living with chronic conditions: why self- management works in the community and online sue...

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.


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+


Trend: Growing Epidemic of Chronic Diseases

Source: Medical Expenditure Panel Survey, 2006


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


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.


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


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


CDSMP – A Proven Program

Skill-building components Goal setting Brainstorming Problem solving Feedback and sharing


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


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


CDSMP Participant CharacteristicsCharacteristic Percent of Total

Age 60+ 73%

Gender Female 77%

Living Alone 46%

Racial/Ethnic Minority Group 32%

Multiple Chronic Conditions 62%


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


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


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


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


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


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


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/

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=n0yD01eesLL6sM&tbnid=xsn9E2W6KC13TM:&ved=0CAUQjRw&url=http://simonmainwaring.com/facebook/where-to-start-if-your-brand-wants-to-build-an-online-community/&ei=W-W6UeXOEM2ZqQHm6ID4Aw&bvm=bv.47883778,d.aWc&psig=AFQjCNFDut14ieETjBIMwdwulg1APasadQ&ust=1371289296879977


Suite of online self-management programs

Cancer: Thriving and Surviving


Core Self-Management Concepts

Systematically use the following strategies to enhance self-efficacy:

• Goal Setting• Modeling• Reinterpretation of Symptoms• Social Persuasion

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=F5ua6Q8KPRq-YM&tbnid=8yysKIGIQKyfIM:&ved=0CAUQjRw&url=http://www.glassdoor.com/blog/goal-setting-enhance-career/&ei=puW6UZQTxo6qAfe3gIAH&bvm=bv.47883778,d.aWc&psig=AFQjCNF5eg3YXDsZFoHmm7IZXCld7ITXrw&ust=1371289370318786


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


Getting started at www.restartliving.org


Demo

24


Workshop Invitation

25


Secure Enrollment


Participant Consent


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


Visit Us Online!

www.ncoa.org/cha

http://www.ncoa.org/cha


Questions?

Katy [email protected]

Sue [email protected]

mailto:[email protected]



living with chronic conditions: why self- management works in the community and online sue...

Documents

advocacy organization

nonprofit service

aging ncoa national

aging trend

depression slide

cdsmp cdsmp participants

aging look whos

aging key risks