HEALTH FAILURE MODE AND EFFECTS ANALYSIS APPLIED TO HOME MECHANICAL VENTILATION

To use home mechanical ventilation, it is necessary to choose the right target group that can benefit from moving to home care. Moving a patient to home care with home mechanical ventilation involves a number of risks. The aim of this study was to use Health Failure Mode and Effects Analysis (HFMEA) to analyse health risks at a time when a patient is just preparing to move to home care, and a nursing plan is being drawn up. HFMEA was used to analyse health risks. The expert team divided the process of nursing care into 7 parts with other own subprocess, which are 18 in total. Altogether, 41 risks were identified, of which 14 failures were analysed after HFMEA application, potential causes were defined, and their follow-up proposed. According to the results of the method used and the analysis of individual risks, it is necessary to focus on detailed setting of the nursing plan with thorough education of informal caregivers who play an important role in it. The education should be regularly repeated and the check of care itself should be supported by created checklists to confirm the individual steps

Cost–Utility Analysis of Home Mechanical Ventilation in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost–utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost–utility analysis was carried out at the end of the study and results are presented in incremental cost–utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective