Optimal NIV Medicare Access Promotion: Patients With COPD

Abstract

This document summarizes the work of the COPD Technical Expert Panel working group.For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation) and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Critical evidence supports changes to current policies, including randomized controlled trial evidence suggesting a mortality benefit from bilevel positive airway pressure with backup rate and updated clinical practice guidelines from the American Thoracic Society as well as the European Respiratory Society. To achieve optimal access to noninvasive ventilation for patients with COPD, we make the following key recommendations: (1) removal of the need for overnight oximetry testing; (2) the ability to initiate therapy using bilevel devices with backup rate capability; and (3) increased duration of time to meet adherence criteria (ie, a second 90-day trial period) in those patients actively engaged in their care. Clear guidelines based on medical necessity are also included for patients who require initiation of or switch to a home mechanical ventilator.Adoption of these proposed recommendations would result in the right device, for the right type of patient with COPD, at the right time. Finally, we emphasize the need for adequate clinical support during initiation and maintenance of home noninvasive ventilation in such patients.

Hospital–Provider Company Network for Home Non-Invasive Ventilation: A Feasibility Pilot Study

“…Following discharge, the HMV center played a crucial role in the complex NIV setup process, requiring multiple adjustments and assessments [16,17]. The present study underscores the importance of a multidisciplinary team approach, involving various healthcare professionals with specific duties (refer to Table S1 in Supplementary Materials).…”

The effectiveness of physiotherapy in children with pneumonia: a case study report

“…8,10 Chest physiotherapy is important in the treatment of most respiratory diseases, and is used for children with chronic respiratory or neuromuscular diseases. 11,12 The main goal of chest physiotherapy for children is to help clear tracheobronchial secretions, thereby reducing airway resistance, increasing gas exchange, and making breathing easier. 2,6 Mechanical interventions based on respiratory physiology are used therapeutically in chest physiotherapy.…”

“…5,15 Infrared is applied for 10 to 15 minutes in the chest or back area, depending on the thorax results, and can be combined with postural drainage with the body position adjusting the results of the chest X-ray, followed by continued chest physiotherapy for 3-5 minutes for each segment with postural drainage, vibration, and percussion, followed by breathing exercise 8 times in two sets. 12 Only children over the age of eight are eligible for autogenic drainage, which is based on active or passive aided control of autogenic drainage of airflow and lung volume-based respiratory rate. 16 Because it does not involve active participation, assisted autogenic drainage is a modified version of autogenic drainage used for newborns and young children.…”

Chronic hypercapnic respiratory failure and non-invasive ventilation in people with chronic obstructive pulmonary disease

“…35 Similar concerns have prompted the Optimal Non-invasive ventilation Medicare Access Promotion (ONMAP) panel in the US to recommend leaving the timing of initiation to the physician's discretion. 52 However, titration in hospital can be associated with increased length of stay and costs. For instance, in one randomised controlled trial, 28 an average of 5.6 (standard deviation 1.1) days were needed for successful non-invasive ventilation titration.…”

“…Acknowledging the complexities of initiation of non-invasive ventilation during outpatient clinics, the ONMAP panel advocated for frequent home visits by respiratory therapists or clinicians to make appropriate device adjustments. 52 With improving telemedicine capabilities, initiation and titration are highly feasible in the ambulatory setting. To that end, a randomised study of home versus in hospital initiation and titration among 67 patients with COPD and stable hypercapnia reported non-inferiority in PaCO 2 concentration reduction and quality of life metrics.…”