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                    Healthy Aging Briefing Series

 Chronic Disease Self-Management Program


             This session will begin promptly at 1:30pm EST
                         Please mute your phone

                      Personal introductions are not necessary
                      The moderator will be on the line shortly
Health Aging Briefing Series

     Partners on the P.A.T.H.
 (Personal Action Toward Health)
 Chronic Disease Self-Management

            November 16, 2006

           Bonnie Hafner RN, BSN
  Area Agency on Aging of Western Michigan
        Partners on the P.A.T.H.
    Chronic Disease Self-Management
   Session Objectives:

       Outline the core component of the Stanford Chronic
        Disease Self-Management Program

       Discuss a model for implementation in the community

       Review program and participant outcomes
    Chronic Disease: The Scope of
            the Problem
   Chronic Disease is the leading cause of death and
    disability among Americans and accounts for 70% of
    all deaths in the US
   87% of persons aged 65 and over have at least one
    chronic condition; 67% have two or more
   25% of the senior population with chronic conditions
    are limited in their ability to perform activities of
    daily living as a result of these conditions
   99% of Medicare Spending is on behalf of
    beneficiaries with at least one chronic condition.
    What is a Self-Management

   Self-Management Education

       Participant learns how to act on problems

       Participant learns how to identify problems

       Participant learns how to generate short-term action plan

       Participant learns problem-solving skills related to
        chronic conditions in general
            Partners on the P.A.T.H.
          (Stanford Model of CDSM)
   Series of 6 sessions, 1 session per week, 2-1/2 hours per
    session held in community settings
   Highly scripted; designed to be lay-led; two leaders
    facilitate each class. Ideally, at least one facilitator also
    has a chronic condition. Peer modeling is a core
   Includes workbook, audiotape
   Groups are small (10-16 people); information-sharing,
    interactive learning activities, problem-solving, decision-
    making, social support for change
   Weekly action plans and feedback
          Partners on the P.A.T.H.
          (Stanford Model of CDSM)
   Subjects covered include:
       Dealing with frustration, fatigue, pain and isolation
       Exercise for maintaining and improving strength,
        flexibility and endurance
       Appropriate use of medication
       Communicating effectively with family, friends and
       Nutrition
       Evaluating new treatments
           Partners on the P.A.T.H.
          (Stanford Model of CDSM)
   Proven effective per research completed in 1996
       Improved health status (significant improvements in
        disability, fatigue, social/role limitations, self-
        reported general health)
       Decreased health care utilization (spent fewer days in
        the hospital, trend toward fewer outpatient visits and
       Improved health management behaviors (significant
        improvements in exercise, cognitive symptom
        management, communication with physicians)
Project Partners and Roles- AoA- funded Evidence
Based Prevention Program Initiative for the Elderly
    Area Agency on Aging of Western Michigan- overall
     coordination; receipt and distribution of funds
    Community Aging Service Providers- (CASP) 4 aging service
     providers serving diverse high risk populations; as trained lay
     leaders- taught CDSMP classes, participated in recruitment of
     participants and host sites, assisted with completion of
     participant outcome surveys; trained in Motivational
     Interviewing and Stages of Change
    Grand Valley State University- evaluation and research
    Priority Health (Health Maintenance Organization)-
     recruitment of members to classes; assist with introduction
     and adoption of CDSMP into health care provider system
    Other
         Why We Chose This Model
   Well developed and tested
   Lay-led model allowed us to use CASP staff to implement
    along with lay peer leaders
   Fit closely with mission of all partners
   Model embracing all chronic conditions allowed a broad base
    of potential partners, recruitment opportunities and sites
   Allowed CASP staff to increase their ability to respond to
    health issues as they already do for financial and social issues
   Assisted CASP staff to respond to issues from an empowering
    perspective, incorporating stages of change training
   Model was well-known to our health care partner and strongly
    supported their commitment to implement self-management
    strategies as described in the Chronic Care Model of Health
    Care Delivery
    Partners on the PATH (Stanford CDSMP)
       Adaptations to the Original Model
   Used CASP staff to implement program paired with lay leaders

   Outcome surveys completed at baseline, immediately after
    classes and 6 months after classes

   CASP staff followed participants for 6 months after classes
    completed (until final survey done)

   Population focused on adults 60+ with one or more of four
    diagnoses: arthritis, chronic lung disease, diabetes or
    cardiovascular disease
             Stanford CDSMP
Planning- What Do You Need to Get Started?
    Master Trainers- can teach classes and train lay leaders- must
     complete a 4-1/2 day training per Stanford staff

    Peer Leaders- complete a 4-day training taught by 2 Master
     Trainers- can teach classes

    Stanford license- each organization teaching the Stanford CDSMP
     must purchase a license from Stanford

    Training materials- Books and tapes for participants and lay

    Other- Host sites, referral system, marketing materials,
       Adoption-Recruiting Community
    Organizational Support, Training Sites
   Appropriate Sites: Any place where older adults congregate

   Any agency that works with adults
       interested in promoting optimal health
       fostering empowerment

   Sites include: senior centers, meal sites, aging service
    providers, senior housing sites, churches, salvation army

   Adopting organizations can include local health department,
    health care organizations/systems , university extension
    programs, diabetes outreach networks, parish nurses

   Exploring YMCA (especially those with senior programming,
    arthritis classes), physician groups, disease-specific
     Recruiting Implementation Sites
             Lessons Learned
   Meet with the manager of the site to discuss benefits of
    the program, expectations and gain support.

   Ask for the informal “leader” of the older adult group.

   Choose a place where the infrastructure for meetings is
    in place.

   Consider parking, accessibility

   Choose sites that older adults are comfortable coming to.
Reach- Outreach- Recruiting Participants
(The toughest, most time-consuming part)
   Community Outreach
       Reaching high risk, diverse older adult populations
       Strongest response-
         •   approach already formed groups of older adults
         •   find a “champion” ; identify a “trusted” member of the group
         •   meet them where they normally gather, offer incentives
         •   sell the program in “steps”, starting with introductory sessions
         •   Talk about “what's in it for them”
         •   Keep an “interest list” as mailing list for future class schedules
       Word of Mouth
       Senior Centers, churches, meal sites, senior apartments, health clinics,
        health fairs
       Brochures, posters
       Media-radio, TV, newspaper articles- use success stories
   Health Care Plan Referral
       3000 letters
   Physician Referral-approaches, challenges
    Implementation, Fidelity and the
           Stanford CDSMP
   Maintain fidelity to the core components of the
       training per Stanford guidelines
       built-in quality/fidelity check-points
       scripted weekly sessions

   Tips
       Buddy new trainers with experienced ones
       Set up mechanism for class materials, marketing
        materials, evaluations, class attendance and fidelity
        policies, scheduling and approaching sites
    Implementation, Fidelity and the
           Stanford CDSMP
   Choose lay leaders carefully
       Believes in and understands the benefit of the program
       Positive role model in terms of how they manage their
        chronic disease
       Good listener, non-judgmental
       Comfortable in front of a group
       Can read and follow a script
       Can understand the importance and purpose of fidelity
       Understands the time commitment
       Short job description and brief interview?
       Offer incentives—small stipend, mileage for attending
        training and teaching sessions
       We used a mixture of CASP staff and lay leaders
       Previous PATH participants could be good choice
        Implementation, Fidelity and the
               Stanford CDSMP
   Training and support of lay leaders
       Training at least once a year, up to 20 per training
       Need 2 master trainers, leader manuals, participant
        workbooks and tapes, organizational licenses, 2 rooms, 2
        easels with paper and marking pens, tape/CD player,
        lunches provided for 4 days
       Master trainer observation of leaders teaching their first
        classes before final approval given
       Meet with the leaders on the last day to go over logistics
        (getting materials, marketing sites, paperwork and
        evaluations, where to go for support)
       Offer regular support, especially in the beginning and at
        least once a year thereafter for ongoing training,
        appreciation and refresher
    Effectiveness: Participant Outcome
   With complete data at baseline and follow up for 170 people,
    P.A.T.H. participants demonstrated significant changes in:
        minutes of aerobic exercise
        cognitive symptom management
        pain
        health distress
        fatigue
        shortness of breath
        Increases in health care utilization were noted. We are examining
         outliers that may have affected this data.
    *Some changes were not significant until 6-months after classes
    *Using an abbreviated survey post-research
    *Allow plenty of time and additional assistance for survey completion, depending on literacy
     of participants

   Other program measures…
        Costs of implementation
   One-time costs                        Recurring costs
       Training 2 Master Trainers            Stanford relicensure
        (Spanish and English)                 Lay leader trainings
       Participant materials (books          F/U MT observation of lay
        and tapes)                             leaders
       Training supplies                     Cost of actual PATH
       Staff time for prep-                   workshops
        permanent charts                      Marketing
       Translation (Spanish)                 Recruitment time
       Infrastructure                        Ongoing staff training
                                              Admin/staff time
   Recruit new partners and explore new potential
    sources of funding
       Older American Act funding
       Local Millage funding for classes
       Possible 3rd party payment (Insurance, Medicare)
       Millage-funded Health Promotion Coordinator for Kent
       Kent County PATH Group
            Dissemination /Partnership
   Statewide PATH expansion
       Michigan Partners on the P.A.T.H.
         • MDCH, OSA, MSU Extension, TENDON, Med-Net-One

       Expansion into an adjacent AAA Region

       Embedding EBHP assessment and referral into the four
        Michigan ADRC demonstration projects
What participants say…

  “I liked it because it was a discussion-type program, not just a
  person lecturing. By sharing, people help each other. Setting
  goals with the group helped motivate me.”
                              Eunice W.

“PATH was a good thing for me. It made me set goals. I wanted
  to walk two miles a week and I did it. PATH gave me the
  incentive to live fully on a daily basis and eat the right foods.
  Now I’m doing the stuff I feel I need to do.”
                                      Melissa G.

Stanford Web site:

The Expert Patient Programme:

Contact Information:
Bonnie Hafner
Area Agency on Aging of Western Michigan
1279 Cedar NE
Grand Rapids, MI 49503
(616) 222-7026

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