Living Well with Chronic Conditions - Utah Department of Healthhealth.utah.gov/arthritis/pdf/Website...
Transcript of Living Well with Chronic Conditions - Utah Department of Healthhealth.utah.gov/arthritis/pdf/Website...
10/11/2012
1
Living Well with
Rebecca Castleton – Christine WeissUtah Arthritis Program
gChronic Conditions
A Group Model Sustained by a Network of Partners
Inthepast20yearsorso,theStanfordUniversity,PatientEducationResearchCenterhasdeveloped,tested,andevaluatedself‐managementprogramsforpeoplewithchronichealthproblems
Living Well with Chronic ConditionsStanford Model of CDSMP
Allprogramsaredesignedtohelppeoplegainself‐confidenceintheirabilitytocontroltheirsymptomsandhowtheirhealthproblemsaffecttheirlives
Workshopsarehighlyinteractive,focusingonbuildingskills,sharingexperiencesandsupport
Onceaprogramisdeveloped,itisevaluatedforeffectivenessthrougharandomized,controlledtrial,whichis2‐4yearsinlength
It is ONLY after a program has been shown to be safe
Living Well with Chronic ConditionsStanford Model of CDSMP
ItisONLYafteraprogramhasbeenshowntobesafeandeffectivethroughthesetrialsthatitisreleasedfordissemination
ThiswastheprocedurefortheChronicDiseaseSelf‐ManagementProgram(CDSMP)
Living Well with Chronic ConditionsStanford Model of CDSMP
ProgramDescription
Designedforpeoplewholivewithanychroniccondition
Living Well with Chronic ConditionsStanford Model of CDSMP
Basedonthesymptomsofchronicconditions
Participantslearntoolsthatenablethemtoself‐managetheirsymptoms
Communityorhealthcare‐basedsettings
Chronic Conditions Represented in CDSMP Workshops
• 44.5%Arthritis• 40.3%Hypertension• 33.3%Diabetes• 31.6%HighCholesterol
• 14.9%Asthma• 9.8%Fibromyalgia• 9.1%Cancer• 7.7%KidneyDisease
Source: Utah Arthritis Program, 2010
% g• 29.3%ChronicJointPain• 27.7%ChronicPain• 23.9%Depression• 17.4%HeartDisease
% y• 5.6%Osteoporosis• 4.0%LungDisease• 3.3%Stroke
10/11/2012
2
Chronic Conditions Represented in CDSMP Workshops
20.9%(465)
12.9%
9.5%(211)
3.1%(68)
FiveorMore
Four
h
Source: Utah Arthritis Program, 2011
20.4%(454)
17.6%(391)
15.7%(350)
12.9%(286) Three
Two
One
Missing
None
Living Well with Chronic ConditionsStanford Model of CDSMP
PatientEngagementActivities
Participantslearnhowtoidentifyproblems
Participants learn how to act on problems Participantslearnhowtoactonproblems
Participantslearnhowtogenerateshort‐termactionplans
Participantslearnproblem‐solvingskillsrelatedtochronicconditionsingeneral
Living Well with Chronic ConditionsStanford Model of CDSMP
ProgramSubjectMatter Dealingwithfrustration,fatigue,painandisolation
Exercise for maintaining and improving strength, Exerciseformaintainingandimprovingstrength,flexibilityandendurance
Appropriateuseofmedicationandpropernutrition
Communicatingeffectivelywithfamily,friendsandhealthprofessionals
Evaluatingnewtreatments
Living Well with Chronic ConditionsStanford Model of CDSMP
ProgramStructure
Seriesof6sessions,1sessionperweek,2hourspersession
Heldincommunitysettings(includinghealthcare)
Highlyscriptedcurriculum
Living Well with Chronic ConditionsStanford Model of CDSMP
ProgramStructure
Designedtobelay‐led;2leadersfacilitateeachclass;atleast1facilitatoralsohasachroniccondition
Workshopsofferedatnocharge
AvailableinUtahin:English,Spanish,Tongan,Samoan,andNavajo
Living Well with Chronic ConditionsStanford Model of CDSMP
Week1 Differencebetweenacuteand
chronicconditions Shorttermdistractions Introduceactionplans
Week2
Healthyeating Communicationskills Problemsolving
• Week5 Medicationusage
Dealingwithdifficultemotions Physicalactivityandexercise
Week3 Betterbreathingtechniques Musclerelaxation Painandfatiguemanagement
Week4 Futureplansforhealthcare
g Makinginformedtreatment
decisions Depressionmanagement Positivethinking Guidedimagery
• Week6 Workingwithyour
healthcareprofessional Planningforthefuture
10/11/2012
3
ActionPlans
• Somethingtheywanttodo
A h bl
• ConfidenceLevel
• Problem Solving
Living Well with Chronic ConditionsStanford Model of CDSMP
• Achievable
• ActionSpecificWhatHowmuchWhenHowoften
ProblemSolving
Living Well with Chronic ConditionsStanford Model of CDSMP
ImprovedOutcomes6mo. 2yrs.
Selfefficacy √ √Selfratedhealth √ √Disability √Roleactivity √Energy/fatigue √ √Healthdistress √ √MD/ERvisits √ √Hospitalization √
Lorig, et al 1999, 2001
Living Well with Chronic ConditionsStanford Model of CDSMP
ImprovedOutcomes1 2 3 4 5
Self‐efficacy X X X XSelf‐ratedhealth X XFatigue X X XFatigue X X XAnxiety/Distress X X XRolelimitation X XHRQOL XPain XExercise X X XCog.Sympmgmt X X X1=Lorig 05, 2=Barlow 05, 3=Goeppinger 07, 4=Kennedy 07, 5=Gitlin 08
Living Well with Chronic ConditionsStanford Model of CDSMP
WorkshopResources
Resourcebook:LivingaHealthyLifewithChronicConditions
CD: Time for Healing CD:TimeforHealing
Weeklyactionplansandfeedback
Groupsaresmall:10‐15people Shareinformation,interactivelearningactivities,problem‐solving,decision‐making,socialsupportforchange
Living Well with Chronic ConditionsStanford Model of CDSMP
Whatparticipantsaresaying.... “IknowIcanself‐manageafewproblemsandmakelifebetterformeandmyhusband.”
“Itgavemesomeimportantcopingmechanisms.”
“Thisclasshashelpedmegetmylifeinorder.”
“Irecommendthiscourseandhandbooktoallseniors.”
“Wehavesetgoals,accomplishedthemandwillcontinuetomanageourlivesbetterduetothisclass.”
Source:ClassparticipantsofWasatchandSummitCountycourses
Tomando Control de Su SaludStanford Model of Spanish CDSMP
SpanishProgramDevelopment
NotatranslationbutanindependentdevelopmentinSpanishSpanish
Developedtobeculturallyappropriate
FocusgroupsconductedinSpanish
Healthcareprofessionalsworkingwithpersonswithchronicconditions
10/11/2012
4
Tomando Control de Su SaludStanford Model of Spanish CDSMP
SpanishProgramDevelopment
Participantsincorporatehealthyhabitsintotheirlives: Healthyeatinghabits
Exercise(physicalactivity)
Cognitivemanagementofsymptoms
Bettercommunicationwithhealthcareproviders
Overallperceptionofbetterhealth
Living Well with Chronic ConditionsStanford Model of CDSMP
Infrastructure MasterTrainers– 11instateofUtahasofOctober2011(8English,2Spanish) Attend4½daytrainingatStanfordUniversity Teach classes and train leaders Teachclassesandtrainleaders
PeerLeaders/Instructors Complete4‐daytrainingtaughtby2MasterTrainersinordertoteachclasses
StanfordLicense EachorganizationteachingthisprogrammustpurchasealicensefromStanford– UtahislookingintoaStatewidelicense
TrainingMaterial ResourcebooksandCDsforparticipantsandleaders
Living Well with Chronic ConditionsStanford Model of CDSMP
GeneralPatientandProviderBenefits
Anevidence‐basedprogramsuchasLivingWell/CDSMPcancapturemanychronicdiseasesthroughthisonechannelg
Self‐managementsupportoption
Canimproveself‐ratedhealthandenergylevels
Reducedhealthcareutilization(EDvisits)
AstheNewJerseyprogramputsit:FeelBetter!
Inconservativeterms,thetwo‐yearsavingsduetoreducedhospitaldaysandoutpatientvisitsisapproximately$590perparticipant($490in
$
Costs vs. Savings
hospitalizationand$100inoutpatientvisits).Afteradjustingforparticipantcostsandeconomiesofscaletheactual2‐yearsavingsperparticipantwerebetween$390and$520.
Lorig,etal.MedicalCare,2001
Implementation‐• Partnerswhowouldliketoadministertheprogramontheirown
Th ld f d h l d d
CDSMP Partnership Model
• Theagencywouldfindtheirownleadersandruntheworkshopstowhatsuitstheirneedsthebest
• AreaAgenciesonAging,Clinics,LocalHealthDepartmentsareexamples
CDSMP Partnership Model
Host‐• Theseareagenciesthatmaynothavetheresourcestoimplement,butwouldstillliketohave a workshop offered at their sitehaveaworkshopofferedattheirsite
• Alocalpartnerwouldthenbringtheworkshoptothem
• TheHostPartnerwouldsimplyprovidefacilityuseandrecruitparticipants
10/11/2012
5
CDSMP Partnership Model
Referral‐
• Partnerswhohaveaccesstoapopulationbutdonothaveabilityordesiretoimplementclassesinownsetting
• Referpatients/clientsintocurrentclasses
• Healthcareprovidersandhealthplansareexamples
CDSMP Partnership Model
Marketing‐• Partnerswhomaynotfallintotheotherthreepartnershipcategoriesp p g
• Examplesincludeagencieswithaccesstonewsletters,listservs andothermediachannels
Living Well with Chronic ConditionsStanford Model of CDSMP
Resources StanfordUniversity’ssiteonCDSMPhttp://patienteducation.stanford.edu
UtahArthritisProgram(classschedules)http://health.utah.gov/arthritis
AdministrationonAging:www.aoa.gov
NationalCouncilonAging:http://healthyagingprograms.org
Living Well with Chronic ConditionsStanford Model of CDSMP
ContactInformation
[email protected]; 801‐538‐[email protected];801 538 9340
[email protected];801‐538‐9458
UtahArthritisProgram:www.health.utah.gov/arthritis(forclassschedules)