1997 OPEN FORUM Abstracts
AN INCREASE IN THE NUMBER OF VENTILATOR DEPENDENT INDIVIDUALS (VDI) IN MINNESOTA FROM 1992-1997.
Adams A. Shapiro R. Marini JJ. University of Minnesota-St Paul Ramsey Medical Center, St. Paul, MN.
Background: No registry of VDIs in the United States currently exists. In 1986 and 1992 we conducted complete surveys of VDI care providers in Minnesota and reported an increase in VDIs of 110% between those years. Since 1992 there has been a clarification of the role for non-invasive ventilation and, we suspected, an increase in its use with VDIs. There has also been an increase in facilities providing care for ventilated patients, including 2 group homes specifically for VDIs. Methods: We repeated our survey in 1997 in an identical manner to the previous surveys (Chest 1993; 103:1463). We contacted all known care providers for VDIs in Minnesota and requested information (without personal identifiers) about the VDI. A VDI is defined as requiring ventilatory assistance for more than 6 hr/day for more than 30 days. The definition includes patients receiving non-invasive ventilation with bilevel pressure devices using a back up rate. Our methods may not report those that own their device and do not receive service. We will, also, not report patients that receive bilevel positive pressure ventilation without a back up rate but who may be, in fact, ventilator dependent. Results: By our methods, there was a 35% increase in VDIs between 1992 and 1997. 48% of that increase was attributable to VDIs receiving non-invasive ventilation. VDIs receiving non-invasive ventilation were in each diagnostic category, without a predominating specific disease. The percentage increase (35% compared to 110%) and VDI added/year (14.2 compared to 19.0) has lessened between the 1992 and 1997 surveys. The percentage of VDIs receiving care in facilities, compared to care at home, continues to increase to over 40% of the total in 1997. Conclusions: The rate of increase in VDIs appears to be decreasing compared to the 1992 survey. Since the 1992 survey there is an increase in the use of non-invasive ventilation. The increase in the use of non-invasive ventilation and the increase in use of care facilities for VDI care are less expensive options than acute care or home care with full time licensed care providers. The decreasing rate, increased use of non-invasive ventilation and choice of care facilities may be explained, in part, by a general effort to control costs. Future surveys or studies of VDIs would be aided by a more refined definition of ventilator dependency. Supported by SCOR HL50512 and the Ramsey Foundation.