Transcript Document

Evidence Based Health Promotion:
What's the Buzz All About?
Mary Hertel: Central MN Council on Aging
Debra Laine: Arrowhead Area Agency on Aging
Dave Fink: Metropolitan Area Agency on Aging
Tuesday June 18, 2013 8:00 am to 9:15
Lake Superior Ballroom, City side
Information to be presented:
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What are Evidence Based programs and
why are they important
Research and demonstrated outcomes
How EBP can fit within the patient
engagement model, compare/contrast with
patient education
Overview of specific EBP’s including
Stanford Self-Management, A Matter of
Balance and Tai chi: Moving For Better
Balance
Describe how you or your organization can
get more involved
What is Evidence Based health
promotion programming?
Simply put it is:
programs based on research.
What evidence do we need?
Evidence that
a health issue
exists
Evidence that
a program is
effective
Evidence
about design,
context and
attractiveness
of program
Why the interest in Evidence Based Programs?
Magnitude and serious of health and
social problems in our communities
Awareness of preventability of many
problems
Emergence of evidence-based
practices and programs
Spend limited resources more efficiently
EBP’s have Demonstrated Outcomes
Consider:
“people with chronic conditions rarely spend more
than 1% of their life at a healthcare facility. It is the
other 99% of one’s life - when an individual is at home that determines whether they return to full health or
not.”
Those with ongoing health issues will make many daily
health decisions:
 Diet, exercise, medication, when to seek medical care
may not fully understand implications of particular
health decision
 may lack support to make better choices
Can Clients Be Engaged?
23% adopted new health behaviors (but unsure could
maintain if stressed)
Remaining 77%:
 Remain passive recipients (12%)
 Lack basic facts to follow treatment
recommendations (29%)
 Have facts, but no skills, confidence (36%)
Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation
result in improved self-management behaviors? Health Services Research, 42, 1443-1463.
How can Evidence Based
Programs help?
Self-Management Differs
From Patient Education (but we need both)
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Self-management
- Manage life with
disease
- Problem solve and
make decisions
- Improve
confidence in
abilities to make
changes
- Increase skills &
self-confidence
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Patient Education
- Change
behaviour's
- Information,
technical skills
- Disease–specific
knowledge
- Use specific tools
(e.g., Care Plans,
Action Plans)
Advantages of Evidence Based Programs:
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First, they can significantly improve the health and wellbeing of older adults in the community.
Second, they can help attract new participants and
funders through innovative programming.
Third, they can create powerful partnerships with other
organizations, including health care providers
Evidence-based programming provides value
Lets talk about some of the Evidence
Based Programs
Stanford University Self Management
Programs:
 Chronic Disease Self Management (Living
Well with Chronic Conditions)
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Chronic Pain Self Management
 Diabetic Self Management
Additional programs:
A Matter of Balance
 Tai Chi Moving for Better Balance
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What is the Stanford Chronic Disease Self-Management
Program (CDSMP)
“Living Well with Chronic Conditions”
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Developed by Stanford University’s
patient education program
Leader Training 4 Days lead by 2
Master Trainers
Structured 10-15 participants in a
six-week workshop series done by 2
certified leaders
Participative instruction with peer
support
Designed to enhance medical
treatment
Outcome-driven: impacts show
potential for reduced or avoided costs
Evidence-based: a tested model
(intervention) that has demonstrated
results
Living Well with Chronic Conditions
Techniques
• Action planning
• Feedback/ problem solving
• Decision Making
• Management Tools
• Physical
• Psychological
• Emotional
The process or the way CDSMP is taught is as
important, if not more important than the
subject matter that is taught.
Living Well With Chronic Conditions
Workshops (CDSMP)
Keys to Success
•The format addresses specific problems and
goals for people with ongoing health
problems. It is not a drop-in support group.
•The workshops are not prescriptive.
Participants choose their own goals and
track their own progress toward success.
•Pair of trained peer leaders offer guidance
and support, but participants find practical
solutions individually and together.
Living Well With Chronic Conditions Workshop
Evidence
CDSMP participants experienced the following outcomes 6 months
after starting the CDSMP program
• Increased exercise;
• Better coping strategies
and symptom
management;
• Better communication
with their physicians;
• Improvement in their
self-rated health,
disability, social and role
activities, and health
distress;
• More energy and less
fatigue;
• Decreased disability;
• Fewer physician visits
and hospitalizations.
Lorig et al., 1999
Stanford’s CDSMP is Evidence-based
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Found to benefit targeted populations.
Including a decrease in health care
costs
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Demonstrated it does not cause
harm.
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Demonstrated it does not waste
resources. CDSMP can facilitate the
Triple Aim Goals
Lets do a quick demo!
Options for Involvement
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Offer the program(s) at your clinic/organization
with your staff, and/or volunteer peer leaders.
Training is available through the Area Agencies
on Aging
Offer the program at your clinic/organization in
partnership with a community provider
Refer your patients to programs that your
organization offers or to community partners;
visit www.mnhealthyaging.org for a listing of
workshops
or call Senior Linkage Line 1-800-333-2433
Resources
Minnesota
National
Board on Aging: http://www.mnaging.org/
Council on Aging (NCOA): http://www.ncoa.org/
NCOA: Center
for Healthy Aging
 http://www.ncoa.org/improve-health/center-for-healthy-aging/
Online Training
Modules:
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-trainingmodules/
Highest Tier Evidence-Based Health Promotion/Disease Prevention
Programs
http://www.ncoa.org/improve-health/center-for-healthy-aging/contentlibrary/Title-IIID-Highest-Tier-Evidence-FINAL.pdf
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Stanford
Patient Education Research Center:
http://patienteducation.stanford.edu/
A Matter of Balance:
Managing Concerns about Falls
(Falls Prevention)
What do we know about falls?
Up to 30% of community dwelling adults
fall each year
 About 20% of falls cause physical injury
 Leading cause of hospitalized injury
 Leading cause of ER-treated injury
 MN ranks 3rd in the nation in fall related
deaths – twice as many per capita as the
national average
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What we know about Falls
1/2 to 2/3 of falls occur around the home
 A majority of falls occur during routine
activities
 Falls usually aren’t caused by just one
issue. It’s a combination of things coming
together
 A large portion of falls are preventable!
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What we know about Falls
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Falls are :
◦ Common
◦ Predictable
◦ Preventable
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Falls are not a natural part of aging!
What do we know about fear of
falling?
It is reasonable to be concerned about falls safety is important
 1/3 to 1/2 of older adults acknowledge fear
of falling
 Fear of falling is associated with:
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decreased satisfaction with life
increased frailty
depression
decreased mobility and social activity
Fear of falling is a risk factor for falls
What is A Matter of Balance?
A Matter of Balance is a program:
 based upon research conducted by the
Roybal Center for Enhancement of LateLife Function at Boston University
 designed to reduce the fear of falling and
increase the activity levels of older adults
who have concerns about falls
A Matter of Balance: Managing
Concerns About Falls
During 8 two-hour classes, participants
learn:
 To view falls and fear of falling as
controllable
 To set realistic goals for increasing activity
 To change their environment to reduce
fall risk factors
 To promote exercise to increase strength
and balance
A Matter of Balance: Managing
Concerns About Falls
What Happens During Classes?
 Group discussion
 Problem-solving
 Skill building
 Assertiveness training
 Exercise training
 Videotapes
 Sharing practical solutions
Who could benefit from A Matter
of Balance?
Anyone who:
 is concerned about falls
 has sustained a fall in the past
 restricts activities because of concerns
about falling
 is interested in improving flexibility,
balance and strength
 is age 60 or older, ambulatory and able to
problem-solve.
Administration on Aging Grant
In 2003, AoA launched a three year
public/private partnership to increase older
people’s access to programs that have proven
to be effective in reducing their risk of disease,
disability and injury
Grant Goals:
•Develop a volunteer lay leader model and
test whether it is successful when compared
with original research
•Share our approach with others in Maine and
around the country
A Matter of Balance Outcomes
Participant Outcomes
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97 % - more
comfortable talking
about fear of falling
97 % - feel comfortable
increasing activity
99 % - plan to continue
exercising
98 %- would recommend
A Matter of Balance
* % who agree to strongly agree
Comments:
I
am more aware of my
surroundings. I take time to
do things and don’t hurry.
I have begun to exercise
and am looking forward to
a walking program.
I have more pep in not
being afraid.
Participants Report:
Increased confidence in taking a walk,
climbing stairs, carry bundles without
falling
 More confidence that they can increase
their strength, find ways to reduce falls,
and protect themselves if they do fall
 An increase in the amount they exercise
on a regular basis
 Fewer falls after taking MOB
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Impact in MN
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Steady increase of participants
◦ 2012; 845 participants with 721 completers
◦ 2011; 777 participants
◦ 2010; 444 participants
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Less than 1% report no improvement in:
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Finding a way to get up from a fall
More steady on feet
Finding a way to reduce a fall
Protecting yourself incase of a fall
Physical activity
Options for Involvement




Offer the program(s) at your clinic/organization
with your staff, and/or volunteer peer leaders.
Training is available through the Area Agencies
on Aging
Offer the program at your clinic/organization in
partnership with a community provider
Refer your patients to programs that your
organization offers or to community partners;
visit www.mnhealthyaging.org for a listing of
workshops
or call Senior Linkage Line 1-800-333-2433
Resources
Minnesota
National
Board on Aging: http://www.mnaging.org/
Council on Aging (NCOA): http://www.ncoa.org/
NCOA: Center
for Healthy Aging
 http://www.ncoa.org/improve-health/center-for-healthy-aging/
Online Training
Modules:
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-trainingmodules/
Highest Tier Evidence-Based Health Promotion/Disease Prevention
Programs
http://www.ncoa.org/improve-health/center-for-healthy-aging/contentlibrary/Title-IIID-Highest-Tier-Evidence-FINAL.pdf

Stanford
Patient Education Research Center:
http://patienteducation.stanford.edu/
The Question:
Is there an evidence-based fall prevention
program that would be culturally
appropriate for and accessible to non-English
speaking older adults?
Tai Chi: Moving For Better Balance
(TCMFBB)
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Developed by Dr. Fuzhong Li, Oregon Research
Institute
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8 forms of Yang style Tai Chi adapted specifically for
fall prevention
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Reduces the risk of falls by improving balance,
muscle strength, flexibility and mobility
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Twice/week for 1 hour plus practice, 2 twelve week
sessions
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One certified leader
Tai Chi origins
• Monks in the mountains of China 600 years ago
• Created as a self-defense martial art
• Evolved into a health & wellness exercise program
“Moving meditation”
• 8 forms that emphasize
- weight shifting
- postural alignment
- coordinated movements
• 4 S’s
- slow
- smooth
- soft
- safe
- Integrated breathing
Seated
&
Standing
Leader qualifications
• No previous Tai Chi
experience required
• Experience working with
older adults & group
exercise programs very
helpful
• Enjoy leading groups
• Willing to learn, practice
and continually improve
Leader training
• 2 day intensive
workshop
• Led by Dr. Li
• Follow-up
sessions with local
leader
• Leader sharing
sessions
• DVD and tips
2012 pilot test
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Timeframe: April – December, 2012
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10 bilingual leaders trained:
◦ Initial 2-day training
◦ 3 two hr. follow-up sessions
◦ Quarterly leader sharing and updates
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7 languages: Laotian, Korean, Khmer, Hmong,
Somali and Vietnamese and English
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Classes: Two 12 week sessions, twice/week for 1
hour
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Stipends: To organizations @ $30/class
Pilot test results
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Participants: 124 first session, 129 second
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Retention: 64% attended half or more, 49%
attended 3/4 or more
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Retention higher in organizations with active
existing programming and leaders - 86% attended
half or more, 68% attended 3/4 or more
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Participation and retention higher with Asian older
adults than East African older adults
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“Timed up and go” test – avg. 2 second
improvement
What participants said…
 “The Tai Chi class helped me be able to use old muscles I
have not used in a while. Now I can stretch my arms up very
high.”
 “I was walking with a cane for a couple of years. After I join
the class I am able to walk without a cane.”
 “The Tai Chi exercise program helped me a lot with
emotional stress and physical improvement.”
 “Because of a stroke, I couldn’t use my arm. But I am able
to move and use my arm and lift up to my head.”
What we learned
 Bilingual leaders are effective
 Organizations with existing active older adult
programs had stronger participation/retention
 Cultural backgrounds
may make a difference in
participation/retention
 Older adults will attend and do benefit
2013 participating organizations
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Brian Coyle Center
Centro
Common Bond
Korean Service Center
Lao Advancement Org. of Am.
Presbyterian Homes & Services
United Cambodian Assn. of MN
VOA/Park Elder Center
Vietnamese Social Services
Oromo, Somali
Spanish
English, Somali, Spanish
Korean
Laotian
English
Khmer
Hmong
Vietnamese
Also, Mahube-Otwa RSVP in Land of the Dancing Sky AAA and
Central MN Council on Aging (both in English)
A word on funding
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MAAA Title IIID funds target non-English speaking
older adults
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MAAA pays IIID organizations to host Tai Chi
classes and funds the leader training
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As space allows, other organizations attend leader
training and reimburse MAAA for costs
What’s next…
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Metropolitan Area Agency on Aging
 3rd training, new organizations and leaders
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Land of the Dancing Sky AAA & Mahube-Otwa
RVSP
 2nd training, more leaders
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Central MN Council on Aging
 Getting started
Additional TCMFBB info
NCOA link to TCMFBB: http://www.ncoa.org/improve-health/centerfor-healthy-aging/tai-chi-moving-for-better.html
Research basis for TCMBB:
 “Tai Chi and fall reductions in older adults: a randomized controlled
trial,” Journal of Gerontology, 2005:
http://www.ncbi.nlm.nih.gov/pubmed/15814861
 “Translation into Community-based Falls Prevention Program,”
2008, American Journal of Public Health:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424086/
“Tai Chi and Postural Stability in Patients with Parkinson's Disease,”
2012, New England Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMoa1107911
MN Healthy Aging website
Options for Involvement




Offer the program(s) at your clinic/organization
with your staff, and/or volunteer peer leaders.
Training is available through the Area Agencies
on Aging
Offer the program at your clinic/organization in
partnership with a community provider
Refer your patients to programs that your
organization offers or to community partners;
visit www.mnhealthyaging.org for a listing of
workshops
or call Senior Linkage Line 1-800-333-2433
Contact Information:
Mary Hertel, RN EBHP Coordinator/Trainer
Central MN Council on Aging
Direct:320-202-6945
Agency: 320-253-9349
[email protected]
Debra Laine, Special Programs Developer
Arrowhead Area Agency on Aging
218-529-7534
[email protected]
Dave Fink, Program Developer
Metropolitan Area Agency on Aging
651-917-4633
[email protected]
Questions ?
“Those things that we do for
ourselves, day-to-day that improve
or maintain our health and make
us feel better”