2017/8/8

Chronic Organ Dysfunction

Ver.1: 2015713
Ver.2: 2016420
Ver.:2017527

Common Disease



Common disease Common

TOP50
!



,. 2000

Common Disease?
2.0
COPD

1.4
1.3







ACS COPD

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35.7 28.5%
19.5 15.5%
12.5 9.9%
12.4 9.9%
5.9 4.8%
5.2 4.2%
2.9 2.3%
2.5 2.0%
COPD 1.7 1.4%
1.6 1.3%
25.3 20.2% 11.1%

45

45

7 7
5% 22%
5%

VTE/PTE 4%
COPD 4%

4%

DKA 5% 12%
4%
CHFCOPDLCCKD
AIHA/ITP 3%

5% 5%
2% 4%
: 1%
1%
307/151147/263/

Common Disease


CHFCOPDCKDCHCND

(
!
)
ACSStroke


DPC!

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Chronic Organ Dysfunction



CHD:Chronic Heart Disease

CPD:Chronic Pulmonary Disease
COPD
CLD:Chronic Liver Disease
NAFLD/NASH
CKD:Chronic Kidney Disease
DMHT
CBD:Chronic Brain Disease

At risk Basal Clinical Discomfort / End
change symptom decompensated stage
stageA Stage B Stage C Stage D
AHA)
CHD

Stage Stage Stage~

CPD
Child A Child B Child C

PLT
CLD
Stage1 Stage2 Stage3B Stage45 ESKD

3A HD
CKD
MCI AD

CBD FAST1~3 FAST4~6 FAST7

LVH
Stage?
? ?

Stage

Stage CXRECGStage?



!! Stage??

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At risk





COD

Clinical symptom
Basal Change

a
a


Stage2


COD

Discomfort/Discompensated
Endstage






RAS

ACP
DPC

!

ACP

SPSSICF

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COD
CHF SHFM
CPD BODE index

CLD MELD, CLIP score
CKD CRIB
CBD FAST, MRI, ADEPT


http://www.zaitakuiryo-yuumizaidan.com/data/file/data1_20110516101021.pdf

SHFM COPD BODE index

(FEV)
(6)
(MRC)
BMI)

10
34

Seattle Heart Failure Model The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic
Obstructive Pulmonary Disease
https://depts.washington.edu/shfm/ NEJM Volume 350:1005-1012 March 4, 2004 Number 10

CLIP score CKD CRIB

Prediction of ESRD and Death Among People With CKD: The Chronic Renal Impairment in
Discrimination Value of the New Western Prognostic System (CLIP Score) for Hepatocellular Carcinoma in Birmingham (CRIB) Prospective Cohort Study. Am J Kidney Dis. Dec 2010; 56(6-2): 10821094.
662Japanese Patients. (HEPATOLOGY 2001; 34:529-534. http://www.skh.org.tw/gi/activity/CLIP.pdf StageK/DOQI (Kidney Disease Outcomes Quality Initiative)

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:Multimorbidity

QOL, etc.

:Managing patients with multimorbidity in primary care. BMJ. 2015

http://cmj.publishers.fm/

Illness Trajectory

Patterns of Functional Decline at the End of Life. JAMA. 2003;289(18):2387-2392

COD
CHF SHFM !
CPD BODE index
CLD MELD, CLIP score
CKD CRIB

CBD FAST, MRI, ADEPT

http://www.zaitakuiryo-yuumizaidan.com/data/file/data1_20110516101021.pdf

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ADL

Palliative

Prognostic

Score

(:Stage1~2)

:Stage3
:Stage4
:Stage5
Generalist masters.

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:Multimorbidity

QOL

STARTSTOPP/BEERS
:Managing patients with multimorbidity in primary care. BMJ. 2015
http://cmj.publishers.fm/

Coordination Coordination
Kurt C. Stange. A science of Connectedness. Ann Fam Med 2009 7 387-394

Refer!! System holarchy

(Hierarchy of holons
Collateral referral

Interval referral

Cross referral

Sprit referral

GERD

???

QOL
!


ABCDE+III+QRST

:Infection : :

Ion & fluid: :
Insulin & nutrition: :

:QOLADL()
:
:
:()
:()
:()

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Common Disease










Common Disease

Stage
StageCOD
StageStage1
Common disease

Generalist masters

http://www.zaitakuiryo-yuumizaidan.com/data/file/data1_20110516101021.pdf