Chronic Disease Self-Management Program (CDSMP) Evidence-based Chronic Disease Self-Management Program for Older Adults

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1 Chrnic Disease Self-Management Prgram (CDSMP) Evidence-based Chrnic Disease Self-Management Prgram fr Older Adults Prgram Apprved by AA, CDC, and NCOA Web Site Prgram Synpsis Year Prgram First Implemented in Cmmunity Settings: Early 1990s General descriptin f prgram CDSMP is a lay-led participant educatin prgram ffered in cmmunities in the United States and several ther cuntries. Participants are adults experiencing chrnic health cnditins such as hypertensin, arthritis, heart disease, strke, lung disease, and diabetes; their family members, friends and caregivers can als participate. The prgram prvides infrmatin and teaches practical skills n managing chrnic health prblems. The CDSMP gives peple the cnfidence and mtivatin they need t manage the challenges f living with a chrnic health cnditin. Prgram gal The verall gal is t enable participants t build self-cnfidence t take part in maintaining their health and managing their chrnic health cnditins. Reasning behind the prgram design and elements: Peple with chrnic cnditins have similar cncerns and prblems; Peple with chrnic cnditins must deal nt nly with their disease(s), but als with the impact n their lives and emtins; Lay peple with chrnic cnditins, when given a detailed leader's manual, can teach the CDSMP as effectively, if nt mre effectively, than health prfessinals (Lrig et al, 1999); The prcess r the way the CDSMP is taught is as imprtant, if nt mre imprtant, than the subject matter that is taught. Target ppulatin Adults with chrnic diseases Essential prgram cmpnents and activities The CDSMP fcuses n prblems cmmn t individuals suffering frm chrnic diseases. Cping strategies such as actin planning and feedback, behavir mdeling, prblem-slving techniques, and decisin making are applicable t all chrnic diseases. Individuals are taught t cntrl their symptms thrugh: Relaxatin techniques; Healthy Eating; Managing sleep and fatigue; Manage Medicatins;

2 Exercise; Cmmunicatin with health prviders. Length/Timeframe f prgram 2.5 hurs per week ver a 6 week perid. Recmmended class size peple Desired utcmes Increases in healthy behavirs (i.e., exercise and cgnitive symptm management techniques, such as relaxatin); Psitive changes in health status (less pain, fatigue, and wrry; less health distress); Increased self-efficacy; Better cmmunicatins with health prviders; Fewer visits t physicians and emergency rms. Measures and evaluatin activities There are several utcme evaluatin tls available that range frm detailed utcme evaluatin questinnaires t simple (whether and hw successfully participants are fllwing their actin plans). Health Outcmes and Evidence Supprting Health Outcmes Over a perid f 2 years, Agency fr Healthcare Research and Quality (AHRQ)- funded investigatrs cmpared health behavirs, health status, and health services use in patients age 40 t 90 years (average age, 65) wh had cmpleted the CDSMP (Lrig et al., 1999). When cmpared t baseline measures taken fr the 6 mnths prir t the CDSMP, researchers fund that CDSMP participants had: Increased exercise; Better cping strategies and symptm management; Better cmmunicatin with their physicians; Imprvement in their self-rated health, disability, scial and rle activities, and health distress; Mre energy and less fatigue; Decreased disability; Fewer physician visits and hspitalizatins. Lrig et al. (2001a) fund that after 1 year, CDSMP participants had: Significant imprvements in energy, health status, scial and rle activities, and self-efficacy; Less fatigue r health distress; Fewer visits t the emergency rm; N decline in activity r rle functins, even thugh there was a slight increase in disability after 1 year. In the same study by Lrig et al. (2001a), after 2 years CDSMP participants had: N further increase in disability; 2

3 Reduced health distress; Fewer visits t physicians and emergency rms; Increased self-efficacy. The increase in patients' perceptins f their self-efficacy was assciated with reduced health care use (Lrig et al., 2001a). Self-efficacy, the degree f belief peple have that they can perfrm the behavir required t prduce a desired utcme, is crucial t the success f the CDSMP (Lrig et al., 1999). The mre selfefficacy peple have, the mre cntrl they believe they have ver their behavir (Lrig et al., 1999; Lrig, Maznsn, & Hlman, 1992). Therefre, increasing selfefficacy cntributes t better decisinmaking prcesses, strnger mtivatin, and perseverance (Lrig et al., 1992). Prgram Csts Training fees: At Stanfrd University Fr the 4½ day CDSMP Master Training, including all instructin, ne set f all materials, and breakfast fr 5 days, lunch fr 4 days and ne evening banquet, $1,600 per health prfessinal r $900 fr a lay persn with chrnic disease. CDSMP bks (~$19 each) and relaxatin tapes/cds (~$12 each) are required fr each CDSMP class participant. Off-SiteTraining Training by Stanfrd at a site ther than Stanfrd fr CDSMP is $16,000 fr 4½ days f Master training. Fr additinal training cst infrmatin, please see the Stanfrd Patient Educatin website at Licensing fees: Licenses are ffered at the fllwing rates: $ fr ffering 10 r fewer wrkshps a year $1,000 fr ffering 30 r fewer wrkshps a year Every rganizatin ffering a Stanfrd prgram must purchase a license fr that prgram. If mre than ne prgram is being ffered, the rganizatin must have a license fr each prgram. A multiple-prgram license is available. Each license is gd fr 3 years frm the date f issue. Renewal is mandatry if an rganizatin wishes t cntinue CDSMP prgram fferings beynd the license term. Every licensed rganizatin must make a yearly reprt (due n the anniversary f riginal license agreement) t Stanfrd. The reprt shuld: state the number f wrkshps ffered during the past year; dates f each wrkshp and number f participants; identify the leaders f each wrkshp and number f leader trainings cnducted; state the number f trainings fr Master Trainers. 3

4 Fr ther licensing details, including dwnladable applicatins, visit: Prgram Savings The CDSMP saved frm $390 t $520 per patient ver a 2-year study perid because participants used fewer health care services. CDSMP participants used less hspital and physician services than they had used befre participating in the prgram, and less than thse wh had nt participated in the CDSMP cntrl grup (Lrig et al., 1999; Lrig et al., 2001a). Specifically, researchers fund that hspitalizatin rates fr CDSMP participants did nt increase ver the 2-year duratin f the study. Fr example, during the first 6 mnths, CDSMP participants were hspitalized fewer days than they had been during the 6 mnths befre they began the prgram. (Lrig et al., 2001a). CDSMP participants als had 2.5 fewer visits t the emergency rm and their physicians (Lrig et al., 2001a). The CDSMP cst between $70 and $200 per persn t administer. After subtracting csts frm the savings due t lwer health services use, the ttal amunt saved as a result f the CDSMP ver a 2-year perid was estimated at $390 t $520 per persn (Lrig et al., 1999; Lrig et al., 2001a). Further evidence f the effectiveness f the CDSMP can be fund in a study funded by Kaiser Permanente (Lrig, Sbel, Ritter, Laurent, & Hbbs, 2001b). Kaiser CDSMP participants had fewer visits t the emergency rm and fewer hspital days cmpared t the year prir t cmpleting the CDSMP. As a result, they reduced their health care csts. (2001b). Kaiser Permanente paid apprximately $200 per participant fr CDSMP training, materials, and administratin. With 489 participants, Kaiser's ttal cst was $97,800. Hwever, if the cst t care fr each participant decreased $990 because participants used fewer health services, Kaiser Permanente's net savings wuld be nearly $400,000 (Lrig, Sbel, Ritter, Laurent, & Hbbs, 2001b). Resurce Requirements Wrkshps can be ffered in cmmunity settings such as senir centers, churches and hspitals. A flipchart and markers are required fr each class. Training Requirements Instructr training Facilitatr trainings fr representatives f health care rganizatins run 4½ days per prgram and are held at Stanfrd University. It is strngly suggested that health prfessinals bring a lay persn with chrnic disease with them. All wrkshps and trainings are designed t be facilitated by 2 peple. Each trainee receives a detailed leader's manual, and a cpy f the wrkshp's textbk and audi CDs (if applicable). Thse being trained as Master Trainers (trainers f leaders) will als receive a trainer's manual and a prgram implementatin tl kit. Stanfrd can als cme t yu, prviding tw Stanfrd trainers t train up t 26 Leaders and/r Master Trainers at an rganizatin s facility. Lcal Master Trainers can then serve as an 4

5 rganizatin s n-site trainers fr the future. Such training may be shared amng multiple rganizatins t reduce csts, if desired. Instructr certificatin required? Yes Instructr qualificatins Instructrs must be health prfessinals, r lay leaders r with a chrnic health prblem. Instructrs must be able t cmplete the CDSMP training. Number f instructrs required per class Tw. Wrkshps are facilitated by a team f tw trained leaders, pairing either tw lay leaders, r a health prfessinal and a lay leader wh has a chrnic disease. 5

6 References Cst Data: Stanfrd Patient Educatin Research Center, Stanfrd University Schl f Medicine, Department f Medicine. Chrnic Disease Self-Management Prgram Web site: Summaries f Outcme Data: Preventing Disability in the Elderly With Chrnic Disease. Research In Actin, Issue 3. AHRQ Publicatin N. 02-0O18, April Agency fr Healthcare Research and Quality, Rckville, MD. Stanfrd Patient Educatin Research Center, Stanfrd University Schl f Medicine, Department f Medicine. Chrnic Disease Self-Management Prgram Web site: Original utcme data: Lrig K.R., Maznsn P.D., Hlman H.R. (1992). Evidence suggesting that health educatin fr self-management in patients with chrnic arthritis has sustained health benefits while reducing health care csts. Arthritis Rheum, 36(4): Lrig K.R., Sbel D.S., Stewart A.L., Brwn Jr. B.W., Ritter P.L., Gnzález V.M., Laurent D.D., Hlman H.R. (1999). Evidence suggesting that a chrnic disease selfmanagement prgram can imprve health status while reducing utilizatin and csts: A randmized trial. Medical Care, 37(1):5-14. Lrig K.R., Ritter P., Stewart A.L., Sbel D.S., Brwn B.W., Bandura A., Gnzález V.M., Laurent D.D., Hlman H.R. (2001a). Chrnic Disease Self-Management Prgram: 2-year health status and health care utilizatin utcmes. Medical Care, 39(11), Lrig K.R., Sbel D.S., Ritter P.L., Laurent D., Hbbs M. (2001b). Effect f a selfmanagement prgram n patients with chrnic disease. Effective Clinical Practice, 4(6), This prgram verview was prepared by Ellen Schneider, Assciate Directr fr Operatins and Cmmunicatins, UNC Institute n Aging. Fr further prgram infrmatin, please visit the prgram web site listed n page 1. We extend ur thanks t Katy Plant, Stanfrd Patient Educatin Research Center, fr reviewing this summary and t the NC Area Agency n Aging directrs fr their assistance in designing the frmat fr this dcument. 6