入院関連機能障害予防システム（HPS)の先駆的導入 : 病院全体の医療の質を高めることを目指した本邦初の取リ組み

摘要

Background: Functional disability, such as gait disturbance and lower extremity muscle atrophy, can develop in hospitalized patients owing to inactivity. This disability can be referred to as "hospitalization-associated disability" (HAD). Although HAD is preventable, no institution in Japan has applied a systematic approach for preventing HAD. Therefore, we developed and applied a system, which we called the HAD Prevention System (HPS), in some departments of our hospital. The purpose of this study was to perform an initial evaluation of the safety and feasibility of the HPS. Subjects and methods: The concept of the HPS is as follows. First, the physicians and nurses of a ward fill out an HPS evaluation sheet for screening "HAD high-risk patients" and submit the completed sheet to physiatrists at the Department of Rehabilitation Medicine. Second, the physiatrists examine the patients identified with screening and order a rehabilitation program to prevent HAD if needed. Third, the rehabilitation program is administered by physical therapists. The HPS evaluation sheet was originally developed on the basis of the results of previous studies investigating risk factors for HAD. Results: From July 1 to November 30, 2013， HPS evaluation sheets were submitted for 426 patients. Of these patients,116 underwent rehabilitation in the early phase of their admissions. In 65% of patients undergoing rehabilitation, the program was started within 5 days of admission and produced no adverse events. Of the patients undergoing rehabilitation, 79% did not have HAD during their hospitalization and 77% returned home after discharge. Conclusion: Our proposed HPS was safely introduced in our hospital and appears to facilitate the early rehabilitation of hospitalized patients. We believe the introduction of this system can improve the quality of a hospital's medical care.%直接的に運動障害をきたさない疾患（たとえば、肺炎、心不全、悪性腫瘍など）で入院した場合であつても、その入院治療に伴う長期の安静臥床によって、歩行障害、下肢·体幹の筋力低下などの機能障害（特に運動障害）が発生することは臨床上よく経験される。このような機能障害は、以前は原因の如何を問わず、まとめて「廃用症候群」と称されていたが、最近では、「入院での安静臥床」を主たる原因とする場合に限り「入院開連機能障害（hospitalization-associateddisability.以下，HAD)」と称されるようになっている(Fig.1)。HADは、全入院患者の30〜40%以上に発症すると報告されており、HADの発症が患者の生活レベルを低下させ、結果として在院日数の延長をももたらすことは想像に難しくない。しかしながら、本邦の病院施設では、現状としてHADの認知度が決して高くはなぐ各診療科·各医師によってその対応•考え方も異なり、「HADが発症してから初めて」機能回復目的でリハビリテーシヨン（以下、リハ）の介入が行われる場合が多い。