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Implementing the Chronic Disease

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					Implementing the
Chronic Disease Self-
Management Program
(CDSMP) for Employees
of a State Health Unit:
Lessons Learned
Nancy Patton, RN, MS
Ohio Department of Health
Director, Arthritis Program
8th Annual Arthritis Grantee Meeting
Atlanta, Georgia
September 18, 2007
Why Implement at the State Health Unit?
• CDSMP is one of the evidence-based programs
  approved for funding by the CDC Arthritis
  Program

• Bureau of Health Promotion and Risk Reduction
  (BHPRR) seeking opportunities for categorical
  program integration

• Need for Master Trainer candidates to become
  fully certified by teaching two participant
  courses (close to home=less time/cost for
  BHPRR)

• Increase buy-in from upper management by
  familiarizing them with the program and the need
  to implement and embed across the State
Ohio’s 23 New Master Trainer Candidates
February, 2007
Approval Process
• Arthritis Program Supervisor

• Deputy Director, Human Resources
  – State Employee Health Clinics
  – State Employee Health Nurses
  – State Employee Assistance Program
    (behavioral and mental health)


• Individual Participants’ Supervisors
Logistics
• Finding room(s) to hold classes

• Advertising

• Registration process

• Incentives (NOT)
Logistics
• Finding room(s) to hold classes

• Advertising

• Registration process

• Incentives (NOT)
Logistics
•   Finding Room(s) to hold classes
•   Advertising
•   Registration process
•   Incentives (NOT)
Logistics
•   Finding room(s) to hold classes
•   Advertising
•   Registration process
•   Incentives (NOT)
Formal Evaluation
• Stanford University’s standard pre
  and post-program survey tools
• Stanford University’s pre and post
  program “presenteeism” scale
  (future)
Formal Evaluation
• Stanford University’s standard pre
  and post-program survey tools

• Stanford University’s pre and post
  program “presenteeism” scale
  (future)
Informal Evaluation
• Weekly meetings of trainers
• Verbal reports of progress from
  participants during classes
• Unsolicited verbal reports from
  participants to trainers between
  classes
• Post-course meeting with State
  Employee Health Nurse Supervisor
  and Deputy Director of State
  Employee Health and EAP programs
Comparison of Implementation Issues Community
Setting vs. Worksite Setting: Lessons Learned
                                             CDSMP Implementation Issues
                                 State Health Unit Worksite Setting                        Community Setting


Approvals                Approval for participation required by agency and     No prior approval for participation required,
                         supervisor for offerings during work day              self-referred
Participant Cost         Participation may be paid for by employer or a        Participants may need to pay a small fee on
                         small fee may be charged for class materials          their own or be subsidized by a social
                                                                               service agency or organization
Purpose                  Purpose for offering may be altruistic, to increase   Purpose for offering may be altruistic,
                         bottom line via “showing up” for work, being          decrease medical costs, showcase agency,
                         productive while at work and overall job              increase referrals
                         satisfaction
System                                    “Closed” system                                    “Open” system
Characteristics:
                         Strict adherence required to protect employee         Strict adherence required to maintain trust
Confidentiality         from possible discrimination and to maintain trust    within group
                         within group
                         Proximity to other participants during work week,     May be more difficult to contact other
Networking between      contact information readily available, possible       participants due to lack of proximity and
participants             prior contact (+ or -)                                unfamiliarity
                         Readily available from on-site employee class         Available by phone, e-mail or once/week in
Support and follow-up   leaders, EAP, employee health 5 days/week             class
                         Cost-free meeting rooms available but usually not     Cost may be associated with use of space.
Physical and fiscal     the same room every week. Fiscal resources            Location and type of space may not be
resources                available to purchase classroom supplies in bulk      ideal, eg. non-accessible
                         at state discount
Comparison of Implementation Issues Community
Setting vs. Worksite Setting: Lessons Learned (cont.)
                                           CDSMP Implementation Issues
                               State Health Unit Worksite Setting                        Community Setting


                       Advertising opportunities available though           Communication system can be more
Communication         worksite electronic bulletin board, agency           targeted to certain geographic, community,
                       newsletter, and physical employee bulletin boards    demographic characteristics
                       throughout building. Communication between all
                       parties can take place instantaneously.
                       Participants easily contacted for follow-up          Participants may be “lost” to contact
Evaluation
                       Participants may “pair up” with a friend to attend   Classes held outside of work site. Staffing
Participant profile   classes. This may impact work environment, i.e.      not an issue. Participants less likely to have
                       staffing, if both are from same work area.           health background.
                       Participants may have health background.             Work hierarchy not an issue
                       Management and non-management staff in class
                       together
Future Direction and Plans
• Lay Leader Trainings
  – Intermittent Employee Health Nurses
    enroll in training – “time only”
    supported by State Deputy Director of
    Human Resources
  – Partner with local AAA in Toledo area
    to provide Lay Leaders to hold CDSMP
    classes for ODH employees located in
    the Toledo District Office
  – Arthritis Program funding to provide lay
    leader trainings in partnership with the
    Ohio Retired Teachers Assn.