title: At home and on demand mechanical cough assistance program for patients with amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To establish a cost-effective telephone-accessed consultation and mechanical in-exsufflation (MI-E) and manually assisted coughing, oximetry feedback program for 39 patients with amyotrophic lateral sclerosis.
  
  
  METHODS
  Rapid access to healthcare consultation and to MI-E was provided to treat episodes of distress as a result of secretion encumbrance not reversed by suctioning and associated with a decrease in oxyhemoglobin saturation (SpO(2)) baseline. Avoided hospitalizations, defined by relief of respiratory distress and return of SpO(2) baseline to >or=95% by continuous ventilator use and assisted coughing, were recorded. Patient satisfaction was queried at 6 mos, and a cost analysis was performed of continuous vs. on demand MI-E use.
  
  
  RESULTS
  Thirty-nine patients made a total of 1661 calls in 7.46 +/- 5.8 mos of follow-up. Twenty-seven patients had 66 home care visits by a respiratory therapist for a total time commitment of 89.7 +/- 99.3 min/patient/mo. Twelve patients, all ventilator users, were also brought mechanical in-exsufflators for mechanically assisted coughing for 47 respiratory episodes. Thirty hospitalizations were avoided. Seventy-five percent of the patients were extremely satisfied. Mean monthly cost per patient for on-demand telephone consultation, professional home healthcare visits, and MI-E as deemed necessary was euro403 +/- euro420 or 59% less than for continuous MI-E rental. Hospitalization costs were also spared.
  
  
  CONCLUSIONS
  An on-demand consult and MI-E access program can avoid hospitalizations for patients with amyotrophic lateral sclerosis with significant cost savings.
authors.affiliation: UO di Pneumologia Riabilitativa e Terapia Intensiva Respiratoria, Fondazione Salvatore Maugeri, IRCCS, Lumezzane, Brescia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
authors.forename: Debora
authors.initials: D
authors.lastname: Trainini
authors.forename: Luca
authors.initials: L
authors.lastname: Bianchi
authors.forename: Giuliano
authors.initials: G
authors.lastname: Assoni
authors.forename: Manuela
authors.initials: M
authors.lastname: Saleri
authors.forename: Sonia
authors.initials: S
authors.lastname: Gilè
authors.forename: João C
authors.initials: JC
authors.lastname: Winck
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Gonçalves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D003362:Cost-Benefit Analysis; D003371:Cough; D005260:Female; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007327:Insufflation / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D017060:Patient Satisfaction; D012133:Respiratory Paralysis / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000191:economics*; D017216:Telemedicine / Q000191:economics*