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Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible.

Publication ,  Journal Article
Choi, PJ; Murn, M; Turner, R; Bedlack, R
Published in: Am J Hosp Palliat Care
October 2021

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) is a terminal neuromuscular disease with patients dying within 3-5 years of diagnosis. Most patients choose to forego invasive life sustaining measures. Timing of hospice referral can be challenging given the advancement of non-invasive ventilation (NIV) technology. OBJECTIVE: To describe the characteristics of patients enrolled in hospice from an ALS clinic at 1 academic medical center and to perform a cost analysis for patients who remained on ventilator support. METHODS: Retrospective cross-sectional study of patients enrolled in hospice over a 2-year period. Clinical characteristics included ALS Functional Rating Scale Revised (ALSFRS-R) score, Forced Vital Capacity (FVC), use of NIV and mechanical insufflation-exsufflation (MIE), riluzole use, and length of stay in hospice. A cost analysis was performed for patients enrolled in Duke Home Care and Hospice. RESULTS: 85 of 104 patients who died were enrolled in hospice. Median days enrolled in hospice was 84. Patients who continued on NIV had similar hospice length of stay as those on no respiratory support (88 versus 80 days, p = 0.83). Bulbar patients had a trend toward shorter length of stay in hospice than limb onset patients (71 versus 101 days, p = 0.49). Cost analysis showed that hospice maintained a mean net operating revenue of $3234.50 per patient who continued on NIV. CONCLUSIONS: Hospice referrals for ALS patients on NIV can be challenging. This study shows that even with continued NIV use, most ALS patients die within the expected 6 months on home hospice, and care remains cost effective for hospice agencies.

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Published In

Am J Hosp Palliat Care

DOI

EISSN

1938-2715

Publication Date

October 2021

Volume

38

Issue

10

Start / End Page

1238 / 1241

Location

United States

Related Subject Headings

  • Time Factors
  • Retrospective Studies
  • Respiratory Insufficiency
  • Noninvasive Ventilation
  • Humans
  • Hospice Care
  • Gerontology
  • Cross-Sectional Studies
  • Amyotrophic Lateral Sclerosis
  • 4205 Nursing
 

Citation

APA
Chicago
ICMJE
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Choi, P. J., Murn, M., Turner, R., & Bedlack, R. (2021). Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible. Am J Hosp Palliat Care, 38(10), 1238–1241. https://doi.org/10.1177/1049909120982291
Choi, Philip J., Michael Murn, Roberta Turner, and Richard Bedlack. “Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible.Am J Hosp Palliat Care 38, no. 10 (October 2021): 1238–41. https://doi.org/10.1177/1049909120982291.
Choi, Philip J., et al. “Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible.Am J Hosp Palliat Care, vol. 38, no. 10, Oct. 2021, pp. 1238–41. Pubmed, doi:10.1177/1049909120982291.
Journal cover image

Published In

Am J Hosp Palliat Care

DOI

EISSN

1938-2715

Publication Date

October 2021

Volume

38

Issue

10

Start / End Page

1238 / 1241

Location

United States

Related Subject Headings

  • Time Factors
  • Retrospective Studies
  • Respiratory Insufficiency
  • Noninvasive Ventilation
  • Humans
  • Hospice Care
  • Gerontology
  • Cross-Sectional Studies
  • Amyotrophic Lateral Sclerosis
  • 4205 Nursing