Technology assessment and support of life-sustaining devices in home care. The home care physician perspective.

Practicing physicians are increasingly using life-sustaining devices in the home setting for patients with long-term needs due to chronic conditions. At the same time, public policy focus on technology assessment has broadened from narrow medical concerns about safety and efficacy to considerations of effectiveness, quality of life, patient preferences, and cost/benefit. Around the world high-technology home care (HTHC) features a number of ways to evaluate outcomes. One category of HTHC that requires initial and on-going technology assessment is home mechanical ventilation (HMV). Home MV has developed in nations with a variety of healthcare finance systems: England (national health system), France (national health insurance), and the United States (regulated/market-economy). Approaches to technology assessment differ among nations according to organizational design and evolution. Physician behavior is a major determinant in the application of medical technologies. There are new physician roles that an influence what, when, and how technology is appropriately used in the home--initially and over time. For this reason, it is crucial to consider the role of the practicing physician in home care technology assessment.