Chronic Disease SelfManagement Program

1
Sponsored by The National Council on the Aging
and CareSource
Healthy Aging Briefing Series
Chronic Disease Self-Management Program
WELCOME
This session will begin promptly at 130pm
ESTPlease mute your phonePersonal
introductions are not necessaryThe moderator
will be on the line shortly
2
Partners on the P.A.T.H.(Personal Action
Toward Health)Chronic Disease Self-Management
Program
Health Aging Briefing Series

• November 16, 2006
• Bonnie Hafner RN, BSN
• Area Agency on Aging of Western Michigan

3
Partners on the P.A.T.H.Chronic Disease
Self-Management

• Session Objectives
• Outline the core component of the Stanford
  Chronic Disease Self-Management Program
• Discuss a model for implementation in the
  community
• Review program and participant outcomes

4
Chronic Disease The Scope of the Problem

• Chronic Disease is the leading cause of death and
  disability among Americans and accounts for 70
  of all deaths in the US
• 87 of persons aged 65 and over have at least one
  chronic condition 67 have two or more
• 25 of the senior population with chronic
  conditions are limited in their ability to
  perform activities of daily living as a result of
  these conditions
• 99 of Medicare Spending is on behalf of
  beneficiaries with at least one chronic
  condition.

5
What is a Self-Management Program?

• Self-Management Education
• Participant learns how to act on problems
• Participant learns how to identify problems
• Participant learns how to generate short-term
  action plan
• Participant learns problem-solving skills
  related to
• chronic conditions in general

6
Partners on the P.A.T.H. (Stanford Model of CDSM)

• Series of 6 sessions, 1 session per week, 2-1/2
  hours per session held in community settings
• Highly scripted designed to be lay-led two
  leaders facilitate each class. Ideally, at least
  one facilitator also has a chronic condition.
  Peer modeling is a core component
• Includes workbook, audiotape
• Groups are small (10-16 people)
  information-sharing, interactive learning
  activities, problem-solving, decision-making,
  social support for change
• Weekly action plans and feedback

7
Partners on the P.A.T.H. (Stanford Model of CDSM)

• Subjects covered include
• Dealing with frustration, fatigue, pain and
  isolation
• Exercise for maintaining and improving strength,
  flexibility and endurance
• Appropriate use of medication
• Communicating effectively with family, friends
  and health
• professionals
• Nutrition
• Evaluating new treatments

8
Partners on the P.A.T.H. (Stanford Model of CDSM)

• Proven effective per research completed in 1996
• Improved health status (significant improvements
  in disability, fatigue, social/role limitations,
  self-reported general health)
• Decreased health care utilization (spent fewer
  days in the hospital, trend toward fewer
  outpatient visits and hospitalizations)
• Improved health management behaviors (significant
  improvements in exercise, cognitive symptom
  management, communication with physicians)

9
Project Partners and Roles- AoA- funded Evidence
Based Prevention Program Initiative for the
Elderly

• Area Agency on Aging of Western Michigan- overall
  coordination receipt and distribution of funds
• Community Aging Service Providers- (CASP) 4 aging
  service providers serving diverse high risk
  populations as trained lay leaders- taught CDSMP
  classes, participated in recruitment of
  participants and host sites, assisted with
  completion of participant outcome surveys
  trained in Motivational Interviewing and Stages
  of Change
• Grand Valley State University- evaluation and
  research component
• Priority Health (Health Maintenance
  Organization)- recruitment of members to classes
  assist with introduction and adoption of CDSMP
  into health care provider system
• Other

10
Why We Chose This Model

• Well developed and tested
• Lay-led model allowed us to use CASP staff to
  implement along with lay peer leaders
• Fit closely with mission of all partners
• Model embracing all chronic conditions allowed a
  broad base of potential partners, recruitment
  opportunities and sites
• Allowed CASP staff to increase their ability to
  respond to health issues as they already do for
  financial and social issues
• Assisted CASP staff to respond to issues from an
  empowering perspective, incorporating stages of
  change training
• Model was well-known to our health care partner
  and strongly supported their commitment to
  implement self-management strategies as described
  in the Chronic Care Model of Health Care Delivery

11
Partners on the PATH (Stanford CDSMP)Adaptations
to the Original Model

• Used CASP staff to implement program paired with
  lay leaders
• Outcome surveys completed at baseline,
  immediately after classes and 6 months after
  classes
• CASP staff followed participants for 6 months
  after classes completed (until final survey done)
• Population focused on adults 60 with one or more
  of four diagnoses arthritis, chronic lung
  disease, diabetes or cardiovascular disease

12
Stanford CDSMPPlanning- What Do You Need to Get
Started?

• Master Trainers- can teach classes and train lay
  leaders- must complete a 4-1/2 day training per
  Stanford staff
• Peer Leaders- complete a 4-day training taught by
  2 Master Trainers- can teach classes
• Stanford license- each organization teaching the
  Stanford CDSMP must purchase a license from
  Stanford
• Training materials- Books and tapes for
  participants and lay leaders
• Other- Host sites, referral system, marketing
  materials, coordinator

13
Adoption-Recruiting Community Organizational
Support, Training Sites

• Appropriate Sites Any place where older adults
  congregate
• Any agency that works with adults
• interested in promoting optimal health
• fostering empowerment
• Sites include senior centers, meal sites, aging
  service providers, senior housing sites,
  churches, salvation army
• Adopting organizations can include local health
  department, health care organizations/systems ,
  university extension programs, diabetes outreach
  networks, parish nurses
• Exploring YMCA (especially those with senior
  programming, arthritis classes), physician
  groups, disease-specific organizations

14
Recruiting Implementation Sites Lessons Learned

• Meet with the manager of the site to discuss
  benefits of the program, expectations and gain
  support.
• Ask for the informal leader of the older adult
  group.
• Choose a place where the infrastructure for
  meetings is in place.
• Consider parking, accessibility
• Choose sites that older adults are comfortable
  coming to.

15
Reach- Outreach- Recruiting Participants (The
toughest, most time-consuming part)

• Community Outreach
• Reaching high risk, diverse older adult
  populations
• Strongest response-
• approach already formed groups of older adults
• find a champion identify a trusted member
  of the group
• meet them where they normally gather, offer
  incentives
• sell the program in steps, starting with
  introductory sessions
• Talk about what's in it for them
• Keep an interest list as mailing list for
  future class schedules
• Word of Mouth
• Senior Centers, churches, meal sites, senior
  apartments, health clinics, health fairs
• Brochures, posters
• Media-radio, TV, newspaper articles- use success
  stories
• Health Care Plan Referral
• 3000 letters
• Physician Referral-approaches, challenges

16
Implementation, Fidelity and the Stanford CDSMP

• Maintain fidelity to the core components of the
  program
• training per Stanford guidelines
• built-in quality/fidelity check-points
• scripted weekly sessions
• Tips
• Buddy new trainers with experienced ones
• Set up mechanism for class materials, marketing
  materials, evaluations, class attendance and
  fidelity policies, scheduling and approaching
  sites

17
Implementation, Fidelity and the Stanford CDSMP

• Choose lay leaders carefully
• Believes in and understands the benefit of the
  program
• Positive role model in terms of how they manage
  their chronic disease
• Good listener, non-judgmental
• Comfortable in front of a group
• Can read and follow a script
• Can understand the importance and purpose of
  fidelity
• Understands the time commitment
• Short job description and brief interview?
• Offer incentivessmall stipend, mileage for
  attending training and teaching sessions
• We used a mixture of CASP staff and lay leaders
• Previous PATH participants could be good choice

18
Implementation, Fidelity and the Stanford CDSMP

• Training and support of lay leaders
• Training at least once a year, up to 20 per
  training
• Need 2 master trainers, leader manuals,
  participant workbooks and tapes, organizational
  licenses, 2 rooms, 2 easels with paper and
  marking pens, tape/CD player, lunches provided
  for 4 days
• Master trainer observation of leaders teaching
  their first classes before final approval given
• Meet with the leaders on the last day to go over
  logistics (getting materials, marketing sites,
  paperwork and evaluations, where to go for
  support)
• Offer regular support, especially in the
  beginning and at least once a year thereafter for
  ongoing training, appreciation and refresher

19
Effectiveness Participant Outcome Surveys

• With complete data at baseline and follow up for
  170 people, P.A.T.H. participants demonstrated
  significant changes in
• minutes of aerobic exercise
• cognitive symptom management
• pain
• health distress
• fatigue
• shortness of breath
• Increases in health care utilization were noted.
  We are examining outliers that may have affected
  this data.
• Some changes were not significant until
  6-months after classes
• Using an abbreviated survey post-research
• Allow plenty of time and additional assistance
  for survey completion, depending on literacy
• of participants
• Other program measures

20
Costs of implementation

• One-time costs
• Training 2 Master Trainers
• (Spanish and English)
• Participant materials (books and tapes)
• Training supplies
• Staff time for prep- permanent charts
• Translation (Spanish)
• Infrastructure

• Recurring costs
• Stanford relicensure
• Lay leader trainings
• F/U MT observation of lay leaders
• Cost of actual PATH workshops
• Marketing
• Recruitment time
• Ongoing staff training
• Admin/staff time

21
Maintenance/Sustainability

• Recruit new partners and explore new potential
  sources of funding
• Older American Act funding
• Local Millage funding for classes
• Possible 3rd party payment (Insurance, Medicare)
• Millage-funded Health Promotion Coordinator for
  Kent County
• Kent County PATH Group

22
Dissemination /Partnership Opportunities

• Statewide PATH expansion
• Michigan Partners on the P.A.T.H.
• MDCH, OSA, MSU Extension, TENDON, Med-Net-One
• Expansion into an adjacent AAA Region
• Embedding EBHP assessment and referral into the
  four Michigan ADRC demonstration projects

23
What participants say

• I liked it because it was a discussion-type
  program, not just a person lecturing. By
  sharing, people help each other. Setting goals
  with the group helped motivate me.
• Eunice W.
• PATH was a good thing for me. It made me set
  goals. I wanted to walk two miles a week and I
  did it. PATH gave me the incentive to live fully
  on a daily basis and eat the right foods. Now Im
  doing the stuff I feel I need to do.
• Melissa G.

24
Resources/Questions

• Stanford Web site http//patienteducation.stanfo
  rd.edu
• The Expert Patient Programme
• http//test.nhsepp.org/public/default.aspx
• Contact Information
• Bonnie Hafner
• Area Agency on Aging of Western Michigan
• 1279 Cedar NE
• Grand Rapids, MI 49503
• [phone]
• Bonnie_at_aaawm.org