The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

DOES HOME VENTILATORY CARE REALLY IMPROVE QUALITY OF LIFE AND REDUCE MEDICAL COST FOR VENTILATOR-DEPENDENT PATIENTS IN TAIWAN, R.O.C.?

Mauo-Ying Bien MS RPT CRTT, Ling-Ling Chiang RPT RT, Jia-Homg Wang MD, Chia-Chen Chu BS CRTT. Veterans General Hospital-Taipei, Taiwan, R.O.C.

Introduction: Home ventilatory care for prolonged ventilator-dependent patients (VDPs) has been implemented in many developed countries in order to improve the patient's quality of life (QOL) and reduce medical cost (MC). In Taiwan, because National Health Insurance does not pay for home respiratory care and well-organized care system is locking, most such patients still stay in acute hospital, or even ICU, for a long period of time. Only a small number of VDPs are cared at home at their own expenses, but teir quality of care does not be assured. The purpose of this study is to investigate whether VDPs cared at home have better QOL and less MC than VDPs cared in the hospital. Methods: Seventy-nine VDPs hospitalized in 11 medical centers and 34 VDPs cared at home were included. The monthly cost for ward / personnel, equipment, supplies and others were recorded by U.S. dollars. Four dimensions of life quality - activity of daily living (ADL), family relationship, social role function and emotional function, were assessed by a semistructured questionnaire. The level of ADL was assessed by the modified Barthel Index Scoring system, while the other other 3 dimensions were assessed by a 5-point Linkert type scale in which validity and reliability were tested. All patients and care-givers were interviewed by a trained respiratory therapist and to complete all the questions in the questionnaire. Data were expressed as mean (SD). Student t-test was used to compare the results. A p value of < 0.05 was considered to be significant. Results:

Medical Cost Hospital Group Home Group

(U.S$) (N=79) (N=34)

Ward/Personnel 3370.36(1659.04) 1005.93(1019.98)^{*}

Equipments 2731.57(1761.77) 597.40( 384.09)^{*}

Supplies 1148.30(1317.37) 315.14( 240.64)^{*}3.85(0.77)^{*}

Others 478.69(685.50) 0.96( 5.61)^{*}

Total 7729.20(3416.28) 1919.42(1219.95)^{*}

^{*}Statistical significance compared with hospital group.

p < 0.05

(continued)

QOL Dimensions Hospital Group Home Group

(N=79) (n=34)

Barthel ADL score 8.61(16.70) 24.41(29.69)^{*}

Family relationship: satisfaction with

.family 3.47(0.59) 3.85(0.77)^{*}

.spouse 3.48(0.78) 3.94(0.90)

Social role function: satisfaction with

.friend 3.23(1.01) 3.83(0.71)^{*}

.leasure activity 2.75(0.88) 3.36(0.78)^{*}

.activity level 1.23(0.73) 2.24(1.37)^{*}

Negative emotion 2.95(0.81) 2.44(0.68)^{*}

^{*}Statistical significance compared with hospital group, p < 0.05

Although there was no significant difference in satisfication with the spouse between home VDPs and hospitalized VDPs, the home VDPs did have better ADL score, family relationship, social role function less negative emotional responses. Their monthly MC was only 1/4 of the VDPs'. Conclusion: Home ventilatory care can really improve VDPs' QOL and reduce MC. This result should encourage our government to reorganize reimbursement and care system for VDPs.

Reference: OF-96-076

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