Transcript Document

Stanford Self Management Programs:
Learning to Live Well
Mary Hertel, RN EBHP Coordinator/ Trainer, T-Trainer CDSMP, Master Trainer CPSMP
Central MN Council on Aging (Area Agency on Aging)
Jenny Fransen, RN, Care Coordinator and CDSMP Facilitator at Courage Center
Stephanie Foo, MPH, Outcomes and Research Project Specialist at Courage Center
Split Rock 2, City Side Tuesday 2:45 pm to 4pm
Information to be presented:
 Define Evidence Based programs using the
Stanford Self Management program as an
example
 Discuss 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 programs
 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
Evidence based:
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 evidencebased practices and
programs
Spend limited resources
more efficiently
Community
Health System
Health Care Organization
Resources and
Policies
SelfManagement
Support
Delivery
System
Design
Decision
Support
Clinical
Information
Systems
Productive Interactions
Patient Centered
Informed,
Timely and Efficient
Coordinated
Empowered Patient
Evidence-based and Safe
and Family
www.improvingchroniccare.org
Improved Outcomes
Prepared,
Proactive
Practice Team
EBPs 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.”
Chronically ill patients make many daily health
decisions:
 Diet, exercise, medication, when to seek
medical care
 Sometimes make unwise decisions
 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?
Advantages of Evidence Based Programs:
• 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
Evidence Based Programs
(using Stanford as example)
Stanford University Self Management
Programs(in Minnesota):
• Chronic Disease Self Management (Living
Well with Chronic Conditions)
• Chronic Pain Self Management
• Diabetic Self Management
Self-Management Differs
From Patient Education (but we need both)
Self-management
- Manage life with
disease
- Problem solve and
make decisions
- Improve clients
confidence in
abilities to make
changes
- Increase skills & selfconfidence
Patient Education
- Change behaviors
- Information,
technical skills
- Disease–specific
knowledge
- Use specific tools
(e.g., Care Plans,
Action Plans)
Self-Management Also Encompasses:
 The patient and health professional working
together.
 Often involves the family.
 An holistic approach to care (i.e., medical
and psycho-social components of a
condition).
 Pro-active and adaptive strategies that aim
to empower the individual.
What is the Stanford Chronic Disease Self-Management Program (CDSMP)
“Living Well with Chronic Conditions”
Developed by Stanford University’s
patient education program
 Stanford Programs are licensed
 Leader Training 4 days lead by 2
MasterTrainers
 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
 Evidence-based: a tested model
(intervention) that has demonstrated
results

• Goal setting and action planning
• Feedback/ problem solving
• Decision Making
• Management tools
CDSMP Techniques
Living Well With Chronic Conditions
Workshops (CDSMP)
•
Curriculum including:
•Exercise and nutrition
• Medication usage
• Stress management and managing
fatigue
• Talking with your doctor or health
professional, family and friends
•Evaluating treatment choices
• Dealing with emotions, frustration and
depression
Living Well With Chronic Conditions Workshop
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
Stanford’s CDSMP is Evidence-based
 Found
to benefit targeted populations.
Including a decrease in health care
costs


Demonstrated it does not cause harm.
Demonstrated it does not waste
resources. CDSMP can facilitate the
Triple Aim Goals
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
Chronic Conditions Reported
and compiled by MDH
•
•
•
•
•
•
•
•
•
Arthritis/other
Hypertension
High Chol
Chronic Pain
Diabetes
Heart Disease
Osteoporosis
Cancer
Depression
54%
51%
36%
30%
24%
22%
20%
15%
14%
•
•
•
•
•
•
•
•
•
Lung disease
AMD
Stroke
Asthma
Emphysema or
COPD
Parkinson’s
Disease
Kidney disease
MS
Other
12%
9%
8%
6%
3%
3%
2%
2%
21%
Healthy Living with
Courage
• CDSMP adapted for people with
disabilities
• Offered at Courage Center
• Rehabilitation and resource center with
co-located primary care, psychiatry, and
physiatry
• Facilitated by registered nurse care
coordinator and volunteer
The need for a self-management
program is great…
Persons with disabilities
• Likely to have multiple secondary conditions
• More likely to be physically inactive
• More likely to experience pain
• Face greater barriers to accessing timely
primary care
National Center for Health Statistics, 2011.
Healthy Living with Courage
Participants
• Two six-week sessions since January
2013
• Nine participants in total, five completed
the program
• 78% male, 67% white
• 44% were 51 years of age and over
• 67% had public insurance
Healthy Living with Courage
Participants
Disability Type for All Participants (n=9)
Spinal Cord
Injury
22%
Neurological
11%
Fibromyalgia
11%
Arthritis
23%
Brain Injury
22%
Stroke
11%
Adapting CDSMP
• Modifications are necessary to make CDSMP
disability sensitive
• Some additions were made to the lessons and
classroom setup
• Exercise issues: “Do what you can do.”
• Sensitivity to hearing, vision, and cognitive
impairments
• Larger room, smaller group
• Avoid snacks, serve bottled water instead
Addressing Barriers
• Persons with disabilities face unique
barriers that make attending the program
more difficult
• Barriers to attendance must be addressed
• Transportation
• Organization
• Financial barriers
• Need for additional personal assistance
Outcomes
• Tracked pre-program and post-program
scores for three measures
• Center for Disease Control’s Healthy Days
measure
• Patient Activation Measure
• PROMIS Depression Measure (Short Form 8a)
• Post-program survey on self-reported
improvements and satisfaction with
program
Measures
• CDC’s Healthy Days
• Assesses perceived sense of well-being over
past 30 days
• PROMIS Depression
• Measures symptoms of depression over
past week
• Patient Activation Measure (PAM)
• Gauges patient’s knowledge, skills, and
confidence in managing own health
Outcomes
Measures
Before
Program
11.6
After
Program
11.8
Change
Avg. HD
0.2
Score
Avg.
56.3
55.1
-1.2
Depression
Score
Avg. PAM
45.6
48.1
2.5
Higher Healthy Days and PAM scores indicate improved outcomes. Lower
Score
PROMIS depression scores indicate improved outcomes.
Patient Activation Measure
• A change of one point is associated with
• 1.7% decline in hospitalizations
• 3.4% gain in A1c testing or LDL testing
• 1.8% gain in A1c control
Reported Improvements
Percentage of Participants Reporting Improvements
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
80%
60%
60%
60%
60%
40%
Manage your
stress
Manage
fatigue
Eat healthier
40%
Do more
Set and
Continue
Cope with
walking or achieve goals work or feelings such
other
other daily as anger,
physical
activities frustration,
activities
sadness,
depression,
or fear
Program Satisfaction
Percentage of Participants who "Agree"
or "Strongly Agree"
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
100%
80%
67%
60%
I felt safe sharing
I would
Overall, I am
I learned from I am confident I can
successes and
recommend the satisfied with the other members of manage my chronic
setbacks with program to others
program
the group
conditions after
group
with disabilities
the program ends
In summary…
• Improvements in Healthy Days, PROMIS
depression, and PAM scores were detected but
were not statistically significant
• Small sample size
• Measurement period
• Post-program survey indicates that participants
believe the program helped them better manage
their stress and health conditions
• Realistic expectations
• Self-acceptance
• Tools for self-care (action plans, relaxation exercises)
Facilitator Feedback
• Facilitating the program can be demanding
• Time commitment
• Consciousness and support of clients’ disability
needs
• But also very rewarding
• “Participants have a sense of pride in their
accomplishments and want to continue to
succeed in making positive changes in their
health. I’ve been seeing patients that attended
the program more frequently in our clinic since
the class ended.”
• Facilitators also benefit from the program
Chronic Pain Self-Management
CPSMP is a 6 week, 2.5 hours per week workshop developed for
people who have a primary or secondary diagnosis of chronic
pain.
Pain is defined as being chronic or long term when it lasts for
longer than 3 to 6 months, or beyond the normal healing time of
an injury.
During this workshop a variety of topics important to those with
chronic pain are covered including: goal setting, relaxation,
nutrition, medication management, exercise, communication and
problem solving
Requires 2 Certified trained Leaders
Training is either 4 days or 2 days if CDSMP trained
Diabetic Self-Management Program
DSMP is a 6 week, 2.5 hours per week.
This workshop is for people with type 2 diabetes. It teaches the
skills needed in the day-to-day management of diabetes and to
maintain and/or increase life’s activities.
Requires 2 Certified trained Leaders
Training is either 4 days or 2 days if CDSMP trained
Implementation of CDSMP in Minnesota
Current license holders include:
•Central MN Council on Aging(Area Agency on Aging)
•5 Area Agencies on Aging covering all of Minnesota
•Minnesota Department of Health
•Native American Community Clinic: “Living in Balance”
•Sanford Health: “Better Choices, Better Health”
•Veterans’ Administration Health System
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 (please see handout)
• 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
MN Healthy Aging website
Resources
•Minnesota Board on Aging: http://www.mnaging.org/
•National 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/content-library/TitleIIID-Highest-Tier-Evidence-FINAL.pdf
•Stanford Patient Education Research Center:
•http://patienteducation.stanford.edu/
•SAMHSA National registry of Evidence Based Programs and Practices:
•http://nrepp.samhsa.gov/Index.aspx
Questions ?
“Those things that we do for
ourselves, day-to-day that improve
or maintain our health and make
us feel better”
Contact information:
Mary Hertel: RN, T-Trainer CDSMP, Master Trainer CPSMP, DSMP
Central MN Council on Aging (Area Agency on Aging)
Direct:320-202-6945
Agency: 320-253-9349
Email: [email protected]
Jenny Fransen, RN, Care Coordinator and CDSMP Facilitator at Courage
Center
[email protected]
Stephanie Foo, MPH, Outcomes and Research Project Specialist at
Courage Center
[email protected]