Organization and delivery of home-based care for chronic obstructive pulmonary disease patients receiving long-term home non-invasive ventilation: a systematic review.

Abstract

Chronic obstructive pulmonary disease (COPD) contributes substantially to morbidity, mortality, and healthcare costs. For patients with chronic respiratory failure, long-term home non-invasive ventilation (LTHNIV) is an effective therapy, yet existing guidelines offer little direction on the most effective initiation and organization of care. We review current LTH-NIV implementation and management strategies and factors that facilitate or hinder successful treatment. A systematic review of studies investigating the organization and implementation of LTHNIV for COPD patients was performed. Studies reporting primary clinical, economic, or organizational data on LTHNIV with home-based care were included, with a particular focus on interventions aiming to improve outcomes or care organization. The findings were synthesized narratively. CRD42025648464. From 870 records, 46 studies were included. The majority were from Europe, with fewer studies from Asia and North America. Differences in how LTHNIV is delivered to COPD patients were identified, with variation in initiation settings, stakeholder involvement, and follow-up strategies. Hospital-based initiation remained common, although outpatient and home-based models, often supported by remote titration or telemonitoring, were increasingly used. Follow-up was typically scheduled every 3-6 months across outpatient, inpatient, and home-based modalities. Successful care relied on patient education, technical support, and structured follow-up, supported by remote consultations. These new strategies promise improved patient comfort, adherence, communication, and collection of patient-centred outcomes. Telemonitoring emerged as a promising adjunct, enhancing individualized care, facilitating closer follow-up and early identification of technical or clinical issues. The delivery of LTHNIV remains heterogeneous, even within countries. This variability in care organization and reporting mandates establishing harmonized, patient-centred pathways that integrate telemonitoring and coordinate collaboration among stakeholders, ensuring that patients and their caregivers remain central to the care process.