OXYGEN CONSERVATION DEVICES IMPROVE PORTABILITY AND REDUCE THE COST OF CARE FOR AMBULATORY HOME OXYGEN THERAPY PATIENTS
J. Stegmaier RRT, J. Lewarski RRT, G. Frate-Mikus, RRT, Hytech Homecare, Mentor, Ohio
Background: Decreases in Medicare oxygen reimbursement (30% since 1997) have placed a strain on suppliers trying to meet patients portable oxygen needs. Recent advances in the development and availability of oxygen conserving devices (OCD) may offer oxygen suppliers a cost-saving adjunct to compressed gas portable oxygen systems. OCD's are designed to ration compressed oxygen by delivering flow during the patient's inspiratory cycle only. This is achieved through a demand or time-cycled system and a pre-determined dose of O2 (varies by manufacturer). Actual gas savings will depend on respiratory rate and with some devices, tidal volume. Although sound in theory, there is little published data supporting clinical applications and actual cost savings. We developed an OCD clinical trial protocol based on the AARC CPG for oxygen therapy in the home. We used the DeVillbis EX2000D PulseDoseÒ Conserving Device, and the Puritan Bennett CompanionÒ CR 50 Conserving Device. Method: Over a period of one year, 49 patients were evaluated for the use of an OCD. Patients were identified by their high utilization of cylinders (>4/week) or use of liquid oxygen (LOX) for portability. All patients had ordered liter flows of 2 lpm. OCD trial criteria was limited to stable, ambulatory patients with a baseline respiratory rate (RR) <40 bpm and resting and ambulatory Sa02> 90% on their prescribed oxygen. A physician's order was obtained for the clinical assessment and trial of the OCD. The patient was trialed first on the PulseDoseÒ OCD at their prescribed O2 liter flow (unit in the pulse mode). The following acceptable OCD trial criteria was measured at rest and with ambulation: ability to trigger the unit with inspiration, a change in Sa02 of 2% or less, Sa02 remained > than 90% and a RR between 6-40 bpm. If the patient failed any of the criteria using the PulseDoseÒ, the trial was repeated using the CompanionÒ(following the same protocol). PulseDoseÒ was our device of choice due to its greater conserving ability and standard nasal cannula use.
# of Patients
Weight of System
Avg. Portability on 2 lpm (based on mfg. Specs)
All cylinder weights and approximate hours of portability are based on aluminum ?D? cylinders filled to 2000 psi. Liquid portability is based on a typical 1.25-liter portable unit.
Results: 44 of the 49 patient's (90%) were able to tolerate one of the OCD's as per the protocol. Of the 5 patients that failed, 2 (4%) failed due because of O2 desaturation and 3 (6%) failed due to an inability to trigger either device.
Conclusions: Oxygen dependent patients able to tolerate the use of an OCD will achieve extended oxygen portability. LOX patients gained an average of 2-3 hours (when using the Pulse DoseÒ) and cylinder patients gained an average of 7-9 hours. In all cases, little or no additional weight was added to the portable system. Patient satisfaction was measured via a telephone survey. 98% of the patients (43 of 44) felt the OCD improved their overall quality of life, due in part to the improved portability as well as a significant decrease in the number of deliveries for oxygen. Deliveries to supply oxygen to this study group decreased by 64% (176 deliveries to 63 deliveries per month). With our average cost of an oxygen delivery at $40.00 and an average OCD acquisition cost of $425.00, we project that the effective and appropriate selection and use of an OCD in this patient group will result in an estimated annual savings of over $35,540.