Implementing and Sustaining Chronic Disease Self-Management Education Programs

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1 IlluminAge Presentation June 11, 2015 Implementing and Sustaining Chronic Disease Self-Management Education Programs Cora Plass, MSW, ACSW Senior Director National CDSME Resource Center 1

2 Objectives Introduce NCOA and the role of the National CDSME Resource Center Provide an overview of the burden and impact of chronic diseases Explain why CDSME is important for CBOs Describe the suite of Stanford programs Offer helpful tips and resources for planning, implementing, and sustaining your programs 2

National Council on Aging (NCOA) Who We Are: NCOA is the nation s leading nonprofit service and advocacy organization representing older adults and the

3 National Council on Aging (NCOA) Who We Are: NCOA is the nation s leading nonprofit service and advocacy organization representing older adults and the community organizations that serve them. Our Mission: To improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged. 3

4 NCOA Social Impact Goal Touch the lives of 10 million older adults by 2020 Improved health and reduced disability through greater access to proven programs Greater economic security through increased access to benefits, financial resources, and job opportunities Enhanced capacity to live independently in the community 4

5 Center for Healthy Aging Primary Goal Increase the quality and years of healthy life for older adults Two National Resource Centers Chronic Disease Self-Management Education (CDSME) Falls Prevention Other Key Areas of Focus Behavioral Health Oral Health Physical Activity 5

6 National CDSME Resource Center Funded by ACL/AoA for more than a decade Serves as national clearinghouse for collecting and sharing information, resources, and best practices Provides TA to support state and community partners with implementing, scaling, and sustaining CDSME programs Provides a variety of communication channels for networking, sharing, and contributing to knowledge base Manages and maintains national database for CDSME More than 21,000 workshops in 46 states, DC, and Puerto Reaching almost 240,000 people (March 2010 May 2015) Well over half have multiple chronic conditions (MCC) 6

7 Chronic Disease Epidemic 7 out of 10 deaths are from chronic diseases 80% of older adults have at least one chronic disease Nearly 2 of every 3 older adults have multiple chronic conditions 95% of health care costs for older Americans are for chronic diseases Spending escalating with the increase in chronic diseases and the aging population Primary focus has been on sick care rather than prevention 7

8 Chronic Diseases are Highly Preventable Poor health and disability are not inevitable consequences of aging 8

9 Self-Management Education A Key Factor to Improving Health but Vastly Underutilized Practicing simple self-management techniques on a regular basis can improve the health and quality of life of older adults. While self-management education programs have grown, they are still not reaching enough older adults to have an impact on population health. The unmet need presents a unique opportunity for aging organizations to step up to the forefront by making CDSME a priority. 9

10 CDSME Stanford s Suite of Programs Chronic Disease Self-Management - English and Spanish Diabetes Self-Management - English and Spanish Arthritis Self-Management Chronic Pain Self-Management Cancer: Thriving and Surviving Positive Self-Management Program for HIV 10

11 Stanford University 11

12 Stanford CDSME Workshop Overview Small-group workshop developed by Kate Lorig, RN, PhD, at Stanford University 6 interactive sessions/2.5 hours each Facilitated by trained leaders, one of whom has a chronic health condition Participants: Gain knowledge, confidence, and skills to better manage their health Set goals and action plans to make positive lifestyle changes Learn from and support one another to make changes that lead to better health Learn problem solving to overcome barriers to achieving their goals 12

Session Topics Action Planning Managing Pain and Fatigue Fitness/ Exercise Getting a Good Night s Sleep Problemsolving Dealing with Difficult

13 Session Topics Action Planning Managing Pain and Fatigue Fitness/ Exercise Getting a Good Night s Sleep Problemsolving Dealing with Difficult Emotions Healthy Eating/Weight Management Working with Health Professionals Decision Making Better Breathing Communication Medication Usage 13

14 CDSMP Program Benefits National Study Better Health Self-assessed health Depression Quality of life Unhealthy physical/mental days Better Care Communication w/ physician Medication compliance Health literacy Lower Costs ER visits Hospitalizations 14

15 Tips for Getting Started or Expanding Your Existing Efforts Proper planning is important Identify the Need Consider enlisting help from your state or local health department epidemiologist to help you understand the prevalence and impact of chronic diseases. Will you start with the generic CDSMP or a disease specific program? Is the program already available? If so, are there gaps to fill or a market niche for your program? Who are your competitors? Where will you start? How will you expand your efforts? 15

16 Tips for Getting Started or Expanding Your Existing Efforts Determine the Capacity What is your organizational capacity? Consider human and financial resources. Who will be involved? Who will be trained? What organizational processes need to be in place? How will you cover the program costs? Assess your readiness - good timing and organizational readiness Who are your potential partners? What roles can they fill? Are there champions that can help you? What other resources are available? Transportation? 16

17 Develop Marketing Approaches Personal approaches and messages are the most effective Community presentations Word of mouth from people who are known Referrals or recommendations from trusted individuals Personal contacts, sign up, and follow up at health fair, church, or other event Referral partnerships are important to fill workshops, e.g., health care systems Messaging should reflect what is important to your target audience Feel better; do the things you want to do; put life back in your life 17

18 Marketing Language Preferences Use language that is positive and empowering Be clear and concise Couch messaging around health benefits Workshop, or program instead of classes Ongoing health condition, rather than chronic disease Helps you learn over teaches Strategies over skills Source: Teresa Brady, CDC Arthritis Program 18

19 Develop a Performance Monitoring and Evaluation Plan What are your goals? How do you measure success? How will you monitor your progress? 19

20 Performance Monitoring and Evaluation Continuous Quality Improvement (CQI) process planning, monitoring, evaluating, and making changes to improve performance Fidelity to what extent are you true to the way the program was designed? 20

21 Plan for Sustainability What Will It Take to Keep Your Program Going What are you going to sustain? What human resources are needed/available and who will do what? Leadership Staffing Partners What will it cost? 21

22 Center for Healthy Aging Resources

23 Resources In our Online Library - Planning RE-AIM - how to use the RE-AIM framework to plan and evaluate your program Reach Effectiveness Adoption Implementation Maintenance Innovation Readiness Assessment Tool Program Cost Calculator Interactive tool 23

24 Marketing Resources Outreach and recruitment - strategies Marketing and recruitment materials State examples and best practices 24

25 Quality Assurance and Evaluation Resources Summary of national and state translational research findings CDSME Infographic for national study with a fillable PDF option to customize for including your data RE-AIM AoA QA Recommendations 25

26 Sustainability Resources Annual meeting presentations and handouts on our home page Creating a Business Plan online training module Examples of sustainability and business plans from states Issue brief Key Factors and Strategies Contributing to Program Sustainability 26

Key Sustainability Components Effective Leadership Adequate Delivery Infrastructure Partnerships Centralized, Coordinated Logistical Processes Business Planning and Financial Sustainability Quality

27 Key Sustainability Components Effective Leadership Adequate Delivery Infrastructure Partnerships Centralized, Coordinated Logistical Processes Business Planning and Financial Sustainability Quality Assurance Strong Public Health and Aging; State/ regional management and support Right-size workforce/ sites to ensure programs are consistently available Embedded into health systems/ reform and turn-key delivery system partners Ongoing marketing, referral, registration, ADRC integration to build demand Business plan; diversified funding (DSMT, fee for service, contracts) Being data driven with CQI and fidelity monitoring to ensure quality and promote value 27

28 Questions/Discussion Cora Plass

The Southeast Minnesota Partnership for Community-Based Health Promotion REIMAGINING THE EXPERIENCE OF HEALTH

The Southeast Minnesota Partnership for Community-Based Health Promotion REIMAGINING THE EXPERIENCE OF HEALTH Evidence-Based Health Promotion Programs and the WellConnect Model 1. Introductions 2. The