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Stanford Chronic Disease
Self-Management Program
Kate Lorig, RN, DrPH
 Joined Stanford in 1979 as a Cal
Public Health graduate student
 Developed the Arthritis SelfHelp Course
 Directs the Stanford Patient
Education Research Center
Original Research 1991-1996
 RCT funded by Agency for Health Care
Research & Policy and CA Tobacco
Money
 Purpose: To develop and evaluate a
community-based, self-management
program that assists people with
chronic illness
Tested Program Features
 Based on self-efficacy: the confidence
one has that he/she can master a new
skill or affect one’s own health
 Workshop content was derived from
focus groups of people with CI
Tested Program Process
 17-hour program taught by a team
 CI Content:
• Manage symptoms
• Adhere to medication regimens
• Communicate with providers
• Maintain functional abilities
Tested Outcomes
 Health Status
 Health Utilization
 Self-efficacy
 Self-management behaviors
Original Study Results at 6 Months
 Increased Exercise
 Better Coping Strategies and Symptom Management
 Better Communication with Physicians
 Improved Self-Rated Health, Disability, Social &
Role Activities and Health Distress
 More Energy, Less Fatigue & Decreased Disability
 Fewer MD Visits and Hospitalizations
Original Study Results at 1 Year
 Significant improvements in energy,
health status, social & role Activities
and self-Efficacy
 Less fatigue or health distress
 Fewer visits to the ER
 No decline in activity or role functions
Original Study Results at 2 Years
 No Further Increase in Disability
 Reduced Health Distress
 Fewer Visits to MDs and ERs
 Increased Self-Efficacy
Original Study
Demonstrated Cost Savings
 Reduced hospitalizations, hospital
days, ER visits and MD visits resulted
in reduced health care costs
 Program costs = $70 to $200 per
person
 Program savings = $320 to $520 per
person
CDSMP Outcomes
Outcome Category
Self-efficacy
Psychological Health
Status
Physical Health
Status
Health Behaviors
Healthcare utilization
Health Outcome
Greater self-efficacy
Improvements in C1 self efficacy
Better psychological wellbeing
Improvements in mental stress management
Improvements in frequency of cognitive symptom management
Greater energy
Lower health distress
Considerably greater health-related quality of life
Significant improvements in mental stress
Significant improvements in shortness of breath
Significant improvements in pain/physical discomfort
Significant improvements in activity limitation
Improvement in disability
Improvement in depression
More exercise and relaxation
Significant improvements in eating breakfast
Significant improvements aerobic exercise
Fewer hospitalizations
Fewer days of hospitalizations
Fewer visits to physicians and ERs
Self-rated health
Significant improvements in self-reported health
Social role /
limitations
Fewer social role limitations
Better communication with physicians
Improved participation in social/role activities
Greater partnership with clinicians
Stanford Chronic Disease SelfManagement Education Programs
 Chronic Disease Self-Management
Program
 Diabetes Self-Management Program
 Arthritis Self-Management Program
 The Chronic Pain Self-Management
Program
 The Positive Self-Image Program
 Spanish language programs
Delivery of CDSMP
 Program is scripted and delivered by
trained leaders
T-Trainers
Master Trainers
Program Leaders
CDSMP “HEALTHIER LIVING”: About
the Program
 Designed to help people better manage
chronic health conditions and live a
happier, healthier life
 Six-week workshop
 Highly scripted and structured to protect
fidelity
 Group format–typically led by 2 peers
Workshop Overview
 Managing symptoms
 Dealing with difficult






emotions
Improving communication
Relaxation techniques
Tips for eating well
Effective problem-solving
Develop a tool box
Setting weekly goals
Supports “Healthy Behavior” Change
 Make the new behavior as easy to do as possible
and help participants develop individualized action
plans or routines
 Provide structured reinforcement to monitor (and
celebrate!) progress
 Provide support through group and facility-based
programming
 Use peers to help reinforce desired behavior
Thanks to Dr. Rachel Seymour for permission to use slides
Participants Learn and Practice
Action Planning
 Something YOU want to do
 Reasonable
 Behavior-specific
 Answer the questions:
What?
How much?
When?
How often?
 Confidence level of 7 or more
Program Tool Box







Physical Activity
Better Breathing
Medications
Managing Fatigue
Problem Solving
Planning
Using Your Mind
Managing Pain
Communication
Healthy Eating
Understanding
Emotions
 Working with
Health
Professionals




Participants Learn How to
Manage the Symptom Cycle
Fatigue
Shortness of
Breath
Poor
Sleep
SYMPTOMS
A Vicious Cycle
Physical
Limitations
Pain
Stress/Anxiet
y
Depressio
n
Difficult
Emotions
CI Symptom Management
Techniques
 Relaxation
 Changing their diets
 Managing sleep and fatigue
 Using meds correctly
 Exercise
 Communication with health providers
Other CDSMP Content
 Sexual Relations
 Advance Directives
 Nutrition
 Pain Management
 Text: Living a Healthy Life with Chronic
Conditions
CDSMP Covers Multiple CI
 Focuses on common problems
 Coping Strategies:
• Action planning & feedback
• Behavior modeling
• Problem-solving techniques
• Decision-making
Problem Solving
1. Identify the problem
2. List ideas to solve the problem
3. Select one method to try
4. Check the results
5. Pick another idea if the first one didn’t work
6. Use other resources
7. Accept that the problem may not be solvable NOW
Decision-Making Tool
Pro
Total Points
Rating
Con
Rating