title: Home mechanical ventilation in Canada: a national survey.
abstract: BACKGROUND
  No comprehensive Canadian national data describe the prevalence of and service provision for ventilator-assisted individuals living at home, data critical to health-care system planning for appropriate resourcing. Our objective was to generate national data profiling service providers, users, types of services, criteria for initiation and monitoring, ventilator servicing arrangements, education, and barriers to home transition.
  
  
  METHODS
  Eligible providers delivering services to ventilator-assisted individuals (adult and pediatric) living at home were identified by our national provider inventory and referrals from other providers. The survey was administered via a web link from August 2012 to April 2013.
  
  
  RESULTS
  The survey response rate was 152/171 (89%). We identified 4,334 ventilator-assisted individuals: an estimated prevalence of 12.9/100,000 population, with 73% receiving noninvasive ventilation (NIV) and 18% receiving intermittent mandatory ventilation (9% not reported). Services were delivered by 39 institutional providers and 113 community providers. We identified variation in initiation criteria for NIV, with polysomnography demonstrating nocturnal hypoventilation (57%), daytime hypercapnia (38%), and nocturnal hypercapnia (32%) as the most common criteria. Various models of ventilator servicing were reported. Most providers (64%) stated that caregiver competency was a prerequisite for home discharge; however, repeated competency assessment and retraining were offered by only 45%. Important barriers to home transition were: insufficient funding for paid caregivers, equipment, and supplies; a shortage of paid caregivers; and negotiating public funding arrangements.
  
  
  CONCLUSIONS
  Ventilatory support in the community appears well-established, with most individuals managed with NIV. Although caregiver competency is a prerequisite to discharge, ongoing assessment and retraining were infrequent. Funding and caregiver availability were important barriers to home transition.
authors.affiliation: Department of Critical Care and Research Institute, Sunnybrook Health Sciences Centre; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto; the Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital; Mt Sinai Hospital; Li Ka Shing Knowledge Institute, St Michael's Hospital; and West Park Healthcare Centre, Toronto, Ontario, Canada. louise.rose@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Respiratory Rehabilitation and the Sleep Centre, The Ottawa Hospital, and the Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: McKim
authors.affiliation: Children's Hospital of Eastern Ontario (CHEO), the CHEO Research Institute, and the University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Katz
authors.affiliation: London Health Sciences Centre and the Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Leasa
authors.affiliation: University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Mika
authors.initials: M
authors.lastname: Nonoyama
authors.affiliation: Centre for Research in Inner City Health, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: West Park Healthcare Centre and the Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Goldstein
authors.affiliation: Vancouver General Hospital; the Provincial Respiratory Outreach Program, Vancouver Coastal Health; and the University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Road
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D017028:Caregivers; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000628:therapy; D012138:Respiratory Therapy / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: chronic respiratory failure; home ventilation; outcomes; ventilator-assisted individuals