Showing papers by "Joan Escarrabill published in 2003"

Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients

Abstract: It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation. To this end, 222 COPD patients (3.2% female; 71 +10 yrs (mean+SD)) were randomly assigned to HH (n =121) or conventional care (n =101). During HH, integrated care was delivered by a specialised nurse with the patient 's free-phone access to the nurse ensured for an 8-week follow-up period. Mortality (HH: 4.1%; controls: 6.9%) and hospital readmissions (HH: 0.24 +0.57; controls: 0.38 +0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13 +0.43 versus 0.31+0.62); and 2) a noticeable improvement of quality of life ( D St George's Respiratory Questionnaire (SGRQ), -6.9 versus -2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient 's satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7 +2.3 versus 4.2+4.1 days). A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.

Quality control of mechanical ventilation at the patient's home.

Abstract: During home mechanical ventilation the prescribed settings are applied without permanent supervision of health professionals. After a long-time period of unattended operation at home the ventilator may not apply the ventilation parameters prescribed. This quality control study of home mechanical ventilation assessed whether tidal volume (VT), frequency (f), and minute ventilation (V′ E) actually applied by the ventilator coincide with the values set on the ventilator control panel and with those prescribed. Actual VT, f, and V′ E applied by the ventilator in 30 patients on nocturnal HMV were measured at the patients' homes. The patients were subjected to volume targeted assist ventilation through nasal mask ( n =28) or tracheostomy ( n =2). The values of VT, f, and V′ E set at the ventilator were recorded. The actual and set VT, f, and V′ E values were compared with those prescribed. Considerable differences were found between actual, set and prescribed VT, f, and V′ E. Actual V′ E was significantly lower than V′ E set: mean difference was 0.82 l/min, with considerable individual differences. Differences between actual and prescribed V′ E were caused both by a poor performance of the ventilator and by a discrepancy between the values prescribed and those set at the ventilator control panel. Regularly assessing the actual performance of ventilators at the patient's home is a quality control procedure useful for detecting malfunctions which could improve compliance and outcome of home mechanical ventilation.