Evidence-Based Solutions to DSME/T Challenges

Transcription

1 Stanford Self-Management Programs: Evidence-Based Solutions to DSME/T Challenges Robin D. Edelman, MS, RD, CDE Sandra A. Parker, RD, CDE Paula Ackerman, MS, RD, CDE Charlotte Hayes, MMSc, MS, RD, LD, CDE

2 2 Session Learning Objectives: 1. Recognize characteristics of Stanford community based selfmanagement programs. 2. Identify natural partners for CDEs among organizations offering and sponsoring Stanford programs. 3. Discuss outcomes of Stanford self-management programs and collaborative efforts. 4. Describe actual and potential cost-savings and system improvements. 5. Use web links for referring patients to online versions of the Stanford self-management programs. 6. Explain the differences between online and small group communitybased Stanford programs.

3 3 Tackling Diabetes: All Hands on Deck Persons with Diagnosed Diabetes, United States,

4 Tackling Diabetes All Hands on Deck DSME High tech & clinical DSMS High talk

5 5 Diabetes Self-Management Support Standard 8: A personalized follow-up plan for ongoing self-management support will be developed collaboratively by the participant and instructors. The patient s outcomes and goals and the plan will be communicated to the referring provider. National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

6 6 Diabetes Self-Management Support Activities to assist the individual with diabetes to implement and sustain the ongoing behaviors needed to manage their illness. Behavioral Educational Psychosocial Clinical National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

7 7 Diabetes Self-Management Support The effectiveness of providing DSMS through disease management programs, trained peers and health community workers, communitybased programs, use of technology, ongoing education and support groups, and medical nutrition therapy has also been established. National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

8 8 Tackling Diabetes All Hands on Deck

9 9 Administration on Aging ARRA Grants - spreading Stanford self-management programs 2 year grant period ended March states, DC, and Puerto Rico participated Grantees predominantly state units on aging (16 health departments) 98,468 went through the programs* 73,657 completing (75% retention) 14 pilots focused on the diabetes program 2 incorporated into accredited DSME/T programs (MI and MA) 4 in the process of accreditation (San Diego, Houston, Chicago, Dallas) *Stanford programs included Chronic Disease and Tomando Control de su Salud, Diabetes, Tomando Control de su Diabetes, Chronic Pain, and Arthritis in English and Spanish

10 10 Vermont s Experience Vermont s Blueprint for Health - healthcare reform Growth of Patient Centered Medical Homes CDE s diverse roles in Stanford programs and reform efforts Chronic disease program spread starting 2005 Diabetes program spread starting 2009 ARRA self-management grant partners A vision for diabetes care using evidence-based self-management programs addressing diverse needs

11 11 Improved Self-Confidence Vermont Outcome Data Baseline 12 Month 53% 52% 57% 54% 37% 39% 41% 41% 62% 49% 52% 66% Keep Fatigue From Interfering Keep Discomfort or Pain From Interfering Keep Emotional Distress From Interfering Keep Other Symptoms or Health Problems From Interfering Do Activities to Manage Condition Things Other Than Meds Can Reduce Illness Effect

12 12 Impact of Health Problems Overall Outlook VT Data Baseline 12 Month 52% 36% 45% 38% 35% 26% 24% 24% Frustrated By Your Health Problems? Discouraged By Your Health Problems? Fearful About Your Future Health? Health A Worry In Your Life?

13 13 Cost Data Recent CDC meta-analysis: Gordon C and Calloway T. Review of Findings on Chronic Disease Self-Management Program Outcomes: Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs. Centers for Disease Control and Prevention and National Council on Aging, 2008; ref 9 Richardson G, et al. Cost Effectiveness of the Expert Patients Programme (EPP) for Patients with Chronic Conditions. Journal of Epidemiology and Community Health, 62: , 2008.

14 14 Lessons Learned: How CDEs Can Benefit Natural partners for referrals to DSME/T Scripting that drives people to their diabetes educators Incorporating action planning (Stanford style) into current practice Evaluating DSME re improved dosing of content to maximize patient retention

15 15 Newer Kid on the Block: Online Stanford Programs Better Choices, Better Health (BCBH) - Diabetes Evidence-based (Lorig, K. et al, Diabetes Care 33: , 2010) Participants register: No cost to participate through January 2013 Advantages for certain participants Working during day (or night) Not group people Enjoy more anonymity but benefit from connection to others

16 16 Foundation of Better Choices, Better Health - Diabetes As with all of Stanford s Programs: Built on structured patient and professional needs assessments Systematically use strategies to enhance self-efficacy:! Goal Setting! Modeling! Reinterpretation of Symptoms! Peer support! Social Networking!"#

17 17 BCBH-Diabetes What s Taught? Healthy Eating 6 weeks Sharing/Problem Solving 6 weeks Action Planning 5 weeks Exercise 2 weeks Preventing Hypoglycemia 1 week Monitoring glucose 1 week Stress/Depression 3 weeks Medications 1 week Preventing Complications 1 week Communication skills 2 weeks Sick Days 1 week!$#

18 18 BCBH-Diabetes: More Information Online curriculum in learning centers developed/reviewed by CDEs with content that complies with clinical standards of diabetes care endorsed by AADE and ADA participants peer-led by two trained facilitators participating actively on discussion boards Peer facilitators are supervised by online mentor who has immediate access to CDEs Individual clinical advice is NOT provided Posts with erroneous information and disrespectful posts can be removed Questions?