Chronic Disease Self-Management 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 1:30pm ESTPlease mute your phonePersonal introductions are not necessaryThe moderator will be on the line shortly

2. Health Aging Briefing Series Partners on the P.A.T.H.(Personal Action Toward Health)Chronic Disease Self-Management Program 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 incentives—small 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. 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 Costs of implementation

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 I’m doing the stuff I feel I need to do.” Melissa G.

24. Resources/Questions Stanford Web site: http://patienteducation.stanford.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 (616) 222-7026 Bonnie@aaawm.org