What is missing is the evidence of effectiveness and value of home respiratory care products and services. Appropriate research, conducted in the home using the products and services the patient will be using, is necessary to determine clinical appropriateness and improved outcomes. Effective therapy should improve patient care with an overall reduction in health care costs.

Practical and appropriate

Respiratory research in the home needs to be practical and appropriate. Testing products or procedures in a way that cannot be implemented in the home due to quality-of-life issues (i.e., patient compliance or reimbursement limitations) only will produce interesting conversation and little value. Studies need to be designed with the products that actually will be used in a real-life scenario with procedures that can be accomplished by the patient or family.

Again, the home is not the hospital, and patients have free will to accept or reject the options available to them. So even if a product or procedure has been proven effective in the hospital, it may have little value in the home. The challenge for home respiratory research moving forward will be the ability to design, control, and test products and procedures with scientific merit.

Scientific method for clinical research is well-established and needs to be followed if any study in the home will be valid. The basis premise is to determine what question you want to answer. For home respiratory care, there are many options to choose from. Researchers have tested and published papers on oxygen therapy, yet effective oxygenation of a patient at all activity levels, using the oxygen equipment provided the patient has not been tested or published.

The practical application of a scientific method discovered during research has to be the endpoint. Once a well-stated question is identified, the topic should be reviewed to discover similar topics in the literature. This helps researchers refine their study and eliminate duplication if the subject has been scientifically tested.

A prediction of what the investigator feels will come of the study is the hypothesis. This hypothesis will need to be tested which is the beginning of the research project. Carefully established test protocols with appropriate control of variables will set the foundation of the study. Focusing on a specific variable, an adequate number of tests will need to be determined to identify statistical significance. It is best to consult with a statistician before starting a study to insure adequate control and number of tests required.

After collecting the data, a full review of the information obtained will allow the researcher to discover trends or variables where conclusions can be identified. The controls that were set in the protocol will help to focus on the main issue for the study. The summary of the data puts the findings of the research in a well-stated conclusion, and graphs and/or tables will help to make the data collected as clear as possible. The article should show the reader:

The specific question you are attempting to answer

• What other research is available in this specific area
• How the research was organized so others could duplicate the study if they wish
• How the data were collected
• The rational for your conclusions and summary
• References used in the article.

Growing the field

Home respiratory care needs more investigation of products, services, and overall value to help direct future growth in the field. The difficulty in funding and conducting home-based research has left the field with little to no scientific evidence on the products and procedures routinely used in home care today. Documenting any study conducted in the home can add value to the base of knowledge available.

Some of the best home respiratory therapists have learned through the school of "hard knocks" and have the experience to do the job better than others. If this experience had been documented and shared, there may be more therapists with this knowledge without the burden of individual on-the-job learning with a trial-and-error methodology.

Any data collected in an objective fashion that may have value to another home therapist should be shared. Depending on the level of control and other factors necessary for scientific merit, there are several outlets for sharing the information: newsletters or websites, presentations at state association meetings, white papers, abstracts or poster presentations, state respiratory association magazines, trade magazines, and scientific journals.

The goal of collecting objective data in home respiratory care, and sharing it with others, is to determine the value of the therapy, the clinical outcomes of therapy, and the most economical methodology. The effectiveness of home respiratory care needs documentation. The process of equipment delivery and maintenance must be understood as only a process, not an outcome.

Politicians and payers do not understand that equipment does not create results, and this problem has occurred as clinicians have not done their job of validating outcomes and the value of home respiratory care. Clinical research, with evidence collected in the home on products and procedures used in the home, needs to be established as a foundation to any respiratory program. Without this evidence, the opinions of home care providers and clinicians will be just as valid as those from payers and politicians when it comes to payment for these services in the home.

Resource

1. Special issue: research and publication in respiratory care. Respir Care. 2004;49(10). Available from: www.rcjournal.com/contents/10.04/contents.cfm.

Robert McCoy, BS, RRT, FAARC, is managing director of Valley Inspired Products, Apple Valley, Minn.