possible. A new report in the February issue of JAMDA suggests that PMV in the home may be both feasible and financially beneficial for some patients.
In Prolonged Mechanical Ventilation: A Comparison of Patients Treated at Home Compared to Hospital Long-Term Care (HLTC), the authors studied 120 PMV patients aged 18 and older, all insured by the same HMO. They found that those who received this treatment at home tended to be younger, had improved functional status, less comorbidity, more financial difficulty, and longer duration of PMV than those receiving care in HLTC.
The primary diagnoses for home PMV were degenerative neuromuscular disease and chronic lung disease. In HLTC settings, PMV patients were more likely to have acute illnesses with or without resuscitation.
The study found that home PMV patients were more alert and able to communicate than their counterparts in HLTC, and they reported less depression. Home PMV patients also had lower six-month mortality rates and less frequency of pressure ulcers. There were no differences for infection rates or hospitalization; and caregiver strain was similar in both care sites.
The authors conclude that when appropriate and eligible patients are identified for home PMV, this can be both viable and financially beneficial.
The study was conducted by the Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, and the Institute for Aging Research, Hadassah-Hebrew University medical Center, Mt. Scopus, Jerusalem, Israel; Department of Geriatric Rehabilitation, Hebrew University-Hadassah Medical School, Jerusalem, Israel; and Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.