Chronic Health APACHE: Difference between revisions

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''This article is about Chronic Health in the context of the APACHE score, see [[Comorbid Diagnosis]] for info on the comorbidities we collect.''
''This article is about Chronic Health in the context of the APACHE score, see '''[[Comorbid Diagnosis]]''' for info on the comorbidities we collect, and '''[[Charlson Comorbidity Index]]''' for the Charlson comorbidities that are also used for the '''[[Alert]]''' score.''


The Chronic Health field is stores information about specific chronic pre-existing underlying disease conditions. This value is used in conjunction with [[Admit Type for APACHE II]] to calculate the [[APACHE_Scoring_table#Chronic_Health_Score|Chronic_Health_Score]], one of the components of the [[Category:APACHE II | APACHE II score]].  
This value is now derived from ICD10 diagnoses, see [[Change for Apache Chronic to ICD10 from separate variable]] for details.  


To be considered to be a '''chronic''' disease, the chronic condition have been documented as present before current hospitalization.
{{Data_element
| field_name = Ap_Chronic
| CCMDB_label = Chronic
| CCMDB_tab = Apache
| element_description = Specific chronic pre-existing conditions used for [[APACHE]] score.
| in_table = L_Log table
| data_type = string
| datafield_length = 30
| program_collecting = CC
| created_raw = Raw
| data_element_sort_index = 56
| data_element_start_date =
| data_element_end_date = 2022-02-17
}}
 
This value is used in conjunction with [[Admit Type for APACHE II]] to calculate the [[APACHE_Scoring_table#Chronic_Health_Score|Chronic_Health_Score]], one of the components of the [[Category:APACHE II | APACHE II score]].
 
To be considered to be a '''chronic''' disease, the chronic condition must have been documented as present before current hospitalization.


==Chronic Health Table==
==Chronic Health Table==
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
{| class="wikitable" border=1  
|- style="background-color:#CCFFCC"  
|- style="background-color:#CCFFCC"  
|style="font-weight:bold" | Dropdown in CCMDB.mdb
|style="font-weight:bold" | Dropdown in CCMDB.accdb
|| Orignial APACHE II CH list with definitions
|| Orignial APACHE II CH list with definitions


Line 19: Line 36:
* Chemotherapy
* Chemotherapy
* Radiation therapy
* Radiation therapy
* Post BMT (Bone Marrow Transplant)
* Post BMT ([[Bone Marrow Transplant]])
* sufficiently advanced disease to suppress resistance to infection
* sufficiently advanced disease to suppress resistance to infection
* Include patients on methotrexate or cyclophosphamide, etc. (for autoimmune disorders)
* pt is on immunosuppressive drugs (RA or SLE pts)
* {{List of immunosuppressive drugs}}


|-  
|-  
|| 2. '''Met Cancer'''
|| 2. '''Met Cancer'''
* sufficiently advanced disease to suppress resistance to infection
* sufficiently advanced disease to suppress resistance to infection  
||
||
|-
|-
|| 3. [http://en.wikipedia.org/wiki/Hematological_malignancy '''HematMalign'''] e.g. Lymphoma or Leukemia  
|| 3. [http://en.wikipedia.org/wiki/Hematological_malignancy '''HematMalign'''] e.g. Lymphoma or Leukemia  
* sufficiently advanced disease to suppress resistance to infection
* sufficiently advanced disease to suppress resistance to infection
||  
||  
|- style="font-size:11pt"
|- style="font-size:11pt"
||    4. '''AIDS'''
||    4. '''AIDS'''
|  
|  
|-  
|-  
|| 5. '''CRF-severe'''
|| 5. '''CRF-severe'''
| Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.
| Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.
|-  
|-  
|| 6.''' Liver-severe'''
|| 6.''' Liver-severe'''
Line 68: Line 83:
|| 8. '''CVS min exert'''
|| 8. '''CVS min exert'''
| [[Classification_of_Angina#Class_4 | Class 4 Angina]] - pain @ rest or with minimal exertion
| [[Classification_of_Angina#Class_4 | Class 4 Angina]] - pain @ rest or with minimal exertion
|-  
|-  
|| 9. '''No Chronic Health'''
|| 9. '''No Chronic Health'''
|  
|  
|}
|}


== Implementation ==
== Implementation ==
* Chronic Health is stored as a single-choice dropdown in [[CCMDB.mdb]]
* Chronic Health is stored as a single-choice dropdown in [[CCMDB.accdb]] and [[Centralized_data.accdb]]
* when sent for import into [[TMSX]] the chronic health score is translated into ''yes'' or ''no''
* There is an additional option "0HasChronic"; this can not be selected in [[CCMDB.accdb]] but is used in [[Centralized_data.accdb]] for old records that were imported from [[TMSX and MedTMS]] where the detailed data was not collected
* the fields were made into a pick list of 9 items that belong to one of the five APACHE II Chronic Health categories because Medicine wanted to use both [[APACHE II]] and [[SAPS II]] on Medicine patients. [[SAPS II]] and [[APACHE II]] scored these same chronic health items differently. SAPS is no longer collected.
{{discussion}}
*Is this field used by anything else, eg [[MOST]]? Ttenbergen


== Potential change ==
== ICD10  ==
{{Potential Change}}
We are moving to derive this concept from [[APACHE Comorbidities in ICD10 codes]].
As per minutes from DB meeting 13 Dec 2013; expected implementation 2-3 quarter 2014:


There was a long discussion about the coding of the APACHE comorbidity field.  This boils down to a score of 0 or 2 or 5, depending on the presence/absence of a list of specific chronic conditions.  Some of the conditions result in a score of 5, and others a score of 2.  A patient with none of these conditions gets a 0.  If multiple conditions are present the score is 2 if all of them are 2’s and it’s 5 if any of them are 5’s. 
=== Change log ===
* 2022-02-17 - decided to stop collecting this and apply [[Change for Apache Chronic to ICD10 from separate variable]]
Unfortunately, in Ed’s program this is programmed incorrectly, so legacy APACHE total
* 2022-02-09 - Julie, Tina and Allan discussed Julie's most recent analysis of this; there are still many differences in dx vs chronic, with higher and lower counts for different components. Allan quotes a paper that acknowledges this difference in count, but that the Apache ''score'' ends up similar. Question raised: is the saving of time in no longer collecting this as a field worth the loss of accuracy.
scores have been incorrect.
* 2021-04-22 - preliminary analysis of how deriving this from ICD10 would compare with previous manual collection; many differences; Tina emailed Allan and Julie, more to come
*NOTE: Chronic Health is scored correctly in the ICU database [[TMSX]].  The only thing in the ICU database program is that the it is not transparent if patient was either emergency surgery or a medical patient (non operative) patient. At the time so long ago, medical and emerg surgery were grouped together because they both give 5 points if a chronic health condition is present.  SO....if ELECTIVE surgery is chosen and PLUS one or more APACHE II specific chronic health condition is present, then 2 points.  If medical patient (non operative) or emergency surgery, PLUS one or more APACHE II specific chronic health conditions are present, then 5 points.  If there are NO APACHE II specific chronic Health conditions present, then 0 points, does not matter if you where elective, emergent or medical patient.[[User:TOstryzniuk|Trish Ostryzniuk]] 20:18, 2014 January 27 (CST)
* 2021-04-19 - Added ''Drug-induced immunosuppression'' since that component of this code was not previously collected comprehensively
*In Ed’s program it is coded as Yes/No according to the presence/absence of ANY of the listed conditions; and thus cannot correctly distinguish a score of 2 vs. 5.  With the advent of the laptops, the collectors are presented with 9 options:  a list of 8 conditions and a choice of “none”.  But here still they’re not provided with the scores (2 or 5) and so cannot systematically choose the highest scoring condition that’s present.  Even worse, until summer 2013, we didn’t retain even that more detailed (but still problematic) information and simply converted it to Yes/No.  We decided that the ultimate solution (to be implemented “later”) is to make this right by integrating identification of these specific chronic conditions with the more general comorbidity identification, in the following way:
* 2021-03-11 - The list of drugs is at [[Template:List of immunosuppressive drugs]].  
*(a) eliminate the stand-alone listing of the APACHE comorbid conditions,
* 2021-02-22 - AG sent email to Julie and Tina to get back to this change.  
*(b) alter the general comorbidity identification such that in addition to the ability to list any number of conditions, the specific APACHE conditions are each listed with a radio button to identify it as present/absent, and change the laptop software such that if listed as present, that entity automatically gets entered into the total list of comorbid conditions, and
* 2018-11-28 - AG confirmed that this is an option
*(c) this more detailed information about the presence/absence of the specific APACHE conditions will enable correct scoring of the APACHE comorbidity score.
But we also want to go back and change/improve the APACHE comorbidity (and total) scoring in the legacy data.  To avoid systematic bias, we will accept random error in the following way: (i) for those whose Yes/No variable in Ed’s program is “Yes”, we will randomly assign a 2 or a 5, with weighting according to the proportion expected to be present for the conditions scoring a 5 vs. those scoring a 2.  We can eventually obtain these from our own data once we implement the modifications “later”, but for now we can look to published data, or try to mine our own comorbidity listings from the legacy data to obtain this proportion.


== Legacy ==
* when sent for import into [[TMSX and MedTMS]] the chronic health score was translated into ''yes'' or ''no''; when we moved to [[Centralized_data.accdb]] these were imported as "0HasChronic"
* the fields were made into a pick list of 9 items that belong to one of the five APACHE II Chronic Health categories because Medicine wanted to use both [[APACHE II]] and [[SAPS II]] on Medicine patients. [[SAPS II]] and [[APACHE II]] scored these same chronic health items differently. SAPS is no longer collected.


== Related articles ==
{{Related Articles}}


[[Category: APACHE II]]
[[Category:APACHE II]]

Latest revision as of 10:32, 30 July 2025

This article is about Chronic Health in the context of the APACHE score, see Comorbid Diagnosis for info on the comorbidities we collect, and Charlson Comorbidity Index for the Charlson comorbidities that are also used for the Alert score.

This value is now derived from ICD10 diagnoses, see Change for Apache Chronic to ICD10 from separate variable for details.


 
 
 
 

Legacy Content

This page contains Legacy Content.

  • Explanation: This is a legacy data field, its DataElementEndDate is in the past.
  • Successor: No successor was entered

Click Expand to show legacy content.

Data Element (edit)
Field Name: Ap_Chronic
CCMDB Label: Chronic
CCMDB tab: Apache
Table: L_Log table
Data type: string
Length: 30
Program: CC
Created/Raw: Raw
Start Date:
End Date: 2022-02-17
Sort Index: 56
Data Dependencies(Reports/Indicators/Data Elements):

Specific chronic pre-existing conditions used for APACHE score.

  • SMW

Legacy implementation right in the table

  • Cargo


  • Categories
  • Forms


This value is used in conjunction with Admit Type for APACHE II to calculate the Chronic_Health_Score, one of the components of the .

To be considered to be a chronic disease, the chronic condition must have been documented as present before current hospitalization.

Chronic Health Table

Dropdown in CCMDB.accdb Orignial APACHE II CH list with definitions
1. Immunocompromized (this category includes the following: Metastatic Cancer, Hematological Malignancy-Lymphoma, Leukemia and also AIDS) (this is applicable to items 1-5. Receiving therapy that suppresses resistance to infection such as: at least one of the following:
  • ≥15mg/kg/day hydrocortisone
  • >3 mg/kg’day of methylprednisolone for >5 days (for entire LOS if pts LOS is less than 5 days).
  • ≥10 mg prednisone
  • Chemotherapy
  • Radiation therapy
  • Post BMT (Bone Marrow Transplant)
  • sufficiently advanced disease to suppress resistance to infection
  • Include patients on methotrexate or cyclophosphamide, etc. (for autoimmune disorders)
  • pt is on immunosuppressive drugs (RA or SLE pts)
List of immunosuppressive drugs   
  • Used to treat an increasing variety of conditions: immune-mediated (RA, UC, Crohn's, lupus, MS, psoriasis, etc); after organ transplant.
  • Only considered immunosuppressive if given systemically (po, im or iv)
  • Corticosteroids (unlike all the others, these only count if > a given daily dose and used for at least 2 weeks prior to admission)
    • Dexamethasone: >0.25 mg/day
    • Hydrocortisone: >40 mg/day
    • Prednisone (methyl-prednisolone): >10 mg/day
    • Prednisolone: >8 mg/day
  • Cancer chemotherapy -- includes any agents, if received within the past 6 months
  • Nonsteroidal immunosuppressives -- includes any of these, if received within the past 1 month
    • Abatacept (Orencia)
    • Azathioprine (Imuran)
    • Adalimumab (Humira)
    • Anakinra (Kineret)
    • Basiliximab (Simulect)
    • Certolizumab (Cimzia)
    • Cyclophosphamide (Cytoxan)
    • Cyclosporine
    • Daclizumab (Zinbryta)
    • Etanercept (Enbrel)
    • Everolimus (Afinitor, Zortress)
    • Golimumag (Simponi)
    • Infliximab (Remicade)
    • Ixekizumab (Taltz)
    • Leflunomide (Arava)
    • Lenalidomide
    • Methotrexate
    • Mycophenolate (CellCept)
    • Natalizumab (Tysabri)
    • Rituximab (Rituxan)
    • Secukinumab (Cosentyx)
    • Sirolimus (Rapasumne)
    • Tacrolimus (Prograf)
    • Tocilizumab (Actemra)
    • Tofacitinib (Xeljanz)
    • Ustekinumab (Stelara)
    • Vedolizumab (Entyvio)

Do not include

  • hydroxychloroquine - as per task meeting 2022-04-20 it is an immune modulator, but not very immunosuppressive
2. Met Cancer
  • sufficiently advanced disease to suppress resistance to infection
3. HematMalign e.g. Lymphoma or Leukemia
  • sufficiently advanced disease to suppress resistance to infection
4. AIDS
5. CRF-severe Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.
6. Liver-severe

any of:

  • biopsy proven cirrhosis & previously documented portal hypertension
  • past episodes of
    • GI bleeds related to portal hypertension or varicies
    • hepatic failure or encephalopathy or coma
7. Lung severe

any of the following that results in severe exercise restriction (i.e. unable to climb stairs or perform household duties):

  • COPD-severe
  • Restrictive lung disease-severe
  • Vascular disease-severe

or any of the following

  • documented chronic hypoxia or hypercapnia,
  • secondary polycythemia
  • Pulmonary HTN
  • on home O2 (this does not include home bipap or cpap unless the pt also has one of the other listed conditions)Bipap or cpap if only for airway does not imply lung disease. Cpap for obstructive sleep apnea is just constant positive air pressure to keep the airway open during sleep. Not usually used with oxygen.
  • Ventilator dependent
    • Does being on bipap or cpap for obesity be considered restrictive lung disease severe?--MWaschuk 14:31, 2012 May 28 (CDT)
    • There may be an element of restrictive lung disease with obesity as the lung cannot always fully expand related to pressure on the diaphragm of a morbidly obese pt. To be considered true restrictive lung disease however, this must result in impaired ventilatory function. Most obese pts on bipap are only on bipap at night to maximize the airway. To call this severe restrictive lung disease is incorrect. If they are on home O2 during the day as well or have any of the above issues like documented hypoxia or hypercapnea, then this would be considered severe restrictive lung disease. Bipap at night alone is not sufficient evidence of severe restrictive lung disease even if the pt is obese. --LKolesar 07:16, 2012 May 29 (CDT)
8. CVS min exert Class 4 Angina - pain @ rest or with minimal exertion
9. No Chronic Health

Implementation

ICD10

We are moving to derive this concept from APACHE Comorbidities in ICD10 codes.

Change log

  • 2022-02-17 - decided to stop collecting this and apply Change for Apache Chronic to ICD10 from separate variable
  • 2022-02-09 - Julie, Tina and Allan discussed Julie's most recent analysis of this; there are still many differences in dx vs chronic, with higher and lower counts for different components. Allan quotes a paper that acknowledges this difference in count, but that the Apache score ends up similar. Question raised: is the saving of time in no longer collecting this as a field worth the loss of accuracy.
  • 2021-04-22 - preliminary analysis of how deriving this from ICD10 would compare with previous manual collection; many differences; Tina emailed Allan and Julie, more to come
  • 2021-04-19 - Added Drug-induced immunosuppression since that component of this code was not previously collected comprehensively
  • 2021-03-11 - The list of drugs is at Template:List of immunosuppressive drugs.
  • 2021-02-22 - AG sent email to Julie and Tina to get back to this change.
  • 2018-11-28 - AG confirmed that this is an option

Legacy

  • when sent for import into TMSX and MedTMS the chronic health score was translated into yes or no; when we moved to Centralized_data.accdb these were imported as "0HasChronic"
  • the fields were made into a pick list of 9 items that belong to one of the five APACHE II Chronic Health categories because Medicine wanted to use both APACHE II and SAPS II on Medicine patients. SAPS II and APACHE II scored these same chronic health items differently. SAPS is no longer collected.

Related articles

Related articles:
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