Prolonged Mechanical Ventilation
Advances in life prolonging interventions over the last 30 years have led to a rapidly growing subgroup of patients who are medically stable, but have not successfully weaned from the ventilator and require Prolonged Mechanical Ventilation (PMV).
Long term care of the ventilator-dependent patient is very costly to a state. While a small number of individuals are affected, the per-case cost is very high; as a result, the focus has most often been to provide this care at the lowest cost possible, with little expectation of improved outcomes. Unfortunately, this approach frequently increases the costs to payers over time, and a leads to a poor quality of life for care recipients.
Policy makers must address the increase in frequency of PMV as they project future workforce and resource allocation needs. Care strategies must be developed to accommodate these patients—strategies that recognize the intensive needs of this growing population, while also controlling costs by making delivery of care more efficient.
People + technology + data = better quality and outcomes.
Liberation from PMV
We, along with others have demonstrated that—with the appropriate personnel, technology, monitoring, mobilization and nutrition—a majority of patients deemed ventilator-dependent can nevertheless be liberated from mechanical ventilation:
- 65% Liberated Gantt, Gene (ACCP Chest Conference Center of Excellence presentation, TN Vent Program Statewide 2011)
- 65% Liberated Gantt, Gene (Report to Gov. Bredesen, TN Initial Vent Program 2002)
- 67% Liberated Lindsay, Mark (Mayo 2004)
- 60% Liberated Gracey, D.R. (Mayo 2000)
- 51% Liberated Latriano, B. (Chest 1996)
- 56% Liberated Scheinorhorn (Chest 1997)
Our PMV liberation model was recognized by the American College of Chest Physicians in 2011 as a Center of Excellence.
Enhanced Respiratory Care
As hands-on clinicians, we have been able to develop highly successful ventilator programs; we have learned, firsthand, how to provide better care. Our Enhanced Respiratory Care (ERC) program is a value-based approach that improves outcomes and enhances quality of life. The ERC program, currently deployed in Tennessee, has allowed the state to focus on quality care, quality outcomes, and—most importantly—quality of life for care recipients. The eleven nursing facility ventilator care sites in the state are held to high standards for delivery of care. Further, our Technology Bundles are enabling those care sites to utilize the best and most current equipment available for providing that care.
The State of Tennessee collects extensive data on care and outcomes, and is the first state to implement a pay-for-performance model for this PMV population. The data are clearly demonstrating the value of the ERC program, which, in addition to PMV weaning, includes support for trach and secretion management.