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Chronic Disease Self-Management Education: Program Success and Future Directions

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Geriatrics Models of Care

Abstract

Self-management is recognized as a fundamental part of health care. This chapter provides an overview of Stanford’s suite of chronic disease self-management education (CDSME) programs with an emphasis on the Chronic Disease Self-Management Program (CDSMP). Several issues are addressed including (1) the philosophy behind CDSMP and the core elements designed to help patients deal with their chronic conditions; (2) the range of appropriate delivery settings; (3) patient targets for maximal benefit; (4) recommended metrics and demonstrated outcomes in terms of meeting the triple aims of better health, better health care, and better value; (5) strategies for maintaining fidelity and promoting scalability; (6) integration with current health care technologies (e.g., electronic medical records); and (7) applicability to current health care policies (e.g., the Patient Protection and Affordable Care Act). Offering an excellent model for geriatric practice, the Stanford suite of CDSME has countless potential to help older patients manage their comorbidities. It can also serve as an important bridge between community and clinical care approaches.

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References

  1. National Prevention Council. National Prevention Strategy. In: Services US Department of Health and Human Services, editor. Washington, D.C.: Office of the Surgeon General; 2011.

    Google Scholar 

  2. Brady T, Murphy L, Beauchesne D, Bhalakia A, Chervin D, Daniels B, et al. sorting through the evidence for the arthritis self-management program and the chronic disease self-management program: Executive Summary of ASMP/CDSMP meta-analysis. 2011.

    Google Scholar 

  3. National Council on Aging. Title III-D highest tier evidence-based health promotion/disease prevention programs. 2014.

    Google Scholar 

  4. Ory MG, Smith ML, Patton K, Lorig K, Zenker W, Whitelaw N. Self-management at the tipping point: reaching 100,000 Americans with evidence-based programs. J Am Geriatr Soc. 2013;61(5):821–3.

    Article  PubMed  Google Scholar 

  5. Kulinski K, Boutaugh M, Smith ML, Ory MG, Lorig K. Setting the stage: measure selection, coordination, and data collection for a national self-management initiative. Frontiers in Public Health. 2015. In-press.

    Google Scholar 

  6. Lorig KR, Sobel DS, Stewart AL, Brown BWJ, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14.

    Article  CAS  PubMed  Google Scholar 

  7. Lorig KR, Ritter P, Stewart AL, Sobel DS, William Brown BJ, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39(11):1217–23.

    Article  CAS  PubMed  Google Scholar 

  8. Stanford Patient Education Research Center. Organizations Licensed to Offer the Chronic Disease Self-Management Program (CDSMP). 2014.

    Google Scholar 

  9. Smith M, Ory, MG, Ahn, S, Kulinski, K, Jiang L, Lorig, K. National Dissemination of Chronic Disease Self-Management Education (CDSME) Programs: an incremental examination of delivery characteristics. Frontiers in Public Health Education and Promotion. 2015. In-press.

    Google Scholar 

  10. U.S. Department of Health and Human Services. ARRA - Communities Putting Prevention to Work: Chronic Disease Self-Management Program, vol. 93. Washington, DC; 2009. p. 725.

    Google Scholar 

  11. Lorig K. Living a healthy life with chronic conditions : self-management of heart disease, arthritis, diabetes, depression, asthma, bronchitis, emphysema, and other physical and mental health conditions. 4th ed. Boulder, CO: Bull Pub. Co.; 2012. vii, 343 p. p.

    Google Scholar 

  12. Lee W-C, Dooley KE, Ory MG, Sumaya CV. Meeting the geriatric workforce shortage for long-term care: opinions from the field. Gerontol Geriatr Educ. 2013;34(4):354–71.

    Article  PubMed  Google Scholar 

  13. Towne SD Jr, Smith ML, Ahn S, Ory MG. The reach of chronic disease self-management education programs to rural populations. Frontiers in Public Health: Public Health Education and Promotion. 2:172. 2015. In-press.

    Google Scholar 

  14. Lorig K, Ritter PL, Pifer C, Werner P. Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community Ment Health J. 2014;50(1):96–103.

    Article  PubMed  Google Scholar 

  15. Ory M, Ahn S, Jiang L, Smith M, Ritter P, Whitelaw N, et al. Successes of a national study of the chronic disease self-management program: meeting the triple aim of health care reform. Med Care. 2013;51(11):992–8.

    Article  PubMed  Google Scholar 

  16. Ory M, Smith ML. Evidence-based programming for older adults. Frontiers in Public Health Education and Promotion. 2015. In-press.

    Google Scholar 

  17. Ory MG, Smith ML, Ahn S, Jiang L, Lorig K, Whitelaw N. National study of chronic disease self-management: age comparison of outcome findings. Health Educ Behav. 2014;41(1 Suppl):34S–42.

    Article  PubMed  Google Scholar 

  18. Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991;50(2):248–87.

    Article  Google Scholar 

  19. Mowbray CT, Holter MC, Teague GB, Bybee D. Fidelity criteria: development, measurement, and validation. Am J Eval. 2003;24(3):315–40.

    Article  Google Scholar 

  20. Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. J Public Health Dent. 2011;71(s1):S52–63.

    Article  PubMed Central  Google Scholar 

  21. Frank JC, Coviak CP, Healy TC, Belza B, Casado BL. Addressing fidelity in evidence-based health promotion programs for older adults. J Appl Gerontol. 2008;27(1):4–33.

    Article  Google Scholar 

  22. National Council on Aging. Advantages of Evidence-Based Programs [cited 2014 October 10]. http://www.ncoa.org/improve-health/center-for-healthy-aging/advantages-of-evidence-based.html.

  23. Stanford Patient Education Research Center. Program Fidelity Manual: Stanford Self-Management Programs 2012 Update. 2012.

    Google Scholar 

  24. Glasgow RE, Magid DJ, Beck A, Ritzwoller D, Estabrooks PA. Practical clinical trials for translating research to practice: design and measurement recommendations. Med Care. 2005;43(6):551–7.

    Article  PubMed  Google Scholar 

  25. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–69.

    Article  Google Scholar 

  26. Ahn S, Basu R, Smith M, Jiang L, Lorig K, Whitelaw N, et al. The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health. 2013;13(1):1141.

    Article  PubMed Central  PubMed  Google Scholar 

  27. National Council on Aging. Evidence-based health promotion programs for older adults: key factors and strategies contributing to program sustainability. 2012.

    Google Scholar 

  28. National Council on Aging. Creating a business plan for evidence-based health promotion programs.

    Google Scholar 

  29. Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing? J Am Med Inform Assoc. 2011;18(5):678–82.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51(4):549–55.

    Article  PubMed  Google Scholar 

  31. Brailer DJ. Interoperability: the key to the future health care system. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-19-W5-21.

    Google Scholar 

  32. Stewart BA, Fernandes S, Rodriguez-Huertas E, Landzberg M. A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. J Am Med Inform Assoc. 2010;17(3):341–4.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Hamilton B. Evaluation design of the business case of health information technology in long-term care: project summary. In: Services US Department of Health and Human Services, editor. Washington, DC; 2005.

    Google Scholar 

  34. Branger PJ, van’t Hooft A, van der Wouden JC, Moorman PW, van Bemmel JH. Shared care for diabetes: supporting communication between primary and secondary care. Int J Med Inform. 1999;53(2–3):133–42.

    Article  CAS  PubMed  Google Scholar 

  35. Barretto SA, Warren J, Goodchild A, Bird L, Heard S, Stumptner M. Linking guidelines to electronic health record design for improved chronic disease management. AMIA Annu Symp Proc. 2003;2003:66–70.

    PubMed Central  Google Scholar 

  36. National Council on Aging AoA. Working with State Medicaid Agencies. In: National Council on Aging, http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/NCOA-AoA-Flyer-State-Medicaid-1.pdf.

  37. Anderson G. Chronic care: making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation; 2010. p. 43.

    Google Scholar 

  38. Towne SD Jr, Smith ML, Ahn S, Belza B, Altpeter M, Kulinski KP, Ory MG. Delivering multiple evidence-based programs to at-risk seniors. Frontiers in Public Health: Public Health Education and Promotion 2015. In-press.

    Google Scholar 

  39. Wilson M, Smith ML. Putting CDSMP to work: implementation of the live healthy, Work Healthy Program. National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL122330.

    Google Scholar 

  40. Zuckerman S. What are the provisions in the new law for containing costs and how effective will they be? Washington, DC: Urban Institute; 2010. p. 5.

    Google Scholar 

  41. National Council on Aging Self-Management Alliance. Developing a Value Proposition for Self-Management Washington, DC [cited 2014 October 1]. http://selfmanagementalliance.org/why-self-management/value-proposition/#.VDV1ivldVkl (2014).

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Acknowledgements

We acknowledge partial support from the South, West, and Central Consortium: Geriatric Education Center of Texas, Grant #99-500984. We thank Jessica Smarr and Rachel Coughlin for their editorial assistance.

Author information

Authors and Affiliations

  1. Health Promotion and Community Health Sciences, School of Public Health at Texas A&M Health Science Center, TAMU 1266, College Station, TX, 77843-1266, USA

    Marcia G. Ory Ph.D., M.P.H.

  2. Department of Health Systems Management and Policy, The University of Memphis School of Public Health, The University of Memphis, 133 Robison Hall, Memphis, TN, 38152-3330, USA

    SangNam Ahn Ph.D.

  3. Health Promotion and Community Health Sciences, Texas A&M Health Science Center, 1266 TAMU, College Station, TX, 77843-1266, USA

    Samuel D. Towne Jr. Ph.D., M.P.H., C.P.H.

  4. Department of Health Promotion and Behavior, The University of Georgia College of Public Health, 330 River Road, 315 Ramsey Center, Athens, GA, 30602, USA

    Matthew Lee Smith Ph.D., M.P.H., C.H.E.S.

Authors
  1. Marcia G. Ory Ph.D., M.P.H.
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  2. SangNam Ahn Ph.D.
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  3. Samuel D. Towne Jr. Ph.D., M.P.H., C.P.H.
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  4. Matthew Lee Smith Ph.D., M.P.H., C.H.E.S.
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Corresponding author

Correspondence to Marcia G. Ory Ph.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Senior Services – Aurora Health Care, University of Wisconsin School of Medicine & Public Health, Milwaukee, Wisconsin, USA

    Michael L. Malone

  2. Hunter-Bellevue School of Nursing, Hunter College of the City University of New York, New York, New York, USA

    Elizabeth A. Capezuti

  3. Eastern Virginia Medical School, Norfolk, Virginia, USA

    Robert M. Palmer

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Ory, M.G., Ahn, S., Towne, S.D., Smith, M.L. (2015). Chronic Disease Self-Management Education: Program Success and Future Directions. In: Malone, M., Capezuti, E., Palmer, R. (eds) Geriatrics Models of Care. Springer, Cham. https://doi.org/10.1007/978-3-319-16068-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-16068-9_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16067-2

  • Online ISBN: 978-3-319-16068-9

  • eBook Packages: MedicineMedicine (R0)

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