Résumé :
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Domiciliary ventilation is an established treatment for high tetraplegia. Although there is now extensive international experience of safe home ventilation there is no single model of care. Resource utilization remains to be a significant challenge.We have found that provision of care packages remains heavily reliant on the rehabilitation teambeing creative both in arranging care through various funding bodies, and also in informing health commissioners, private or public, on best options for care. We sought new internationalmodels of home ventilation to bring ideas to our own practice and to informcommissioners of the possible options for such care. We compared models of care packages for domiciliary ventilation for patients in the USA Veterans' Administration (VA) and the UK National Health Service (NHS) in Scotland. We examined case records on a sample of patients with high tetraplegia who required at least sixteen hours of ventilation daily.Where necessary we discussed details and costing of care package and hardware with local health commissioners : these included NHS and local public authoritymanagers in the UK and VA and private insurance managers in the USA. Comparisons of care packages, funding models and costings are presented and discussed. We noted wide variation in costs, most of which were due to nursing care. We show that such patients can live in the community for over a decade providing care is appropriately funded and managed.
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