Comfort, Quality, and Savings: The Case for Home Noninvasive Ventilation
Though noninvasive ventilation (NIV) in name alone sounds like a no-brainer, home NIV has only recently surged in popularity as an alternative to traditional tracheal tubes for respiratory patients.
NIV first came to the forefront of healthcare in the United States in the 1920s for treatment of lung failure and other complications from polio-induced paralysis before the disease was eliminated from the United States. Today, NIV therapy is often applied to patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), neuromuscular disease and chest wall disorders, among others.
Home NIV helps to improve quality of life for patients with extended need for breathing support, offering many benefits to the patients themselves, as well as providers and payers.
Comfort and Convenience
NIVs are a safe and effective alternative to tracheal intubation, offering patients a more physically comfortable positive airway pressure therapy. Instead of introducing foreign elements within the patient’s respiratory system, providers can use external NIV systems to create a portable, as-needed ventilation treatment experience.
And, it can be done at home. Initially, NIV was used primarily in acute care settings, but advances in technology and downsizing of equipment has given way to the rise in home NIV therapy. In being at home, patients are able to be with family and other support systems that can be trained to assist with at-home treatment when clinicians are not present. Additionally, home NIV allows patients to receive treatment in their own environments and within their own routines.
Keeping patients at home and out of the hospital is the aim of any care provider, seeking to improve outcomes and avoid penalties. Often times, exacerbation of COPD can land patients in the hospital and back on ventilation therapy in acute and sometimes intensive care. But, once a patient has progressed from acute, emergency status, the hospital is not actually the safest place for them. In fact, research published in the New England Journal of Medicine has found that patients admitted to hospitals for COPD issues often are readmitted within 30 days, and two-thirds of the readmissions have nothing to do with COPD.
Home NIV therapy cuts down on the adverse effects of hospitalization and improves outcomes by getting patients home sooner. A study by Galli et al., 2014 in Respiratory Medicine compared COPD patients receiving home NIV post-discharge with patients that only received in-hospital ventilation. The results of the research revealed that home NIV patients demonstrated a 10% decrease in mortality and 35% decrease in readmission rates in a six-month period following discharge. Additionally, length of stay was reduced by 4.5 days.
As leader of Reliable Respiratory clinical team and ventilation program, Joseph Zangrilli knows first-hand how transformative non-invasive ventilation devices can be on a patient’s life.
“When we can get patients on therapy early, and they adhere to the program, we find that the exacerbation of their symptoms are dramatically reduced, and they ultimately spend 25-30% less time in the hospital because of it,” said Zangrilli, vice president of clinical operations.
However, he advises that ongoing clinician education surrounding non-invasive ventilation is key. “If clinicians have a deep understanding and appreciation of the capabilities of a NIV device, their patients have a much better chance of being successful in their treatment.”
Savings All Around
By not keeping patients in the hospital longer than they need to be and improving outcomes, home NIV therapy helps to make a positive impact on rising healthcare costs for all parties involved.
Providers can partner with in-home care specialists and intervene, when necessary, freeing up their time to be spent on patients in acute status. Additionally, Medicare and private insurance dollars can be spent more efficiently on home devices and equipment, rather than medical facility resources, which in turn often reduces patient deductibles – all without sacrificing care quality or patient outcomes.
Recently published research has shown savings of $3,927 per patient when home NIV was added to oxygen therapy. In a report at the American Thoracic Society (ATS) 2018 annual meeting, the researchers revealed that quality-adjusted life years with added home NIV was about negative $50,000, meaning less costs but greater quality of life.
And, that is what providers want: greater quality of life for their populations. When positive outcomes on health begin to have ripple effects of improving the whole person, healthcare has done its job. By prescribing home NIV therapy and choosing the right partner, healthcare providers can give patients a chance at a better life.