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Living with Chronic Conditions: Why Self-Management Works
in the Community and Online
Sue Lachenmayr and Katy Plant
2A nonprofit service and advocacy organization © 2012 National Council on Aging
NCOA - National Council on Aging
NCOA is a nonprofit service and advocacy organization.
Our mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged.
3A nonprofit service and advocacy organization © 2012 National Council on Aging
Look Who’s Already Here and Who’s Coming
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 20500
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
Population 60+ by Age: 1900-2050Source: U.S. Bureau of the Census
Age60-64
Age65-74
Age75-84
Age85+
Num
ber o
f Per
sons
60+
4A nonprofit service and advocacy organization © 2012 National Council on Aging
Trend: Growing Epidemic of Chronic Diseases
Source: Medical Expenditure Panel Survey, 2006
5A nonprofit service and advocacy organization © 2012 National Council on Aging
Key Risks for Chronic Conditions
Smoking Poor diet & nutrition Physical inactivity Falls Alcohol & substance abuse Stress Social isolation
30%:genetics, access to health care, etc.
70%: behavior&environmentalfactors
6A nonprofit service and advocacy organization © 2012 National Council on Aging
Chronic Disease Self-Management Assumptions
People with different chronic diseases have similar self-management problems and disease-related tasks.
Individuals can learn to take day-to-day responsibility for their diseases.
Confident, knowledgeable people practicing self-management will experience improved health status and use fewer health resources.
7A nonprofit service and advocacy organization © 2012 National Council on Aging
Stanford University’s Chronic Disease Self-Management Program (CDSMP) Background
Over 20 years of proven impact ‘Gold standard’ of evidence-based
programming Offered locally and worldwide
8A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP – A Proven Program
Program basics Six weekly sessions Peer facilitated Opportunities for discussion and problem solving
Workshop topics include: Exercise and nutrition Medication usage Stress management Talking with your doctor Dealing with emotions and depression
9A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP – A Proven Program
Skill-building components Goal setting Brainstorming Problem solving Feedback and sharing
10A nonprofit service and advocacy organization © 2012 National Council on Aging
160,000 + participants enrolled in CDSMP
CDSMP Participants Reached
2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-20130
10,000
20,000
30,000
40,000
50,000
60,000
3,6369,273
12,19216,486
51,005 51,397
41,340
CDSMP Participants Reached/Projected
11A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP Implementation Sites
More than 11,500 workshops held at nearly 7,000 unique implementation sites
22%
24%
17%
8%
29%
% of Workshops
Senior CenterHealth Care Organiza-tionResidential FacilityFaith-Based Organiza-tionOther
12A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP Participant CharacteristicsCharacteristic Percent of Total
Age 60+ 73%
Gender Female 77%
Living Alone 46%
Racial/Ethnic Minority Group 32%
Multiple Chronic Conditions 62%
13A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP Participants - Chronic Conditions
Multiple
Hyperte
nsion
Arthriti
s
Diabetes
Depression
Lung D
isease
Heart Dise
ase
Osteoporo
sis
Cance
r
Stroke
Other
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
62.4%
45.2% 41.9%31.9%
21.6% 17.3% 16.2% 13.2% 9.5% 5.3%
24.7%
% of Participants
% of Participants
14A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP: Better Care
BaselineMean
12-monthMean % Improvement†
Communication with MD (0~5) 2.6 2.9 9%**
Medication compliance (0~1) 0.25 0.21 12%**
Health literacy (Confidence filling out medical forms) (0~4) 3.0 3.1 4%**
Notes. † These statistics control for covariates gender, age, race/ethnicity, education, number of chronic conditions. Indicates that larger scores are better for this measure Indicates that smaller scores are better for this measure. **p<0.01, *p<.05
15A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP: Better Outcomes
BaselineMean
12-monthMean
%Improvement†
Self-assessed health (1~5) 3.2 3.0 5%**
PHQ depression (0~3) 6.6 5.1 21%**
Quality of life (0~10) 6.5 7.0 6%**
Unhealthy physical days (0~30) 8.7 7.2 15%**
Unhealthy mental days (0~30) 6.7 5.6 12%**
Notes. † These statistics control for covariates gender, age, race/ethnicity, education, number of chronic conditions. Indicates that larger scores are better for this measure Indicates that smaller scores are better for this measure. **p<0.01, *p<.05
16A nonprofit service and advocacy organization © 2012 National Council on Aging
CDSMP: Lower Health Care Costs
Baseline 12-monthAdjusted Ratios†
Percentage with Emergency Room (ER) Visits in the Past 6 Months* 18% 13% 0.68**
Number of ER visits among those with any ER visit 1.5 1.4 1.00
Percentage Hospitalized in the Past 6 Months 14% 14% 1.01
Number of hospitalizations among those with any hospitalization 1.4 1.4 1.00
Notes. † Odds Ratio or Mean Ratio after controlling for covariates gender, age, race/ethnicity, education, number of chronic conditions. Indicates that larger scores are better for this measure Indicates that smaller scores are better for this measure. **p<0.01, *p<.05
17A nonprofit service and advocacy organization © 2012 National Council on Aging
Where To Go For Resources If You Are Offering Programs
Title III D of the Older Americans Act Language requires that funds be used for “programs and activities
which have been demonstrated through rigorous evaluation to be evidence-based and effective.”
Embedding within systems Senior housing Department of Corrections Veterans Administration
Integration with other state and regional initiatives State Units on Aging/Area Agencies on Aging Department of Public Health Multicultural/Minority Health Mental Health and Substance Abuse SCSEP
18A nonprofit service and advocacy organization © 2012 National Council on Aging
Where To Go For Resources If You Are Offering Programs
Partnerships with health care providers/systems State Health Insurance Assistance
Program Federally Qualified Health Centers Care Transitions Initiatives Patient-Centered Medical Homes Other ACA Initiatives
19A nonprofit service and advocacy organization © 2012 National Council on Aging
Where To Start If You Want to Get Involved
As a Participant As a Workshop Leader As a Program Provider
http://restartliving.org http://patienteducation.stanford.edu/organ/
20A nonprofit service and advocacy organization © 2012 National Council on Aging
Suite of online self-management programs
Cancer: Thriving and Surviving
21A nonprofit service and advocacy organization © 2012 National Council on Aging
Core Self-Management Concepts
Systematically use the following strategies to enhance self-efficacy:
• Goal Setting• Modeling• Reinterpretation of Symptoms• Social Persuasion
22A nonprofit service and advocacy organization © 2012 National Council on Aging
Online workshop characteristics
Six-week workshop; new workshop session starts each week
20-25 participants
Highly interactive (discussion boards)
Participants log on several times a week for a total of 2-3 hours each week• No “real time” commitment
Peer led by two Facilitators and monitored by a Mentor
23A nonprofit service and advocacy organization © 2012 National Council on Aging
Getting started at www.restartliving.org
24A nonprofit service and advocacy organization © 2012 National Council on Aging
Demo
24
25A nonprofit service and advocacy organization © 2012 National Council on Aging
Workshop Invitation
25
26A nonprofit service and advocacy organization © 2012 National Council on Aging
Secure Enrollment
27A nonprofit service and advocacy organization © 2012 National Council on Aging
Participant Consent
28A nonprofit service and advocacy organization © 2012 National Council on Aging
Workshop Demo
• Now we will take a look at a Better Choices Better Health workshop set to session 2 of 6
• Interested in offering online workshops?
28
29A nonprofit service and advocacy organization © 2012 National Council on Aging
Visit Us Online!
www.ncoa.org/cha
30A nonprofit service and advocacy organization © 2012 National Council on Aging
Questions?
Katy [email protected]