Chronic Health APACHE

This article is about Chronic Health in the context of the APACHE score, see Comorbid Diagnosis for info on the comorbidities we collect.

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 Chronic_Health_Score, one of the components of the .

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

Chronic Health Table

Dropdown in CCMDB.mdb	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
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. Ventilator dependent
8. CVS min exert	Class 4 Angina - pain @ rest or with minimal exertion
9. No Chronic Health

Implementation

• Chronic Health is stored as a set of options in CCMDB.mdb
• when sent for import into TMSX the chronic health score is translated into yes or no
• 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.