RT Journal Article
SR Electronic
T1 Health Care Use, Costs, and Survival Trajectory of Home Mechanical Insufflation-Exsufflation
JF Respiratory Care
FD American Association for Respiratory Care
SP 191
OP 200
DO 10.4187/respcare.09263
VO 67
IS 2
A1 Rose, Louise
A1 Fisher, Tom
A1 Pizzuti, Regina
A1 Amin, Reshma
A1 Croxford, Ruth
A1 Dale, Craig M
A1 Goldstein, Roger
A1 Katz, Sherri
A1 Leasa, David
A1 McKim, Doug
A1 Nonoyama, Mika
A1 Tandon, Anu
A1 Gershon, Andrea
YR 2022
UL http://rc.rcjournal.com/content/67/2/191.abstract
AB BACKGROUND: Despite expert recommendations for use, limited evidence identifies effectiveness of mechanical insufflation-exsufflation (MI-E) in addressing respiratory morbidity and resultant health care utilization and costs for individuals with neuromuscular disorders. We examined the impact of provision of publicly funded MI-E devices on health care utilization, health care costs, and survival trajectory.METHODS: This is a retrospective pre/post cohort study linking data on prospectively recruited participants using MI-E to health administrative databases to quantify outcomes.RESULTS: We linked data from 106 participants (8 age < 15 y) and determined annualized health care use pre/post device. We found no difference in emergency department (ED) visit or hospital admission rates. Following MI-E approval, participants required fewer hospital days (median [interquartile range] [IQR]) 0 [0–9] vs 0 [0–4], P = .03). Rates of physician specialist visits also decreased (median IQR 7 [4–11] vs 4 [2–7], P < .001). Conversely, rates of home care nursing and homemaking/personal support visits increased. Following MI-E, total costs were lower for 59.4%, not different for 13.2%, and higher for 27.4%. Physician billing costs decreased whereas home care costs increased. Regression modeling identified pre-MI-E costs were the most important predictor of costs after approval. At 12 months, 23 (21.7%) participants had died. Risk of death was higher for those using more medical devices (hazard ratio 1.12, [95% CI 1.02–1.22]) in the home.CONCLUSIONS: Provision of publicly funded MI-E devices did not influence rates of ED visits or hospital admission but did shift health care utilization and costs from the acute care to community sector. Although increased community costs negated cost savings from physician billings, evidence suggests costs savings from reduced hospital days and fewer specialist visits. Risk of death was highest in individuals requiring multiple medical technologies.