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講演資料 - 東京大学医学教育基礎コース

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講演資料 - 東京大学医学教育基礎コース
⮬ᕫ⤂௓
ᆅᇦ䛾デ⒪ᡤ䛻䛚䛡䜛
䝥䝷䜲䝬䝸䞉䜿䜰䛾ホ౯䛾ヨ䜏
-䝥䝷䜲䝬䝸䞉䜿䜰デ⒪䛾ྥୖᨭ᥼䜢┠ᣦ䛧䛶-
2015ᖺ9᭶2᪥
ᮾி኱Ꮫ་Ꮫᩍ⫱䝉䝭䝘䞊
ᯇᮧ་㝔㻌 ᯇᮧ┿ྖ
• 1967ᖺ㻌 ᮾி㒔ୡ⏣㇂༊ୖ㔝ẟ⏕䜎䜜
• 1991ᖺ㻌 ໭ᾏ㐨኱Ꮫ་Ꮫ㒊༞
• ឿᜨ་኱◊ಟ་䚸ᅜ❧ᮾி➨஧⑓㝔⥲ྜデ
⒪⛉䚸ᮾி኱Ꮫ኱Ꮫ㝔
• 䠱䠟䠨䠝⥲ྜෆ⛉/බ⾗⾨⏕኱Ꮫ㝔䝦䝹䝇
䝃䞊䝡䝇Ꮫ⛉
• ᮾி኱Ꮫ་Ꮫᩍ⫱ᅜ㝿༠ຊ◊✲䝉䞁䝍䞊
• 2001ᖺ㻌 ᯇᮧ་㝔㻌 㝔㛗
ᯇᮧ་㝔
• ᮾி㒔ୡ⏣㇂༊
• 1969ᖺ㛤ᴗ
• 2000ᖺ⥅ᢎ
• 㒔ᕷᆺデ⒪ᡤ
– ᶆᴶ䠖ෆ⛉䞉ᑠඣ⛉
– ↓ᗋデ⒪ᡤ
䛔䜟䜖䜛⏫䛾䜅䛴䛖
䛾䛚་⪅䛥䜣㻌 㻌 㻌 㻌
እ㒊⎔ቃ䛾ኚ໬
䑷 Ⲉᮌಖ
ᮏ᪥䛾ෆᐜ
• 㛤Ⓨ䛾⤒⦋
• ྥୖᨭ᥼䛾䛯䜑䛾ヨ䜏
– ᐙᗞ་⒪䛾㉁䝒䞊䝹䝤䝑䜽
– 䝥䝷䜲䝬䝸䜿䜰ໟᣓホ౯䝟䜲䝻䝑䝖஦ᴗ
• ㄢ㢟䛸ᒎᮃ
䛭䜜䛰䛡䛷䛔䛔䛾䠛
䛹䛳䛱䛜Ⰻ䛔㌴䠛
་⒪䛾㉁
• “Quality of care is the degree to which health
services toward individual and population
increase the likelihood of desired health
outcomes and are consistent with current
professional knowledge”
㻌
䝧䞁䝒SL
䝎䜲䝝䝒䝁䝨䞁
㻌 Institute of Medicine 䠄1990䠅
• ་⒪䛾㉁䛸䛿ಶே䛚䜘䜃㞟ᅋ䛻ᑐ䛩䜛་⒪
⾜Ⅽ䛜ᮃ䜎䜜䛯೺ᗣ≧ែ䜢䜒䛯䜙䛩☜⋡䜢
䛒䛢䚸᭱᪂䛾ᑓ㛛▱㆑䛸ྜ⮴䛩䜛ᗘྜ䛔䜢
䛔䛖
• 䛴䜎䜚㐩ᡂྍ⬟䛺┠ᶆ䛻䚸デ⒪䜢䛹䛾⛬ᗘ
㏆䛵䛡䜛䛣䛸䛜䛷䛝䜛䛛䚸䛸䛔䛖䛣䛸
㻌
ᆅᇦ䛾་ᖌ䛸䛧䛶䛾㢪䛔
• 䝥䝷䜲䝬䝸䞉䜿䜰་䛸䛧䛶䚸᪥䚻䛾⮬䜙䛾デ⒪
䜢ྥୖ䛥䛫䜛䚸ᑡ䛺䛟䛸䜒ᚋ㏥䛥䛫䛺䛔䛯䜑䛾
ດຊ䜢䛧䛶䛔䜛་⒪ᶵ㛵䛿䛒䜛䛿䛪
ホ౯䛻㛵䛩䜛䠎䛴䛾どⅬ
ᨵၿⅬ䜢䜏䛴䛡䜛
䛡䜛
ุ᩿ᮦᩱ䛻䛩䜛
• 䛭䛾䜘䛖䛺ດຊ䜢䛧䛶䛔䜛᪋タ䜢ᨭ᥼䛧䛯䛔
• ⤖ᯝ䛸䛧䛶䚸ᝈ⪅䛥䜣/ᆅᇦఫẸ䛾೺ᗣ≧ែ
䛜Ⰻ䛟䛺䜜䜀䛔䛔
ලయⓗ᪉ἲㄽ䛾᳨ウస
ᴗ䜢㛤ጞ㻌 䠄2011ᖺ䠅
ホ౯䛾┠ⓗ䛸≉ᚩ
ホ౯ㄗᕪ䚸
ㄗศ㢮
ᨵၿ䛾䛯䜑䛾ホ౯
ุ᩿䛾䛯䜑䛾ホ౯
チᐜྍ⬟
ᅔ䜛
ᣦᶆ䛾
ᨵゞ䞉ኚ᭦
ᰂ㌾䛻ᑐᛂ
ཧຍ᪋タ䛾
᢬ᢠ
䛒䜎䜚䛺䛔
ᙉ䛔
⮬୺ᛶ䛻ᕥྑ
ᙉ䛔
ᨵၿ䜈䛾
ືᶵ䛵䛡
㣕⾜㊥㞳
㣕ᙧⅬ
䛭䛾௚…
䠄ᯟ⤌䜏䠅㉁ホ౯䛾䠏どⅬ
䠄䝗䝘䝧䝕䜱䜰䞁䝰䝕䝹䠅
ನᡯᴾ
ᢅᆉᴾ
ኽௐᴾ
ἋἚἻἁἓἵὊᴾ
ἩἿἍἋᴾ
ỴỸἚỽἲᴾ
་⒪䛾ᥦ౪యไ㻌
㻌
•デ⒪ᶵჾ䛾᭷↓䞉ᩘ㻌
•ᣦᑟ་䛾ᩘ㻌
•䝇䝍䝑䝣䛾ᩘ㻌
•ཷデཷ௜᫬㛫㻌
ఱ䛜⾜䜟䜜䛯䛛㻌
㻌
•デ᩿䛿ⓗ☜䛛㻌
•἞⒪䛿㐺ษ䛛㻌
•䝣䜷䝻䞊䛿㐺ษ䛛㻌
•グ㘓䛾㐣୙㊊㻌
㻌
㻌
Ᏻᐃ䛜㔜せ
ᝈ⪅䛻ఱ䛜㉳䛣䛳䛯䛛㻌
㻌
•⏕Ꮡ⋡㻌
•ධ㝔⋡㻌
•ྜే⑕Ⓨ⏕⋡㻌
•㠀ணᐃ෌ධ㝔⋡㻌
ᅜ❧䛜䜣◊✲䝉䞁䝍䞊㻌 ᮾᑦᘯඛ⏕㻌 ㅮ⩏䝇䝷䜲䝗䜘䜚
ᅜ❧䛜䜣◊✲䝉䞁䝍䞊㻌 ᮾᑦᘯඛ⏕㻌 ㅮ⩏䝇䝷䜲䝗䜘䜚୍㒊ᨵኚ
12
䝥䝻䝆䜵䜽䝖㛤ጞ䠄2012䠅
• 䜟䛜ᅜ䛾デ⒪ᡤ䛻䛚䛡䜛ྥୖ䛾䛯䜑䛾ᣦᶆ/᪉
ἲㄽ䛾㛤Ⓨ
–
–
–
–
–
䜟䛜ᅜ䛾⌧≧䛻㐺䛧䛯䜒䛾
䝥䝻䝉䝇/䜰䜴䝖䜹䝮ホ౯䜢୺య䛸䛩䜛
ᐈほᛶ䛜㧗䛔䜒䛾
ᐇ⾜ྍ⬟/⌧ᐇⓗ䛺䜒䛾
⌧᫬Ⅼ䛷䛿බ㛤䜢๓ᥦ䛸䛫䛪䚸ෆ㒊䛻䛚䛡䜛ᨵၿ䛾
䛯䜑䛻⏝䛔䜛
• ᖹᡂ24ᖺ-26ᖺᗘᩥ㒊⛉Ꮫ◊✲㈝ຓᡂ㔠䠄ᇶ┙
◊✲䠟䠅䜿䜰Ꮫ
䝥䝷䜲䝬䝸䞉䜿䜰䛾䠑せ⣲
䠝䠖Accessibility䠄㏆᥋ᛶ䠅
䠟䠖Comprehensiveness䠄ໟᣓᛶ䠅
䝥䝷䜲䝬䝸䜿䜰
• Institute of medicine 䠄1997䠅
– 䝥䝷䜲䝬䝸䞉䜿䜰䛸䛿䚸ᝈ⪅䛾ᢪ䛘䜛ၥ㢟䛾኱㒊ศ䛻
㈐௵䜢䜒䛳䛶ᑐฎ䛷䛝䜛ᖜᗈ䛔⮫ᗋ⬟ຊ䜢᭷䛩䜛⮫
ᗋᐙ䛻䜘䛳䛶ᥦ౪䛥䜜䜛䝦䝹䝇䜿䜰䞉䝃䞊䝡䝇䛷䛒䜛䚹
䛭䛾䝦䝹䝇䜿䜰䞉䝃䞊䝡䝇䛿ཷデ䛜䛧䜔䛩䛟䚸⥲ྜⓗ
䛷䛛䛴⥅⥆ⓗ䛷䛒䜚䚸䜎䛯ᐙ᪘䛚䜘䜃ᆅᇦ䜢ど㔝䛻
䛔䜜䛯䜒䛾䛷䛺䛡䜜䜀䛺䜙䛺䛔䚹
• ᪥ᮏ䝥䝷䜲䝬䝸䞉䜿䜰㐃ྜᏛ఍HP
– 䛂ᅜẸ䛾䛒䜙䜖䜛೺ᗣୖ䛾ၥ㢟䚸⑌⑓䛻ᑐ䛧䚸⥲ྜ
ⓗ䞉⥅⥆ⓗ䚸䛭䛧䛶඲ேⓗ䛻ᑐᛂ䛩䜛ᆅᇦ䛾ಖ೺་
⒪⚟♴ᶵ⬟䛸⪃䛘䜙䜜䜎䛩䚹䛃
䜟䛜ᅜ䛾デ⒪ᡤ䛜ᯝ䛯䛩䜉䛝ᆅᇦ䛾
デ⒪ᡤ䛾ᙺ๭䞉ᶵ⬟䛿䠛
• ෆእ䛾ᣦᶆ/ඛ⾜ᩥ⊩䛾ㄪᰝ
• ᴫᛕ䜹䝔䝂䝸䞊䛾ᩚ⌮
• 䝣䜷䞊䜹䝇䜾䝹䞊䝥䜲䞁䝍䝡䝳䞊䠄2013䠅
䠟䠖Coordination䠄༠ㄪᛶ䠅
– 䝥䝷䜲䝬䝸䜿䜰デ⒪䛻ᚑ஦䛩䜛་ᖌ䞉䞉䞉ᇶᖿ⑓㝔䚸୰ᑠ⑓
㝔䚸ᅜಖデ⒪ᡤ䚸㛤ᴗ་䚸䝸䝝䝡䝸䚸ᑠඣ⛉
䠟䠖Continuity䠄⥅⥆ᛶ䠅
– 䝥䝷䜲䝬䝸䜿䜰デ⒪䛻ᚑ஦䛩䜛་⒪䞉௓ㆤ䞉⚟♴
㛵ಀ⫋䠄㠀་ᖌ䠅䞉䞉䞉ᰤ㣴ኈ䚸⸆๣ᖌ䚸ゼၥ┳ㆤ
ᖌ䚸⌮Ꮫ⒪ἲኈ䚸ᆅ᪉་⒪⾜ᨻᐁ䚸ᆅᇦ་⒪㐃
ᦠᐊ䚸䜿䜰䝬䝛䞊䝆䝱䞊
A䠖Accountability䠄㈐௵ᛶ䠅
䠄Institute of Medicine, 1976)
䛣䜜䜙䛾⌮ᛕ䛻ᇶ䛵䛟ᙺ๭䛜ᯝ䛯䛫䛶䛔䜛䛛䠛
⤖ᯝ
㐃ᦠ
ከ⫋✀䛸䛾㐃ᦠ
⑓デ㐃ᦠ䞉デデ㐃ᦠ
⸆ᒁ䛸䛾㐃ᦠ
䝏䞊䝮䝸䞊䝎䞊
ᶆ‽ⓗデ⒪
EBM䞉䜺䜲䝗䝷䜲䞁㑂Ᏺ
ಖ㝤デ⒪䛾㑂Ᏺ
⥅⥆ⓗ䛺▱㆑/ᢏ⾡䛾᭦᪂
ឤᰁண㜵
Quality
Primary
Care
ᝈ⪅⫼ᬒ䛾ᑛ㔜
ᆅᇦ䜈䛾㈉⊩
⏕ά㠃䛾䜰䜴䝖䜹䝮㔜ど
㣗⏕ά䛺䛹䜈䛾㛵୚
㈝⏝䞉⤒῭㠃䜈䛾㓄៖
⮬ᕫ⟶⌮䛾ᨭ᥼
་ᖌ఍άື
ᩆᛴ䞉ఇ᪥ᙜ␒
ᕷẸᩍ⫱
♫఍ᨭ᥼
ᖜᗈ䛔デ⒪
䝁䝰䞁䞉䝕䜱䝆䞊䝈
䛒䜙䜖䜛೺ᗣၥ㢟
୍ḟᩆᛴ
ண㜵་⒪䞉ᑠእ⛉
㧗㱋⪅䜿䜰
䜰䜽䝉䝇
᫬㛫እᑐᛂ
㟁ヰᑐᛂ
ཷデඛ䛾☜ಖ
஧ḟ䜰䜽䝉䝇
䝁䝭䝳䝙䜿䞊䝅䝵䞁
ぶ㏆ឤ䞉ே㛫ᛶ
䜲䞁䝣䜷䞊䝮䝗䝁䞁䝉䞁䝖
䝥䝷䜲䝞䝅䞊䜈䛾㓄៖
ᝈ⪅㑅ዲ䜈䛾㓄៖
⪃ᐹ
• ᖜᗈ䛔デ⒪䞉ᝈ⪅⫼ᬒ䛾⪃៖䞉䜰䜽䝉䝇䞉㐃
ᦠ䞉䝁䝭䝳䝙䜿䞊䝅䝵䞁䛺䛹䛿䚸ඛ⾜◊✲䜔ෆ
እ䛾䜹䝔䝂䝸䞊䛸ඹ㏻䛾䜒䛾䛷䛒䛳䛯䚹
• ᖜᗈ䛔デ⒪䛾䛖䛱䚸㧗㱋⪅䜿䜰䛻㛵䛩䜛䜒䛾
䛜኱䛝䛺㒊ศ䜢༨䜑䛯䚹
• ᆅᇦ䜈䛾㈉⊩䛜䚸䜘䜚᫂☜䛺䜹䝔䝂䝸䞊䛸䛧䛶
ᙧᡂ䛥䜜䛯䚹බඹᛶ䞉බṇᛶ䛸䛧䛶⾲⌧䛥䜜䜛
䜒䛾䛜䚸ᮏ㑥䛷䛿䛂ᆅᇦ䜈䛾㈉⊩䛃䛸䛧䛶ศ㢮
䛥䜜䛶䛔䜛䛛䚹
ᐙᗞ་⒪䛾㉁
デ⒪ᡤ䛷౑䛖䝒䞊䝹䝤䝑䜽
Quality in family practice
Book of Tools
• 䜹䝘䝎䞉䜸䞁䝍䝸䜸ᕞ䛾
ᐙᗞ་⒪デ⒪ᡤ䛾䛯
䜑䛾⥙⨶ⓗ䛺䝒䞊䝹
䝤䝑䜽
• ⮬Ⓨⓗ䛺⥅⥆ⓗ㉁ᨵ
ၿάື䛾䛯䜑䛻⏝䛔䜙
䜜䜛
• ᪥ᮏ䝥䝷䜲䝬䝸䞉䜿䜰㐃
ྜᏛ఍⩻ヂ䝏䞊䝮䛻䜘
䜚㑥ヂ䛜2015ᖺ䛻ฟ∧
䞉䝬䜽䝬䝇䝍䞊኱Ꮫᐙᗞ་⒪⛉䛻
䜘䜚㛤Ⓨ
䞉8䜹䝔䝂䝸䞊䚸70䛾ᣦᶆ
䞉43䛜デ⒪ᡤ⟶⌮䚸27䛜⮫ᗋ
䞉2009ᖺ䛻ฟ∧
Cheryl Levitt
Linda Hilts
http://qualitybookoftools.ca/
䜹䜲᭩ᯘ㻌 2015ᖺ
䜹䝔䝂䝸䞊㡯┠
3WCNKV[$QQMQH6QQNU
+PUVKVWVGQH/GFKEKPG
ᝈ⪅୰ᚰᛶ㻌
ᝈ⪅୰ᚰᛶ㻌
බᖹ䞉බṇᛶ㻌
බᖹ䞉බṇᛶ㻌
㐺᫬ᛶ䛸㏆᥋ᛶ㻌
㐺᫬ᛶ㻌
Ᏻ඲ᛶ㻌
Ᏻ඲ᛶ㻌
ຠᯝⓗ䛺デ⒪㻌
ຠᯝⓗ䛺デ⒪㻌
ຠ⋡ᛶ㻌
ຠ⋡ᛶ㻌
ᣦᶆ䛾౛
C㻌 㐺᫬ᛶ䛸㏆᥋ᛶ
C.1㻌 ㏿䜔䛛䛥䞉䜰䜽䝉䝇䛾Ⰻ䛥
C.2㻌 ᫬㛫እデ⒪䠈ᩆᛴデ⒪
⤫ྜ䜿䜰䛸⥅⥆ᛶ㻌
㐺ษ䛺デ⒪ᡤ䝸䝋䞊䝇㻌
C.1.1.1㻌 㡯┠䛸ゎ㔘
䠟.1㻌 㐺᫬ᛶ䛸㏆᥋ᛶ
• 䠟.1.1
㻌 㻌 ᝈ⪅䛿㟁ヰ䠈䠡䝯䞊䝹䚸䛭䛾௚䛾㟁Ꮚ፹య䛻䜘䛳䛶デ
⒪ᡤ䛻䜰䜽䝉䝇䛷䛝䜛
䞉㻌 䠟.1.2
ᝈ⪅䛿ᚲせ᫬䛻ண⣙䛜䛷䛝䜛
䞉㻌 䠟.1.3
᪂ᝈⓏ㘓䛸䜹䝹䝔䛜㐺᫬䛻฼⏝䛷䛝䜰䜽䝉䝇䜒䜘䛔
䞉㻌 C.1.4
᳨ᰝ䝉䞁䝍䞊䜔ᑓ㛛་䜈䛾⤂௓䛜ᚲせ᫬䛻⾜䜟䜜䛶
䛔䜛㻌
㻌 㻌 ண⣙䜔㐺ษ䛺ຓゝ䚸䝯䝑䝉䞊䝆䜢ṧ䛩䛣䛸䛾䛷䛝䜛ຠ⋡ⓗ䛺㟁
ヰ䝅䝇䝔䝮䚸㟁Ꮚ䝯䞊䝹䛚䜘䜃/䜒䛧䛟䛿௚䛾㟁Ꮚ፹య䛜䛒䜛䚹
㻌
ゎ㔘䠖デ⒪ᡤ⟶⌮⪅䛿௨ୗ䜢グ㏙䛷䛝䜛
• 㟁ヰ䛾䝅䝇䝔䝮䠄ཷ䛡䜛ሙྜ䛸䛛䛡䜛ሙྜ䠅䚸䝪䜲䝇䝯䞊䝹䝯䝑䝉䞊䝆䝅䝇䝔
䝮䛸䛭䛾ᑐᛂ᪉ἲ䚹
• ᝈ⪅䛸䝁䝭䝳䝙䜿䞊䝅䝵䞁䜢䛸䜛䛯䜑䛾㟁Ꮚ䝯䞊䝹䛚䜘䜃/䜒䛧䛟䛿௚䛾㟁Ꮚ
፹య䚹
• ᝈ⪅䛜ண⣙䛺䛧䛷䜒䜿䜰䛻㛵䛩䜛ຓゝ䜔᝟ሗ䜢ᚓ䜛䛣䛸䛜䛷䛝䜛᪉ἲ䚹
䠄౛䠖㟁ヰ䛒䜛䛔䛿㟁Ꮚ፹య䠅
• 㟁ヰ䛒䜛䛔䛿䝯䝑䝉䞊䝆䝅䝇䝔䝮䛾ᨵၿ䛻ᙺ❧䛶䜛䛯䜑䛻䛹䛾䜘䛖䛻ᝈ⪅
䛛䜙䝣䜱䞊䝗䝞䝑䜽䜢ᚓ䚸ά⏝䛩䜛䛛䚹䠄౛䠖ᖺ୍ᅇ䛾ᝈ⪅‶㊊ᗘㄪᰝ䠅
• 䛛䛛䛳䛶䛟䜛㟁ヰ䛻㛵䛧䛶ᐃᮇⓗ䛺䜸䞊䝕䜱䝑䝖䛜⾜䜟䜜䛶䛔䜛䛛䠛䠄ཷヰ
ჾ䜢䛸䜛䜎䛷䛾䝧䝹䛾ᅇᩘ䚸ᛂ⟅䜢ᚅ䛯䛫䛶䛔䛯᫬㛫䚸䛛䛡┤䛧䚸䝯䝑䝉䞊
䝆䛾グ㘓䞉᳨⣴䞉䝣䜷䝻䞊䜰䝑䝥䛾᪉ἲ䠅
䛯䛸䛘䜀ᙜ㝔䛾≧ἣ
ண⣙䜔㐺ษ䛺ຓゝ䚸䝯䝑䝉䞊䝆䜢ṧ䛩䛣䛸䛾䛷䛝䜛ຠ⋡ⓗ䛺㟁
ヰ䝅䝇䝔䝮䚸㟁Ꮚ䝯䞊䝹䛚䜘䜃/䜒䛧䛟䛿௚䛾㟁Ꮚ፹య䛜䛒䜛䚹
㻌
㻌
ᐙᗞ་⒪䛾㉁
デ⒪ᡤ䛷౑䛖䝒䞊䝹䝤䝑䜽
• 䜸䞁䝍䝸䜸་ᖌ఍/䝬䜽
䝬䝇䝍䞊኱Ꮫ䛜㐠Ⴀ䛩
䜛䝥䝻䜾䝷䝮䛷౑⏝
• ໟᣓⓗ/⮬୺ⓗ䝥䝻䜾
䝷䝮
ゎ㔘䠖デ⒪ᡤ⟶⌮⪅䛿௨ୗ䜢グ㏙䛷䛝䜛
• 㟁ヰ䛾䝅䝇䝔䝮䠄ཷ䛡䜛ሙྜ䛸䛛䛡䜛ሙྜ䠅䚸䝪䜲䝇䝯䞊䝹䝯䝑䝉䞊䝆䝅䝇
䝔䝮䛸䛭䛾ᑐᛂ᪉ἲ㻌 ї㻌 䕿
• ᝈ⪅䛸䝁䝭䝳䝙䜿䞊䝅䝵䞁䜢䛸䜛䛯䜑䛾㟁Ꮚ䝯䞊䝹䛚䜘䜃/䜒䛧䛟䛿௚䛾㟁
Ꮚ፹య䚹㻌 ї䕿
• ᝈ⪅䛜ண⣙䛺䛧䛷䜒䜿䜰䛻㛵䛩䜛ຓゝ䜔᝟ሗ䜢ᚓ䜛䛣䛸䛜䛷䛝䜛᪉ἲ
䠄౛䠖㟁ヰ䛒䜛䛔䛿㟁Ꮚ፹య䠅㻌 ї㻌 䕿
• 䜟䛜ᅜ䛷䜒㐠⏝㠃䛷ᕤ
ኵ䛧ヨ㦂ⓗ䛻᥇⏝/ヨ
⏝䛧䛶䛔䜛デ⒪ᡤ䜒
• 㟁ヰ䛒䜛䛔䛿䝯䝑䝉䞊䝆䝅䝇䝔䝮䛾ᨵၿ䛻ᙺ❧䛶䜛䛯䜑䛻䛹䛾䜘䛖䛻ᝈ
⪅䛛䜙䝣䜱䞊䝗䝞䝑䜽䜢ᚓ䚸ά⏝䛩䜛䛛䚹䠄౛䠖ᖺ୍ᅇ䛾ᝈ⪅‶㊊ᗘㄪᰝ䠅㻌
ї㻌 㽢
• 䛛䛛䛳䛶䛟䜛㟁ヰ䛻㛵䛧䛶ᐃᮇⓗ䛺䜸䞊䝕䜱䝑䝖䛜⾜䜟䜜䛶䛔䜛䛛䠛䠄ཷ
ヰჾ䜢䛸䜛䜎䛷䛾䝧䝹䛾ᅇᩘ䚸ᛂ⟅䜢ᚅ䛯䛫䛶䛔䛯᫬㛫䚸䛛䛡┤䛧䚸䝯䝑
䝉䞊䝆䛾グ㘓䞉᳨⣴䞉䝣䜷䝻䞊䜰䝑䝥䛾᪉ἲ䠅㻌 ї㻌 㽢
㛤Ⓨ䝥䝻䝉䝇
㡯┠᳨ウ
ͻ 㡯┠᳨ウ/ᣦᶆೃ⿵཰㞟
ͻ 䝣䜷䞊䜹䝇䜾䝹䞊䝥䠄་⒪⪅䞉ಖ೺⚟♴㛵ಀ⪅䠅
ᣦᶆ㑅ᢥ
ͻ Delphiἲ䜢㏻䛨ྜពᙧᡂ
ͻ ᐇ⾜ྍ⬟ᛶ䞉ጇᙜᛶ䜢᳨ウ䛧㑅ᢥ
䝰䝕䝹஦ᴗ
ͻ 䝺䝉䝥䝖䞉デ⒪㘓䞉ᝈ⪅ㄪᰝ
ͻ ᐇ⾜ྍ⬟ᛶ/⌧ሙ䛾ពぢ䜢㋃䜎䛘ಟṇ
䝕䝹䝣䜯䜲ἲ䛾ὶ䜜
2013ᖺ䠓᭶
ᑓ㛛ᐙ䝯䞁䝞䞊䛾Ỵᐃ
2013ᖺ䠔᭶୰᪪
ᣦᶆ᱌㻌 ㏦௜
2013ᖺ9᭶ึ᪪
➨୍ᅇホⅬ䠇㞟ィ
2013ᖺ9᭶22᪥
䝁䞁䝉䞁䝃䝇఍㆟
2013ᖺ10᭶୰᪪
➨஧ᅇホⅬ䠇㞟ィ
2013ᖺ11᭶୰᪪
ពぢ㞟⣙
2013ᖺ12᭶
ᣦᶆ㡯┠㻌 Ỵᐃ
ໟᣓⓗ㉁ᣦᶆ䛾సᡂ
• 㡯┠ೃ⿵䛾సᡂ
– ඛ䛻సᡂ䛥䜜䛯䜹䝔䝂䝸䞊䛤䛸䚸ඛ⾜ᩥ⊩䛸⌧ሙ䛾▱ぢ䜢
䜒䛸䛻㡯┠ೃ⿵䜢సᡂ䚹
– 䝕䞊䝍※䜢䐟䝺䝉䝥䝖㻌 䐠デ⒪㘓㻌 䐡ᝈ⪅䝃䞊䝧䜲㻌 䐢ᐇ
ᆅㄪᰝ/⮬ᕫホ౯䛻ᩚ⌮䚹
• 㡯┠㑅ᐃ䠖䠱䠟䠨䠝/䠮䠝䠪䠠䛾Delphiኚἲ
– ஦๓䛾༏ྡㄪᰝ䛚䜘䜃1ᅇ䛾ᑐ㠃ᘧ᳨ウ఍䠄䝁䞁䝉䞁䝃䝇
఍㆟䠅䛚䜘䜃஦ᚋホ౯
• ୰ኸ್䠓䚸䛒䜛䛔䛿ពぢ䛻೫䜚䛜䜏䜙䜜䜛䜒䛾䛿୰ኸ್8௨ୖ䜢㑅
ᐃᇶ‽䛸タᐃ䚹
• ᐇ⾜ྍ⬟ᛶ䜢୰ᚰ䛸䛧䛯஧ḟ㑅ᐃ
– ጇᙜᛶホ౯䜢⤒䛯㡯┠䛛䜙ᐇ⾜ྍ⬟ᛶ䜢᳨ウ䛧䚸᭱⤊㡯
┠᱌䜢⟇ᐃ䚹
䝟䝛䝹ᑓ㛛ᐙ
• ᪥ᖖ䛾䝥䝷䜲䝬䝸䜿䜰デ⒪䛾ᐇ㝿䜢⇍▱
• ᛶู䚸デ⒪ᙧែ䚸デ⒪ᆅᇦ䚸⮫ᗋ⤒㦂䛾Ⅼ
䛷೫䜚䛜䛺䛔䜘䛖ᣍ⪸
• ་ᖌ10ྡ䛷ᵓᡂ
• ୍㒊㡯┠䛻䛴䛔䛶䛿㛵㐃⫋✀䠄ゼၥ┳ㆤ䞉
௓ㆤ䞉⸆๣ᖌ䠅䛜ྛ1ྡ䛪䛴ཧຍ
᭱⤊䜹䝔䝂䝸䞊
⤖ᯝ
• ஦๓タᐃᇶ‽䛻฿㐩䠖㻌 70㡯┠/159㡯┠
– 䐟ᖜᗈ䛔デ⒪㻌 32/58䚸䐠䜰䜽䝉䝇㻌 3/13㻌 䐡䝁䝭䝳䝙
䜿䞊䝅䝵䞁㻌 9/15䚸䐢㐃ᦠ-15/29䚸䐣ᆅᇦ㈉⊩㻌 0/17䚸
䐤ᝈ⪅⫼ᬒ䛾⪃៖㻌 4/12䚸䐥ᶆ‽ⓗデ⒪㻌 7/15䛷
䛒䛳䛯䚹
• ୍㒊䜹䝔䝂䝸䞊䛻䛴䛔䛶䛿ᇶ‽䜢⦆䜑䠄୰ኸ್䠓
௨ୖ䠅෌㑅ᐃ䚸䛭䛾ୖ䛷ᐇ⾜ྍ⬟ᛶ䜢㋃䜎䛘᳨
ウ䚹
• ᭱⤊ⓗ䛻42㡯┠䜢᥇⏝䚹
• ᥇⏝㡯┠ᩘ䛾ᑡ䛺䛛䛳䛯䛂ᶆ‽ⓗデ⒪䛃䠄2㡯┠䠅
䛿䚸䛂ᖜᗈ䛔デ⒪䛃䛸䜹䝔䝂䝸䞊䜢⤫୍䛧䛯䚹
ᖜᗈ䛔デ⒪/
ᶆ‽ⓗデ⒪
䠄20㡯┠䠅
䝁䝰䞁䞉䝕䜱䝆䞊䝈
ண㜵་⒪
㧗㱋⪅䜿䜰
䠡䠞䠩/䜺䜲䝗䝷䜲䞁㑂Ᏺ
㐃ᦠ
䠄5㡯┠䠅
ከ⫋✀䛸䛾㐃ᦠ
⑓デ㐃ᦠ䞉デデ㐃ᦠ
䝏䞊䝮䝸䞊䝎䞊
Quality
Primary
Care
ᝈ⪅⫼ᬒ䛾ᑛ㔜
䠄6㡯┠䠅
⏕ά㠃䛾䜰䜴䝖䜹䝮㔜ど
㣗⏕ά䛺䛹䜈䛾㛵୚
㈝⏝䞉⤒῭㠃䜈䛾㓄៖
⮬ᕫ⟶⌮䛾ᨭ᥼
་ᖌ఍άື
ᩆᛴ䞉ఇ᪥ᙜ␒
ᕷẸᩍ⫱
♫఍ᨭ᥼
ෆᐜ
䝕䞊䝍※
ᖜᗈ䛔デ⒪
䠋ᶆ‽ⓗデ⒪
20
ႚ↮Ṕ䞉⚗↮἞⒪䞉⫵⅖⌫⳦䝽䜽䝏䞁䞉ㄆ
▱⑕䞉㢌③䞉⭡③䞉㧗⾑ᅽ䞉⢾ᒀ⑓䞉Ẽ⟶ᨭ
ႍᜥ䞉៏ᛶ⑌ᝈᝈ⪅䜈䛾ฎ᪉䞉ஙඣண㜵
᥋✀䞉௚㝔㏻㝔Ṕ䠋䛚⸆ᡭᖒ䛾☜ㄆ
䝺䝉䝥䝖3
デ⒪㘓15
ᝈ⪅䝃䞊䝧䜲2
䜰䜽䝉䝇
3
᫬㛫እᑐᛂ
⌧ᅾ἞⒪୰䛾⑌ᝈ௨እ䜈䛾ᑐᛂ
ᝈ⪅䝃䞊䝧䜲3
䝁䝭䝳䝙䜿䞊䝅䝵䞁
8
ᝈ⪅ពぢ䛾ᑛ㔜䚸⸆䛾ㄝ᫂䚸䝥䝷䜲䝞 ᝈ⪅䝃䞊䝧䜲8
䝅䞊䜈䛾㓄៖䚸ぶ㏆ឤ䚸ㄔᐇ䛺ᑐᛂ
㐃ᦠ
5
デ⒪᝟ሗᥦ౪᭩䞉䜿䜰䝬䝛䝆䝱䞊䛾ྠ デ⒪㘓2
ᐃ䚸ᑓ㛛་㑅ᢥ䜈䛾ᡭຓ䛡㻌
ᝈ⪅䝃䞊䝧䜲3
ᝈ⪅⫼ᬒ䛾⪃៖
6
ྠᒃᐙ᪘䛾᭷↓䚸㈝⏝㈇ᢸ䛾⪃៖䚸
ᙺ๭䛾⌮ゎ䚸ᆅᇦ⎔ቃ䜈䛾㓄៖䛺䛹
デ⒪㘓1
ᝈ⪅䝃䞊䝧䜲5
ᣦ㻌 㻌 ᶆ
ႚ↮Ṕ
20ṓ௨ୖ䛾䛩䜉䛶䛾ᝈ⪅䛾㐣ཤ1ᖺ௨ෆ䛾ႚ↮Ṕ
䛜デ⒪㘓䛻グ㍕䛥䜜䛶䛔䜛
⚗↮἞⒪
ႚ↮ᝈ⪅䛻ᑐ䛧䛶䚸㐣ཤ24䜹᭶௨ෆ䛻⚗↮἞⒪䛜
㛤ጞ䛥䜜䛶䛔䜛䚸䛒䜛䛔䛿⚗↮἞⒪䛜ᥦ♧䛥䜜䛯䛣
䛸䛜デ⒪㘓䛻グ㍕䛥䜜䛶䛔䜛
⫵⅖⌫⳦䝽䜽䝏䞁
65ṓ௨ୖ䛾䛩䜉䛶䛾ᝈ⪅䛻䛴䛔䛶䚸5ᖺ䛤䛸䛻⫵⅖
⌫⳦䝽䜽䝏䞁᥋✀䛾グ㍕䛜䛒䜛䛛䚸ཷデṔ䛜5ᖺ䛻
‶䛯䛺䛔ሙྜ䛻䛿䚸㐣ཤ5ᖺ௨ෆ䛾⫵⅖⌫⳦䝽䜽䝏
䞁᥋✀Ṕ䛾グ㍕䛜䛒䜛
ㄆ▱⑕ᝈ⪅䛾
௓ㆤ⪅ྠᐃ
䠄8㡯┠䠅
ぶ㏆ឤ䞉ே㛫ᛶ
䜲䞁䝣䜷䞊䝮䝗䝁䞁䝉䞁䝖
䝥䝷䜲䝞䝅䞊䜈䛾㓄៖
ᝈ⪅㑅ዲ䜈䛾㓄៖ 32
75ṓ௨ୖ䛾䚸䝺䝉䝥䝖䛻䛚䛔䛶ㄆ▱⑕䠄␲䛔ྵ䜐䠅
䛾⑓ྡ䛜௜䛔䛶䛔䜛ᝈ⪅䛻䛴䛔䛶䚸୺䛯䜛௓ㆤ⪅
䛜ㄡ䛷䛒䜛䛛ྠᐃ䛥䜜䚸㐣ཤ1ᖺ௨ෆ䛾デ⒪㘓䛻
グ㍕䛥䜜䛶䛔䜛
ᣦ㻌 㻌 ᶆ
㝆ᅽ฼ᒀ๣ᢞ୚ᝈ⪅
䜈䛾๪స⏝䝏䜵䝑䜽
㝆ᅽ฼ᒀ๣ᢞ୚䛜1ᖺ௨ୖ⾜䜟䜜䛶䛔䜛ᝈ⪅
䛻䛴䛔䛶䚸㐣ཤ1ᖺ㛫䛻䚸䜹䝸䜴䝮䞉䜽䝺䜰䝏䝙䞁䚸
⬡㉁䝥䝻䝣䜯䜲䝹(Tcho,HDL,LDL,TG 䛾䛔䛪
䜜䛛3䛴) 䛜⾜䜟䜜䛶䛔䜛
⢾ᒀ⑓ᝈ⪅䛾
ᒀ䛯䜣䜁䛟 ᐃ
⢾ᒀ⑓䛾㏻㝔ᝈ⪅䛷䚸⢾ᒀ⑓⸆䛜ฎ᪉䛥䜜䛶
䛔䛺䛔ᝈ⪅䛻䛴䛔䛶䚸᭱㏆1ᖺ㛫䛷ᒀ䛯䜣䜁䛟
䠄䜒䛧䛟䛿㝶᫬ᒀ䜰䝹䝤䝭䞁䠅䛜 ᐃ䛥䜜䛶䛔䜛
ႍᜥᝈ⪅䜈䛾
྾ධ䝇䝔䝻䜲䝗ᑟධ
ǃ2่⃭๣䜢㐃᪥⏝䛔䛶䛔䜛ᡂேẼ⟶ᨭႍᜥᝈ
⪅䛻䛴䛔䛶䚸䝁䞁䝖䝻䞊䝷䞊䛸䛧䛶྾ධ䝇䝔䝻䜲
䝗䛜ᑟධ䛥䜜䛶䛔䜛
ホ౯ᣦᶆ䠖౛䠄ᝈ⪅䝃䞊䝧䜲䠅㻌
ホ౯ᣦᶆ䠖౛䠄デ⒪㘓䠅
㡯㻌 ┠
䝁䝭䝳䝙䜿䞊䝅䝵䞁
デ⒪ᣦᶆ䠖౛䠄䝺䝉䝥䝖䠅
㡯㻌 ┠
㡯┠ᩘ
䠄3㡯┠䠅
᫬㛫እᑐᛂ
㟁ヰ䞉FAXᑐᛂ
ཷデඛ䛾☜ಖ
ᆅᇦ䜈䛾㈉⊩
᭱⤊㡯┠
䜹䝔䝂䝸䞊
䜰䜽䝉䝇
ஙඣ䛾ண㜵᥋✀Ṕ䛾 䛣䛾デ⒪ᡤ䛷䛿䚸ẕᏊᡭᖒ䜢⏝䛔䛶ண㜵᥋✀䛾
☜ㄆ
グ㘓䜢䛹䛾⛬ᗘ☜ㄆ䛧䛶䛔䜎䛩䛛
䛣䛾デ⒪ᡤ䛾་⒪䝇䝍䝑䝣䛿䚸䛒䛺䛯䛾௚㝔䜈䛾
௚㝔䜈䛾㏻㝔Ṕ䛚䜘
㏻㝔Ṕ䛚䜘䜃䛚⸆ᡭᖒ䛾ෆᐜ䛻䛴䛔䛶☜ㄆ䛧䛶
䜃䛚⸆ᡭᖒ䛾☜ㄆ
䛔䜎䛩䛛
᫬㛫እᑐᛂ
デ⒪᫬㛫እ䛻ලྜ䛜ᝏ䛟䛺䛳䛯ሙྜ䚸䛹䛾䜘䛖䛻
ᑐᛂ䛩䜜䜀䜘䛔䛛䛻䛴䛔䛶䚸䛒䛺䛯䛿䛹䛾⛬ᗘ
▱䛳䛶䛔䜎䛩䛛
⌧ᅾ἞⒪୰௨እ䛾
⑌ᝈ䛾┦ㄯ
㐣ཤ୍ᖺ㛫䛻䚸⌧ᅾ἞⒪୰䛾⑓Ẽ௨እ䛷䛒䛺䛯
䛻ఱ䛛೺ᗣୖ䛾ၥ㢟䛜⏕䛨䛯䛸䛝䚸䛣䛾デ⒪ᡤ䛻
┦ㄯ䛧䜎䛧䛯䛛
᫬㛫እ䛾ᝈ⪅グ㘓
䜈䛾䜰䜽䝉䝇
䛒䛺䛯䛿䚸䛒䛺䛯䛜⌧ᅾ㣧䜣䛷䛔䜛⸆䚸๪స⏝䞉䜰
䝺䝹䜼䞊䛾グ㘓䚸䛣䜜䜎䛷䛛䛛䛳䛯⑓Ẽ䜔䛡䛜䛾
グ㘓䜢䛚ᣢ䛱䛷䛩䛛
⪃ᐹ
䝰䝕䝹஦ᴗ
• 䛂ᆅᇦ䜈䛾㈉⊩䛃䜹䝔䝂䝸䞊䛿䚸᥇⏝䛥䜜䛯㡯
┠䠄4㡯┠䠅䛿ᐇᆅㄪᰝ/⮬ᕫホ౯䛜ከ䛟䚸᭱
⤊㡯┠䛸䛧䛶䛿㑅ᐃ䛥䜜䛺䛛䛳䛯䚹
• ᖜᗈ䛔デ⒪/ᶆ‽ⓗデ⒪䛿䝺䝉䝥䝖䞉デ⒪㘓
ㄪᰝ䛜୺䛺䝕䞊䝍※䛷䛒䜛䚹
• ໭ᾏ㐨ᆅᇦ䛾ྠ୍ἲே䛻䛚䛡䜛䠒デ⒪ᡤ䠄㒔
ᕷ㒊䞉୰ᑠ㒔ᕷ䞉䜈䛝ᆅ䠅䛻䛶ᐇ᪋
• 2014ᖺ8᭶͸10᭶
• 䝺䝉䝥䝖䞉デ⒪㘓䞉ᝈ⪅ㄪᰝ䜢ྠ᫬ᐇ᪋
• 䝁䝭䝳䝙䜿䞊䝅䝵䞁䚸䜰䜽䝉䝇䛻㛵䛩䜛ᣦᶆ䛿
䛩䜉䛶䛜ᝈ⪅䝃䞊䝧䜲䛜䝕䞊䝍※䛷䛒䜛䚹
– 䝺䝉䝥䝖䠖㐣ཤ1ᖺ䠄ᅾᏯᝈ⪅䜢㝖䛟䠅
– デ⒪㘓䠖デ⒪ᡤෆ䛷⫋ဨ䛜ᑐ㇟ᝈ⪅䜢ᥦ♧䞉㜀
ぴ䚸⤖ᯝ䜢ㄪᰝ⪅䠄┳ㆤᖌ䠅䛜㌿グ
– ᝈ⪅ㄪᰝ䠖ㄪᰝᮇ㛫䠄1㐌㛫䠅䛻᮶㝔䛧䛯ᝈ⪅䛻
㓄ᕸ䞉ᅇ཰䜢౫㢗
⤖ᯝ
⤖ᯝ䠄౛䠅ႚ↮Ṕ
• 䝺䝉䝥䝖ㄪᰝ䠖㝔እฎ᪉䛾䛯䜑⸆๣ྡ䛜୙᫂䛷
䛒䜚䛩䜉䛶䛜デ⒪㘓ㄪᰝ䛸䛺䜛
• デ⒪㘓ㄪᰝ
– ୺἞་ពぢ᭩䛾ಖ⟶䞉ᵝᘧ䛜ᆅᇦ䛤䛸䛻␗䛺䜛䛯䜑
1᪋タ䛾䜏䛷᩿ᛕ
– 䠍᪋タ䛒䛯䜚4͸5᪥䛾ㄪᰝᮇ㛫
– 2᪋タ䛷䛿2㡯┠䛾ㄪᰝ䜢᩿ᛕ
– 2᪋タ䛿ୖ㝈10ྡ䛸䛩䜛
㡯┠䢢
ႚ↮Ṕ㻌
• ᝈ⪅ㄪᰝ
ᢳฟㄪ ධຊ䢢
デ⒪ᡤ䢢 ᰝᑐ㇟ 傽僅䢢 ศẕ䢢 ศᏊ䢢
ᝈ⪅䢢 ᝈ⪅䢢
ᣦᶆ䢢
㻞㻜ṓ௨ୖ䛾䛩
䜉䛶䛾ᝈ⪅䛾
㐣ཤ㻝ᖺ௨ෆ
䛾ႚ↮Ṕ䛜デ
⒪㘓䛻グ㍕䛥
䜜䛶䛔䜛㻌
䢧䢢
䣕䣇䢢
䢻䢷䢧䣅䣋䢢
A
㻝㻜㻜㻌
㻢㻢㻌
㻢㻜㻌
㻝㻟㻌
㻞㻝㻚㻣㻌㻌 㻜㻚㻜㻡㻌
㻜㻚㻝㻞㻌
㻜㻚㻟㻠㻌
B
㻝㻜㻜㻌
㻝㻜㻜㻌
㻝㻜㻜㻌
㻞㻣㻌
㻞㻣㻚㻜㻌㻌 㻜㻚㻜㻠㻌
㻜㻚㻝㻥㻌
㻜㻚㻟㻣㻌
C
㻤㻞㻌
㻤㻞㻌
㻤㻞㻌
㻝㻟㻌
㻝㻡㻚㻥㻌㻌 㻜㻚㻜㻠㻌
㻜㻚㻜㻥㻌
㻜㻚㻞㻢㻌
D
㻝㻜㻜㻌
㻝㻜㻜㻌
㻝㻜㻜㻌
㻞㻢㻌
㻞㻢㻚㻜㻌㻌 㻜㻚㻜㻠㻌
㻜㻚㻝㻤㻌
㻜㻚㻟㻢㻌
E
䞊㻌
㻣㻌
㻣㻌
㻡㻌
㻣㻝㻚㻠㻌㻌 㻜㻚㻝㻣㻌
㻜㻚㻞㻥㻌
㻜㻚㻥㻢㻌
F
䞊㻌
㻡㻌
㻡㻌
㻟㻌
㻢㻜㻚㻜㻌㻌 㻜㻚㻞㻞㻌
㻜㻚㻝㻡㻌
㻜㻚㻥㻡㻌
– ᅇ⟅⪅䛿18ྡ䡚131ྡ䛸኱䛝䛺䜀䜙䛴䛝
⤖ᯝ䠄౛䠅ႚ↮Ṕ
㡯┠䢢
ᣦᶆ䢢
㻢㻡ṓ௨ୖ䛾䛩
䜉䛶䛾ᝈ⪅䛻
䛴䛔䛶䚸㻡ᖺ䛤
䛸䛻⫵⅖⌫⳦
䝽䜽䝏䞁᥋✀
䛾グ㍕䛜䛒䜛
⫵⅖⌫⳦
䛛䚸ཷデṔ䛜
䝽䜽䝏䞁㻌
㻡ᖺ䛻‶䛯䛺
䛔ሙྜ䛻䛿䚸
㐣ཤ㻡ᖺ௨ෆ
䛾⫵⅖⌫⳦䝽
䜽䝏䞁᥋✀Ṕ
䛾グ㍕䛜䛒䜛㻌
ᢳฟㄪ ධຊ䢢
デ⒪ᡤ䢢 ᰝᑐ㇟ 傽僅䢢 ศẕ䢢 ศᏊ䢢
ᝈ⪅䢢 ᝈ⪅䢢
A
㻝㻜㻜㻌
㻝㻜㻜㻌
㻝㻜㻜㻌
㻠㻌
⤖ᯝ䠄౛䠅ႚ↮Ṕ
䢧䢢
䣕䣇䢢
㻠㻚㻜㻌㻌
㻜㻚㻜㻞㻌
䢻䢷䢧䣅䣋䢢
㻜㻚㻜㻝㻌
㡯┠䢢
ᣦᶆ䢢
㻜㻚㻝㻜㻌
B
㻝㻜㻜㻌
㻝㻜㻜㻌
㻥㻝㻌
㻥㻌
㻥㻚㻥㻌㻌
㻜㻚㻜㻟㻌
㻜㻚㻜㻡㻌
㻜㻚㻝㻤㻌
C
㻝㻜㻜㻌
㻝㻜㻜㻌
㻝㻜㻜㻌
㻝㻌
㻝㻚㻜㻌㻌
㻜㻚㻜㻝㻌
㻜㻚㻜㻜㻌
㻜㻚㻜㻡㻌
D
㻝㻜㻜㻌
㻝㻜㻜㻌
㻥㻤㻌
㻠㻌
㻠㻚㻝㻌㻌
㻜㻚㻜㻞㻌
㻜㻚㻜㻝㻌
㻜㻚㻝㻜㻌
E
㻝㻜㻜㻌
㻝㻜㻌
㻝㻜㻌
㻜㻌
㻜㻚㻜㻌㻌
㻜㻚㻜㻜㻌
㻜㻚㻜㻜㻌
㻜㻚㻟㻝㻌
F
㻝㻜㻜㻌
㻝㻜㻌
㻝㻜㻌
㻜㻌
㻜㻚㻜㻌㻌
㻜㻚㻜㻜㻌
㻜㻚㻜㻜㻌
㻜㻚㻟㻝㻌
㻣㻡ṓ௨ୖ䛾䚸
䝺䝉䝥䝖䛻䛚䛔
䛶ㄆ▱⑕䠄␲䛔
ྵ䜐䠅䛾⑓ྡ
䛜௜䛔䛶䛔䜛
ㄆ▱⑕ᝈ
ᝈ⪅䛻䛴䛔䛶䚸
⪅䛾௓ㆤ
୺䛯䜛௓ㆤ⪅
⪅ྠᐃ㻌
䛜ㄡ䛷䛒䜛䛛
ྠᐃ䛥䜜䚸㐣ཤ
㻝ᖺ௨ෆ䛾デ
⒪㘓䛻グ㍕䛥
䜜䛶䛔䜛㻌
ᢳฟㄪ ධຊ䢢
デ⒪ᡤ䢢 ᰝᑐ㇟ 傽僅䢢 ศẕ䢢 ศᏊ䢢
ᝈ⪅䢢 ᝈ⪅䢢
䢧䢢
䣕䣇䢢
䢻䢷䢧䣅䣋䢢
A
㻠㻠㻌
㻝㻜㻌
㻝㻜㻌
㻤㻌
㻤㻜㻚㻜㻌㻌
㻜㻚㻝㻟㻌
㻜㻚㻠㻠㻌
㻜㻚㻥㻣㻌
B
㻞㻜㻌
㻞㻜㻌
㻝㻣㻌
㻝㻟㻌
㻣㻢㻚㻡㻌㻌
㻜㻚㻝㻜㻌
㻜㻚㻡㻜㻌
㻜㻚㻥㻟㻌
C
㻡㻡㻌
㻡㻡㻌
㻟㻞㻌
㻠㻌
㻝㻞㻚㻡㻌㻌
㻜㻚㻜㻢㻌
㻜㻚㻜㻠㻌
㻜㻚㻞㻥㻌
D
㻞㻝㻌
㻞㻝㻌
㻞㻜㻌
㻞㻌
㻝㻜㻚㻜㻌㻌
㻜㻚㻜㻣㻌
㻜㻚㻜㻝㻌
㻜㻚㻟㻞㻌
E
㻠㻤㻌
㻝㻞㻌
㻝㻜㻌
㻝㻌
㻝㻜㻚㻜㻌㻌
㻜㻚㻜㻥㻌
㻜㻚㻜㻜㻌
㻜㻚㻠㻡㻌
F
㻠㻠㻌
㻝㻜㻌
㻝㻜㻌
㻤㻌
㻤㻜㻚㻜㻌㻌
㻜㻚㻝㻟㻌
㻜㻚㻠㻠㻌
㻜㻚㻥㻣㻌
⤖ᯝ䠄౛䠅䠖ᝈ⪅ㄪᰝ
⤖ᯝ䠖デ⒪ᡤ⟶⌮⪅䜲䞁䝍䝡䝳䞊
䛣䛾デ⒪ᡤ䛷䛿䚸೺ᗣ䛻䛴䛔䛶䛺䜣䛷䜒┦ㄯ䛩䜛䛣䛸䛜䛷
䛝䜛䛸ᛮ䛔䜎䛩䛛䚹䠄䠂䠅
A
11.1
B
6.3
C
D
12.9
E
9.9
F
(n=124)
26.6
58.9
34.6
53.1
(n=81)
29.8
63.2
5.3
(n=18)
38.9
55.6
5.6
(n=63)
25.4
66.7
䛭䛖ᛮ䜟䛺䛔
䛒䜎䜚䛭䛖ᛮ䜟䛺䛔
䛭䛖ᛮ䛖
኱ኚ䛭䛖ᛮ䛖
䛂஦ົ䛾䚸ཷ௜䛻䛔䜛䝇䝍䝑䝣䛜䛱䜗䛳䛸ᡭ㛫䛜䛛
䛛䛳䛯䛛䛺䚸䛸ᛮ䛖䜣䛷䛩䛡䛹䚸൅䜙䛿䜋䛸䜣䛹㈇
ᢸ䛺䛧䛷䛷䛝䛯䛾䛷䚸኱ኚ䛒䜚䛜䛯䛛䛳䛯䛷䛩䚹䛃
(n=18)
22.2
66.7
• デ⒪㠃䜈䛾ᙳ㡪䛿ᑡ䛺䛔
(n=57)
• ⤖ᯝ䛿ཷ䛡Ṇ䜑䜙䜜䜛
㻌 䛂඲య䛸䛧䛶䛿䚸䛣䛖䛔䛖䜅䛖䛻ホ౯䛧䛶䛔䛯䛰
䛡䛶䜛䛾䛛䛺䛳䛶䛔䛖䜅䛖䛻䛿ᛮ䛔䜎䛩䚹䛃
• ୍㒊㡯┠䜈䛾ពぢ
– 䝃䝬䝸䞊䝅䞊䝖䠄ู⥛䛨᝟ሗ䠅
䛹䛱䜙䛸䜒䛔䛘䛺䛔
⤖ᯝ䠄౛䠅䠖ᝈ⪅ㄪᰝ
⪃ᐹ
ᙜデ⒪ᡤ䛜䚸䛣䛾䜘䛖䛺
䜰䞁䜿䞊䝖䜢ᐃᮇⓗ䛻䛩
䜛䛣䛸䛿ዲ䜎䛧䛔䛣䛸䛰䛸
ᛮ䛔䜎䛩䛛䚹
ᙜデ⒪ᡤ䛜䚸デ⒪ෆᐜ䛻
䛴䛔䛶ᐃᮇⓗ䛻እ㒊䛛䜙
ホ౯䜢ཷ䛡䜛䛣䛸䛿ዲ䜎
䛧䛔䛣䛸䛰䛸ᛮ䛔䜎䛩䛛䚹
4.7
27.3
23.1
49
59.3
䛭䛖ᛮ䜟䛺䛔
䛒䜎䜚䛭䛖ᛮ䜟䛺䛔
䛭䛖ᛮ䛖
䛸䛶䜒䛭䛖ᛮ䛖
16.4
(n=341)
12.6 (n=334)
䛹䛱䜙䛸䜒䛔䛘䛺䛔
• デ⒪ᡤ䛜ᥦ౪䛩䜛䝥䝷䜲䝬䝸䞉䜿䜰䛻䛴䛔䛶
௒ᅇ䛾᪉ἲ䛷䛾ホ౯䛸䝣䜱䞊䝗䝞䝑䜽䛿ᐇ⾜
ྍ⬟䛷䛒䜛
• 䛣䜜䜙䛾άື䛾ጇᙜᛶ䛻䛴䛔䛶䛿䚸ᴫ䛽デ
⒪ᡤ⟶⌮⪅䛻䛿ྠព䜢ᚓ䜙䜜䛯
• ᝈ⪅䛿䛣䜜䜙䛾άື䜢ዲពⓗ䛻䛸䜙䛘䛶䛔䛯
• 䛣䜜䜙䛾సᴗ䛻䛿୍ᐃ䛾᫬㛫䛸ປຊ䛜ᚲせ
䛷䛒䜛
ㄢ㢟
ᝈ⪅‶㊊䛸ᢏ⾡ⓗ䛺㉁
᧙̞ƳƠ
• 䛂ᆅᇦ㈉⊩䛃䛾䜹䝔䝂䝸䞊䛻䛴䛔䛶䛿䛥䜙䛺䜛
᳨ウ䛜ᚲせ
• ຠ⋡ᛶ䛻ၥ㢟䛒䜚䚸䛸䜚䜟䛡デ⒪㘓ㄪᰝ䛻䛚
䛡䜛᫬㛫ⓗ/ᢏ⾡ⓗᅔ㞴
• ᝈ⪅ㄪᰝ䛾䜏䛷䛿䛭䛾᭷ຠᛶ䛻㝈⏺
धᎍƷᚸ̖
• ホ౯㡯┠䛻䛴䛔䛶䛿䛥䜙䛺䜛ᨵኚ䞉㏣ຍ䛜ᚲ
せ
ǘƣƔƴ᧙̞ƋǓ
100
ᢏ⾡ⓗ䛺㉁䠄䝇䝁䜰䠅
ホ౯άື䛻䛴䛔䛶
90
80
70
60
50
২ᘐႎƳᚮၲƷឋ
᭱ప
1/4
㻌㻌㻌
1/4
㻌㻌
1/4
᭱㧗
1/4
धᎍ฼ឱࡇ᪯Ტ၏ᨈᲣ
Acute Myocardial Infarction
Congestive Heart Failure
Pneumonia
Chang et al. Annals of Int Med 2006:665-672
Jha et al. NEJM 2008:1921-31.
ᅜ❧䛜䜣◊✲䝉䞁䝍䞊㻌 ᮾᑦᘯඛ⏕㻌 ㅮ⩏䝇䝷䜲䝗䜘䜚
௒ᚋ䛾ᒎᮃ
• 㐠⏝㠃䛷䛾ᨵၿ
– ホ౯సᴗ䚸䛸䛟䛻デ⒪㘓ホ౯䛻䛚䛡䜛ᨵၿ
– 䛣䛸䛺䜛䝥䝷䝑䝖䝣䜷䞊䝮䛷䛾సᴗ
• ⥅⥆䛧䛶ᐇ᪋䛻䛴䛺䛢䜛䛯䜑䛾᪉⟇
• ᆅᇦ㈉⊩䚸ᅾᏯデ⒪䚸㐃ᦠ䛻㛵䛩䜛ホ
౯᪉ἲ䛾㛤Ⓨ
• ྥୖᨭ᥼䜢䛹䛖䛩䜛䛛䠋⏕ᾭᏛ⩦䛸䛾䝸䞁䜽
䛤Ύ⫈䛒䜚䛜䛸䛖䛤䛦䛔䜎䛧䛯
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