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Introduction Chronic Obstructive Pulmonary Disease (COPD) places a significant burden on healthcare. Non-invasive ventilation (NIV) is an established treatment for acute respiratory failure in COPD, with comprehensive guidelines. 1 However, evidence for its use in the domiciliary setting is more recent, with no standardised criteria for initiating or monitoring treatment. Trials such as HOT-HMV2 demonstrated clinical benefit but excluded patients with BMI >35 or obstructive sleep apnoea (OSA), highlighting limited real-world applicability. We hypothesised that testing local standards in real-world COPD populations could offer insight into realistic expectations for national domiciliary NIV services.Objectives We developed local criteria for domiciliary NIV initiation and follow-up, assessing their feasibility in routine care to inform service design. We also characterised our COPD population to evaluate how well existing research 2 applies to real-world patients.Methods This retrospective observational study used cross-sectional and longitudinal data from 181 COPD patients initiated on domiciliary NIV between 1st July 2021 and 1st July 2024 within an NHS trust. Seven local standards ( table 1) were defined using clinical reasoning alongside available guidelines. Demographics were evaluated at initiation. Patients with ≥12 months of follow-up (n=107) were assessed for hospital readmission, comparing admissions in the year before and after NIV initiation.Results Demographics: 62% female, mean BMI 34 (n=138), 48% BMI >35. 35% had OSA, 67% ≥1 additional respiratory diagnoses. Performance against quality standards was variable (see table 1). However, there was a 33% reduction in hospital admissions among patients with ≥12 months follow-up, and 81% attended ≥3 respiratory clinics in the first year on treatment.Abstract S92 Table 1 Proposed Standard Target% Evaluation Performance n (%) • Hypercapnia at discharge (inpatients) ≥90% with pCO2 >6.5 kPa Reviewed discharge (or closest) blood gases for hypercapnia. 78/109 (72%) • Pre-NIV assessment (outpatients) ≥90% with sleep study and Capillary Blood Glucose (CBG) test Confirmed both tests were/weren’t performed prior to NIV initiation. 14/31 (45%) • NIV usage ≥70% of days with >4h/night in first year Usage data from Lumis devices assessed over first 365 days. 20/36 (56%) • Follow-up within 6 weeks 100% seen within 6 weeks Compared treatment start date to first clinic/phone review. 21/167 (13%) • CBG testing at first clinic if SpO2 <92% 100% with SpO2 <92% should have CBG Checked clinic letters for SpO2 and corresponding CBG tests. 24/48 (50%) • Clinic attendance (first year) ≥80% attend ≥3 respiratory clinics Counted all respiratory clinic visits at ~3, 6, and 12 months. 96/118 (81.36%) • Reduction in hospital admission Pre-NIV admissions vs Post-NIV admissions for patients with at least 12 months follow-up time at the point of data collection. Compared unplanned admissions 12 months before and after NIV start. Mean admissions/patient: 3 pre-NIV vs 2 post-NIV, n=107 patients, 33% reduction Conclusions This study trialled proposed quality standards and examined the real-world COPD population. Our findings show that trial populations do not reflect real-world COPD cohorts, limiting research generalisability. Many standards proved overly ambitious, highlighting the need for evidence-based, achievable national guidelines. These findings support the need for a national audit to inform realistic, standardised domiciliary NIV pathways.References Davies M, et al. BTS Quality Standards for acute NIV in adults. BMJ Open Respir Res. 2018;5(1):e000283.Murphy PB, et al. Home NIV with oxygen therapy vs oxygen alone after COPD exacerbation: RCT. JAMA. 2017;317(21):2177–86.