Building a Comprehensive System of Services to Support Adults Living with Long-Term Mechanical Ventilation

Abstract

Background. Increasing numbers of individuals require long-term mechanical ventilation (LTMV) in the community. In the South West Local Health Integration Network (LHIN) in Ontario, multiple organizations have come together to design, build, and operate a system to serve adults living with LTMV. Objective. The goal was to develop an integrated approach to meet the health and supportive care needs of adults living with LTMV. Methods. The project was undertaken in three phases: System Design, Implementation Planning, and Implementation. Results. There are both qualitative and quantitative evidences that a multiorganizational system of care is now operational and functioning in a way that previously did not exist. An Oversight Committee and an Operations Management Committee currently support the system of services. A Memorandum of Understanding has been signed by the participating organizations. There is case-based evidence that hospital admissions are being avoided, transitions in care are being thoughtfully planned and executed collaboratively among service providers, and new roles and responsibilities are being accepted within the overall system of care. Conclusion. Addressing the complex and variable needs of adults living with LTMV requires a systems response involving the full continuum of care.

Patterns of healthcare utilisation for respiratory complications of adults with neuromuscular disease: a population study

“…In Ontario, although all approvals for publicly funded noninvasive and invasive ventilators are captured in the ADP database, other respiratory equipment including CPAP and bilevel devices may be obtained from nonpublicly funded sources or purchased by individuals [39], and therefore our data may underestimate the use of respiratory support for NMD. Furthermore, availability of respiratory therapists in the community is extremely limited in Ontario [40]. Interestingly, despite a considerable increase in the frequency of PFT monitoring and respiratory specialist Data are presented as n (%) or mean±SD, unless otherwise stated.…”

Factors associated with change in health‐related quality of life among individuals treated with long‐term mechanical ventilation, a 6‐year follow‐up study

“…One of the challenges in clinical practice is to identify and target the patients' genuine needs (Leasa & Elson, 2016). There are different approaches to follow-up.…”

“…Most individuals treated with LTMV have incurable and often chronically progressive diseases (Huttmann & Windisch, ; p. 277). Without LTMV, individuals with CHRF have severely impaired health‐related quality of life (HRQoL) (Dellborg et al., ), but LTMV might have an impact on daily life (Brooks et al., ; Lindahl, Sandmann, & Rasmussen, ) and lifelong follow‐up from the healthcare service is needed (Leasa & Elson, ). Improving or maintaining HRQoL is one of the main goals both in invasively ventilated (AARC, ) and in non‐invasively ventilated individuals (McKim et al., ).…”

“…However, shortcomings in the information and follow‐up provided by healthcare staff have been reported. Access to better trained personnel has been requested by LTMV patients (Chang, Marsh, Smith, & Neill, ), who suffer from severe conditions requiring information, support and long‐term care to enjoy the best quality of life available (Leasa & Elson, ). There is limited knowledge of how indicators like side effects of the treatment, satisfaction with LTMV training and follow‐up might influence changes in HRQoL.…”

“…However, shortcomings in the information and follow-up provided by healthcare staff have been reported. Access to better trained personnel has been requested by LTMV patients (Chang, Marsh, Smith, & Neill, 2010), who suffer from severe conditions requiring information, support and long-term care to enjoy the best quality of life available (Leasa & Elson, 2016).…”