Transcript Slide 1
Evidence-Based Health
Promotion
MGS Conference – April 2009
Kate Houston, Metro Area Agency on
Aging
Debbie Hanka, UCare
Overview of Presentation
Context – Older Adult health concerns in
MN
WHAT is evidence-based health promotion?
WHY evidence-based health promotion?
Examples of evidence based programs and
Local implementation experience
State resources for assisting local
agencies
Chronic Disease in MN
Chronic diseases are the primary
driver of health care costs. They
account for more than 75% of total
annual health care costs in the U.S.
80% of those over 65 years have 1 or
more chronic condition, 65% have
multiple chronic conditions
Chronic Disease in Minnesotans
65 yrs +
Age related macular degeneration - Approx.
25% (nationally)
Alzheimer's Disease - 13% (nationally)
Arthritis - 53%
Diabetes - 13 %
Heart Disease – 6+%
Stroke - 3%
Osteoporosis – 14.4%
What is Evidence-Based Health
Promotion?
A process of planning, implementing,
and evaluating programs adapted from
tested models or interventions in order
to address health issues at an individual
level and at a community level
Source: Altpeter, M., Schneider, E., Bryant, L. Beattie, B., & Whitelaw, N. (2004).Using the evidence base to
promote healthy aging. National Council on the Aging Evidence-based Health Promotion Series, Vol. 1.
Washington, DC: National Council on the Aging.
What is an evidence-based
program ?
An evidence-based program has been
demonstrated to be effective in basic research
that involved the same target audience
It has also been demonstrated to be effective in
dissemination in the “real world.”
There are clear protocols for training and
conduct of the program so that community
programs can maintain fidelity and be
successful.
What do we mean by “fidelity”?
The core elements of the program are
delivered the same way in each class or
session
Fidelity ensures the same participant
outcomes that the research proved can be
obtained.
Each program will specify what are the core
elements, and what can be modified.
Some programs require certified training
and/or licenses to help ensure fidelity
EBHP Programs have demonstrated
outcomes
Improved quality of life
Increased/maintained
mobility
Increased/maintained
independence
Decreased pain
Reduced disability
Later onset
Fewer years of
disability prior to death
Fewer falls
Improved mental health
Positive effect on
depressive symptoms
Possible delays in loss
of cognitive function
Lower health care costs
Decreased hospital
and ED visits
Possibly decreased
med costs
Benefits of an Evidence-Based
Approach
Increases the likelihood of positive participant
outcomes
Safety is built in
Ready made package – no development costs
Makes it easier to justify funding
Helps to establish partnerships –esp. with health care
Leads to efficient use of community resources
Supports the use of common performance measures
Supports continuous quality improvement
Challenges to Implementation of an
Evidence-Based Approach
Feels like standardization
Sometimes difficult to build community support –
everyone wants home grown
Tools and processes are unfamiliar
Requires partnerships - some communities may not
have partners that can help
Start-up costs, training, monitoring and on-going
evaluation require resources
Research target audience may not match yours
Chronic Disease Self Management
Research project conducted by Stanford to
develop and evaluate a community based
self-management program to assist people
with chronic illness.
1000 people participated in RTC and were
followed for 3 years.
CDSMP - Outcomes
Fewer hospital stays and trend toward fewer
outpatient visits and hospitalizations
6-month improvements in exercise, cognitive
symptom management, communication with
physicians, self-rated health, disability, social
and role activities limitations, energy/fatigue
Many results persist for 3 years
CDSMP– Program Description
“Living Well with Chronic Conditions”
resource book provided
Peer led small groups (10-15 participants)
Meet for 6 weeks, 2.5 hours each session
People with different chronic health problems
attend together
Workshops are facilitated by two trained
leaders. Topics addressed include pain
management, exercise, medications,
communication and nutrition
CDSMP Training – Fidelity - License
Attend four day leader training
Fidelity maintained by following curriculum, follow-up
with Master Trainer
Core components include co-leading class
Do not add, delete or change content or process
Do not bring in outside speakers
Follow agenda for each session
Able to paraphrase lecturette and include personal
anecdotes where indicated
Licensed by Stanford
CDSMP IMPLEMENTATION
License
Coordinator
Schedule workshop
Secure site
2 trained leaders
Recruit participants
Marketing to community
Materials, books, snacks, etc.
EnhanceFitness® Beginnings
1994 Randomized Clinical Trial – University
of Washington Health Promotion Research
Center, Group Health Cooperative, Senior
Services (published in 1998)¹
Class held 3 times/week, 1 hour sessions
Originally developed to transition
participants from class to doing exercises at
home
The Results
Participants improved significantly in:
35% improvement in physical functioning
13% improvement in social functioning
52% improvement in depression¹
On-going evaluation
Cost analysis showed EnhanceFitness
participants’ healthcare costs were 21% less
than those of non-participants’ cost after one
year.²
Participants in ethnic community sites
although less physically fit to start with when
compared to majority-white communities,
showed greater improvement after 4 months
than those in majority-white sites.³
EF Training – Fidelity - License
Instructors must become EnhanceFitness certified
Fidelity maintained through observation by and
contact with local Master Trainer
Core components of class include specific strength,
flexibility and balance exercises
Aerobic section of class may be modified in content (time
must not be modified)
Licensed by ProjectEnhance
Master License
Site License
EF IMPLEMENTATION
License
Coordinator
Schedule workshop
Secure site
Trained instructors
Recruit participants
Marketing to community
Weights, cart, stop watch, etc.
Components of a EF Class
Classes meet 2-3 times per week for 60
minutes
Each class includes:
5-8 minutes of Warm-up
20 minutes Cardiovascular activity
3-5 minutes of Cool-down
20 minutes of Strength Training
8-10 minutes of Stretching
Fitness Checks
Pre and Post fitness checks
Timed Sit to Stand
8 foot timed up and go
Bicep curl
From Rikli-Jones Functional Fitness Test
EnhanceFitness at UCare
EnhanceFitness selected based on:
Need for a group exercise option.
Evidence- based approach with proven
results.
High quality instructors and training.
Offered as part of the multi-faceted UCan!
UCare Activity Network including health club
dues reduction and Do-It-Yourself Kit
Classes are available in about 35 sites in a
16 county UCare for Seniors service area.
EnhanceFitness – Metro AOA
Demonstration 2007-2010
Three current sites – 4 to 5 will be added in
2009
Partnership with UCARE, Senior Community
Services, Wilder Services to the Elderly
Sustainability – financial, fidelity, licensing ,
trained instructor pool
Fit within statewide Falls Prevention
strategies
Participant Outcomes in MN
Measure/Test Baseline
Mean
Post Test
Mean
Result
Timed Up &
Go (8 ft.)
10.3 - 2007
8.9 - 2007
7.6– 2008
7.2- 2008
Slightly
significant
Slightly sign.
Timed Sit to
Stand
11.9– 2007
13.2 – 2008
14.8– 2007
14.3– 2008
Significant
Significant
Bicep Curl
15.6 – 2007
17.5 – 2008
19.6 – 2007
18.1 – 2008
Significant
Not
significant
Testimonials
“I feel the class has helped me tremendously.
I was experiencing shortness of breath and
with these classes I began taking deeper
breaths and noticed a big improvement. On
a very busy strenuous trip, I was able to keep
up with the younger people.”
“I really found out I needed this class as I was
really bad at coordination. I liked how she
made sure we did the weight lifting correctly.”
HOW do I decide to implement
evidence-based health
promotion?
Are You Ready to Implement EvidenceBased Health Promotion Programs?
National Council on Aging Organizational
Readiness Checklist
Agency/partnership is willing to do evidencebased health programs and stay true to the model
being implemented
There is funding for the program
There is access both to personnel with the
expertise to do these programs and to the
population that needs these programs
there is buy-in from leadership
How Can You Shift Your Current
Programming to Evidence-Based?
Can you substitute an evidence-based
program for your current program?
Check if the evidence-based program
components match your needs:
Target population: age, gender, race/ethnicity,
health status
Setting: in-home or group
Class leader: personnel with needed qualifications
Matches desired health topic and outcomes
You Don’t Have to Do It Yourself:
Partner With Other Organizations
Everyone has a role and something to offer:
Referral to program or between programs
Program site, refreshments, class
materials
Staff or volunteers to be trained as class
leaders
Participant recruitment/outreach efforts
through existing communications to older
adults
Data collection/analysis capacity
Where do I find Evidence-Based
Programs?
Administration on Aging www.aoa.gov
National Council on Aging
www.healthyagingprograms.org,
CDC Arthritis Program endorsed programs
www.cdc.gov/arthritis/
Arthritis Foundation Exercise and Warm Water
Exercise Programs, Self-Management Program
EnhanceFitness
Chronic Disease Self-Management Program
Active Living Every Day
Where do I find Evidence-Based
Programs?
Other “Stanford Model” programs
http://patienteducation.stanford.edu/
The Community Guide to Preventive Services
www.thecommunityguide.org
Cancer Control Planet http://cancercontrolplanet.cancer.org
www.health.state.mn.us search on “arthritis” choose
Minnesota Arthritis Program
Look under news and events for current training schedule
Coming – training schedules and registration info for other
programs
Evidence-based Interventions in MN –
Statewide Dissemenation
Currently available
Arthritis Foundation
Exercise Program
Arthritis Foundation
Warm Water Exercise
Program
Arthritis Foundation SelfManagement Program *
Coming
Matter of Balance *
Healthy Eating for
Successful Living in
Older Adults *
Eat Better and Move More
(modified)
Early implementation –
will be expanded
EnhanceFitness Senior
Exercise Program
CDSMP – Chronic
Disease Self Management
Program *
* ”Stanford Model”
program or based on
the Stanford Model in
design
Contact Information
Kari Benson
Minnesota Board on
Aging
[email protected].
us
Kate Houston
Metro Area Agency on
Aging
[email protected]
Pam Van Zyl York
Minnesota Department
of Health, Division of
Health Promotion and
Chronic Disease
[email protected].
mn.us
Debbie Hanka
UCare
[email protected]