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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