Stanford Self-Management Programs Effectiveness and Translation Kate Lorig, RN, DrPH Stanford Patient Education Center 1000 Welch Road, Suite 204 Palo Alto CA 94304 650-723-7935 self-management@stanford.edu http:// patienteducation.stanford.edu
Self-Management: What Is It? Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with the medical management, role management, and emotional management of their conditions. Institute of Medicine 2004
How Self-Management Differs From Patient Education Self-Management To Manage Life Including, medical, role and emotional management To Increase Skills/Self- Confidence Patient Education To manage disease by Changing disease related Behaviors To Increase Knowledge To Problem Solve Using many tools To Use Specific Tools
Stanford Self-Management Programs Built on structured patient and professional needs assessments (usually focus groups) Systematically use strategies to Systematically use strategies to enhance self-efficacy Skills Mastery Modeling Reinterpretation of Symptoms Social Persuasion Use of self-tailoring
Stanford Self-Management Programs Basic Structure Peer led small groups & online Standardized training for leaders Highly structured teaching protocol 6 week/ 2.5 hours per week Standardized participant materials Several topics per session Available in several languages
Stanford Self-Management Programs What is Taught Managing symptoms-(pain, fatigue, depression, shortness of breath) Exercise Relaxation Techniques Healthy Eating Communication Skills Medication management Problem Solving Action Planning
The Evidence What we think we know Examples of different modes, populations, and interventions
CDC Meta-Analysis CDC commissioned 2 meta-analyses of the Stanford Programs ( Chronic Disease and Arthritis) 50 studies, conducted in English speaking countries (US, Canada, England, Australia)
CDC Meta-Analysis Findings Participants reported significant improvements in health behaviors and health status, for up to 10 months after the intervention ended Report in Review at CDC
CDC/NCOA Review Summary of 13 CDSMP studies conducted by a variety of investigators CDSMP results in significant, measurable improvements in patient outcomes and quality of life. CDSMP saves enough through reductions in health care expenditures to pay for itself within the first year
Chronic Disease Self-Management Program Demographic Data Age 62 (40-89) years Male 27% Education 14 years No. Diseases 2.2 Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),1217-1223, 2001.
Chronic Disease Self-Management 6-Month Improvements in Health Outcomes Self-Rated Health Self-Rated Health Disability Social and Role Activities Limitations Energy/Fatigue Distress with Health State
Chronic Disease Self-Management Improvements in Utilization and Costs Average.8 fewer days in hospital in the past six months (p=.02) Trend toward fewer outpatient and ER visits (p=.14) Estimated cost of intervention $300
Better Choices Better Health (online CDSMP) What Is Special? Entirely on-line Larger class size - 20-25 people New session starts each week No real time commitment - asked to log on 2-3 times a week Highly interactive (discussion boards)
Online Study: Characteristics Age: 52 years (22-89) Education: 16 years (8-23) Female: 90% Married: 68% Caucasian: 93% Access: 95% logged on either at home or at work Lorig K, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease selfmanagement: A randomized trial. Med Care 2006;44(11):964-971
1 year Improvements Treatment (n= 354) vs. Controls (N=426) Health distress Fatigue Shortness of breath Pain Exercise Practice Stress Management Self-efficacy *all p<.05
Summary What We Think We Know Across conditions, populations, and ages improvements in health status and health behaviors Changes in utilization are less consistent but appear in many studies. At worst programs are probably cost neutral.
What We Think we Know Self-Management Programs can affect quality of life, costs, and behaviors. Programs can be offered in different modes Peers can be trained to deliver successful programs
Translation What is happening now http://patienteducation.stanford.edu
Infrastructure Stanford Licenses program to organizations 523 active licenses in US; 246 International) Established training structure 2329 Master Trainers National Council on Aging Technical Assistance Center Fidelity and Implementation Manuals http://patienteducation.stanford.edu
The Numbers for the Past Year 40,000 participants- 73% attended 4 or more sessions Available in 49 states Program offered in 700 counties, at 5,600 sites 30 countries 18 languages
Recommendations Consider using the CDSMP or other generic delivery model with specialized education available in various formats Study the effectiveness of generic vs. specific education for people with epilepsy.
Questions and Discussion Please!! http://patienteducation.stanford.edu