Researchers: Jeremy M Jacobs¹, Jochanan Stessman¹, Esther-Lee Marcus²

Background: The last couple of decades have witnessed a growing number of patients requiring prolonged mechanical ventilation (PMV),and advancing technology has led to the development of ventilators easily used in both hospital long term care (HLTC) as well as at home. There is a lack of data comparing PMV patients in HTLC to those at home.

Objectives: To describe and compare PMV patients treated at home to those in HLTC, assessing for sociodemographic, medical reasons for PMV, comorbidities, caregiver-burden, and costs.

Method: A descriptive observational study. Data collection by direct interview using structured questionnaire.

Findings: Among a total of 120 PMV patients, more patients at home (40/46) were alert and able to communicate compared to HLTC (22/74). They were younger, suffered more degenerative muscle/nerve disease compared to more cerebrovascular disease, post-resuscitation and post sepsis/shock among HLTC patients. PMV patients in the HLTC had more comorbidity, pressure sores and increased mortality. Both Home and HLTC patients reported similar low levels of shortness of breath, anxiety, and drowsiness. The majority (119/120) were without "Advanced Directives" when initially ventilated, and 85% of communicative patients would choose again to be ventilated, if faced again with the decision. Costs to the Health care fund for PMV at home were one-third of the cost in HLTC (approx. 15,000 nis/Month versus 45,000 nis/Month).

Conclusions: Patients requiring PMV reported low levels of distressing physical symptoms and would choose again to be ventilated if necessary. Home PMV patients tended to be younger, suffer more degenerative illnesses, less comorbidity, lower mortality, and reduced levels of burden among their caregivers. Costs to the health care provider were substantially lower at home compared to HLTC.

Recommendations: Among suitable patients in need of PMV, the delivery of care within the model of Home Hospital is to be encouraged.

Research end date: 05/2019