Evidence Based Health Programs Learning to Live Well Mary Hertel, RN EBHP Coordinator/Trainer T-Trainer CDSMP, Master Trainer CPSMP and Matter of Balance Central MN Council on Aging (Area Agency on Aging) Thursday May 16, 2013
Information to be presented: What are Evidence Based programs and why are they important Research and demonstrated outcomes How EBP can fit within the patient engagement model, compare/contrast with patient education Overview of specific EBP’s including Stanford Self-Management programs and A Matter of Balance Describe how you or your organization can get more involved
What is Evidence Based health promotion programming? • Simply put it is: programs based on research.
What evidence do we need?
Evidence based:
Why the interest in Evidence Based Programs?
Community Health System Health Care Organization Resources and Policies Clinical Self- Delivery Decision Information Management System Support Systems Support Design Productive Interactions Patient Centered Informed, Prepared, Timely and Efficient Empowered Patient Proactive Coordinated and Family Practice Team Evidence-based and Safe www.improvingchroniccare.org Improved Outcomes
EBPs have Demonstrated Outcomes
Consider: “people with chronic conditions rarely spend more than 1% of their life at a healthcare facility. It is the other 99% of one’s life ‐ when an individual is at home ‐ that determines whether they return to full health or not.”
Chronically ill patients make many daily health decisions: Diet, exercise, medication, when to seek medical care Sometimes make unwise decisions may not fully understand implications of particular health decision may lack support to make better choices
Can Clients Be Engaged? 23% adopted new health behaviors (but unsure could maintain if stressed) Remaining 77%: Remain passive recipients (12%) Lack basic facts to follow treatment recommendations (29%) Have facts, but no skills, confidence (36%) Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self ‐ management behaviors? Health Services Research, 42, 1443 ‐ 1463.
How can Evidence Based Programs help?
Advantages of Evidence Based Programs: • First, they can significantly improve the health and well ‐ being of older adults in the community. • Second, they can help attract new participants and funders through innovative programming. • Third, they can create powerful partnerships with other organizations, including health care providers Evidence ‐ based programming provides value
Evidence Based Programs (using Stanford as example) Stanford University Self Management Programs: • Chronic Disease Self Management (Living Well with Chronic Conditions) • Chronic Pain Self Management • Diabetic Self Management Additional programs: • A Matter of Balance • Tai Chi Moving for Better Balance (Bold= training and technical assistance available from all Area Agency’s on Aging)
Self-Management Differs From Patient Education (but we need both) Patient Education Self ‐ management - Manage life with - Change behaviors disease - Information, - Problem solve and technical skills make decisions - Disease–specific - Improve clients knowledge confidence in abilities to make - Use specific tools changes (e.g., Care Plans, - Increase skills & self- Action Plans) confidence
Self-Management Also Encompasses: The patient and health professional working together. Often involves the family. An holistic approach to care (i.e., medical and psycho-social components of a condition). Pro-active and adaptive strategies that aim to empower the individual.
What is the Stanford Chronic Disease Self ‐ Management Program (CDSMP) “Living Well with Chronic Conditions” Developed by Stanford University’s patient education program Structured 10-15 participants in a six-week workshop series done by 2 certified leaders Participative instruction with peer support Designed to enhance medical treatment Outcome-driven: impacts show potential for reduced or avoided costs Evidence-based: a tested model (intervention) that has demonstrated results
Living Well With Chronic Conditions Workshops (CDSMP) • Curriculum including: • E xercise and nutrition • Medication usage • Stress management and managing fatigue • Talking with your doctor or health professional, family and friends • Evaluating treatment choices • Dealing with emotions, frustration and depression Living Well With Chronic Conditions Workshop
• Goal setting and action planning • Feedback/ problem solving • Cognitive Symptom Management • Symptom management • Physical • Psychological • Emotional CDSMP Techniques
Keys to Success • The format addresses specific problems and goals for people with ongoing health problems. It is not a drop-in support group. • The workshops are not prescriptive. Participants choose their own goals and track their own progress toward success. • Pair of trained peer leaders offer guidance and support, but participants find practical solutions individually and together. Living Well With Chronic Conditions Workshop
Stanford’s CDSMP is Evidence-based Found to benefit targeted populations. Including a decrease in health care costs Demonstrated it does not cause harm. Demonstrated it does not waste resources. CDSMP can facilitate the Triple Aim Goals
Evidence CDSMP participants experienced the following outcomes 6 months after starting the CDSMP program • Increased exercise; • More energy and less fatigue; • Better coping strategies and symptom • Decreased disability; management ; • Fewer physician visits • Better communication and hospitalizations. with their physicians; • Improvement in their self ‐ rated health, disability, social and role Lorig et al., 1999 activities, and health distress;
Chronic Conditions Reported and compiled by MDH • Lung disease 12% • Arthritis/other 54% • Hypertension 51% • AMD 9% • High Chol 36% • Stroke 8% • Chronic Pain 30% • Asthma 6% • Diabetes 24% • Emphysema or COPD 3% • Heart Disease 22% • Parkinson’s • Osteoporosis 20% Disease 3% • Cancer 15% • Kidney disease 2% • Depression 14% • MS 2% • Other 21%
Implementation of CDSMP in Minnesota Current license holders include: • Central MN Council on Aging(Area Agency on Aging) • 5 Area Agencies on Aging covering all of Minnesota • Minnesota Department of Health • Native American Community Clinic: “Living in Balance” • Sanford Health: “Better Choices, Better Health” • Veterans’ Administration Health System
Additional Evidence based programs Stanford programs: Chronic Pain Self Management Program Diabetic Self Management Program Other programs: A Matter of Balance, Managing Concerns about Falls Tai Chi, Moving for Better Balance Highest Tier Evidence ‐ Based Health Promotion/Disease Prevention Programs http://www.ncoa.org/improve ‐ health/center ‐ for ‐ healthy ‐ aging/content ‐ library/Title ‐ IIID ‐ Highest ‐ Tier ‐ Evidence ‐ FINAL.pdf
A Matter of Balance (falls prevention) Developed by: Boston University Matter of Balance is an 8 session/ 2 hours per session, workshop designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. Through these classes, participants learn to: • view falls and fear of falling as controllable, • set realistic goals for increasing activity, • change their environment to reduce fall risk factors and • promote exercise to increase strength and balance. This program has been adapted from the original intervention to be more suitable for community ‐ dwelling older adults by allowing small group sessions to be led by a trained facilitators. Requires 2 Certified trained Leaders Leader training is 2 days Reference: Healy, T. C., Peng, C., Haynes, P., McMahon, E., Botler, J. & Gross, L. The Feasibility and Effectiveness of Translating A Matter of Balance into a Volunteer Lay Leader Model. Journal of Applied Gerontology. (2008) 27 (1): 34 ‐ 51. [Online]: http://www.mmc.org/workfiles/mh_PFHA/JAGarticle.pdf
Chronic Pain Self‐Management CPSMP is a 6 week, 2.5 hours per week workshop developed for people who have a primary or secondary diagnosis of chronic pain. Pain is defined as being chronic or long term when it lasts for longer than 3 to 6 months, or beyond the normal healing time of an injury. During this workshop a variety of topics important to those with chronic pain are covered including: goal setting, relaxation, nutrition, medication management, exercise, communication and problem solving Requires 2 Certified trained Leaders Training is either 4 days or 2 days if CDSMP trained
Diabetic Self‐Management Program DSMP is a 6 week, 2.5 hours per week. This workshop is for people with type 2 diabetes. It teaches the skills needed in the day ‐ to ‐ day management of diabetes and to maintain and/or increase life’s activities. Requires 2 Certified trained Leaders Training is either 4 days or 2 days if CDSMP trained
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