Collaboration Using Evidence-Based Programs for Healthy Aging 2012 - - PowerPoint PPT Presentation

Successful Model of Collaboration

2012 National Primary Care Conference on Aging April 30th, 2012

Merlita Compton, MPH Kokua Kalihi Valley Comprehensive Family Services Honolulu, Hawaii

Using Evidence-Based Programs for Healthy Aging

Community Characteristics – Kalihi Valley Community

31% 24% 20% 7% 8% 10%

Filipino Micronesian Samoan Hawaiian East Asian Other

63% 7% 2% 3% 25%

0-100% of poverty level 101-150% of poverty level 151- 200% of poverty level

• ver 200% of

poverty level Health Insurance 43%: Medicaid 37%: Uninsured 15%: Private 5%: Medicare

Overview of Kokua Kalihi Valley Comprehensive Family Services (sites and locations)

Kokua Kalihi Valley Elder Services

• Provides:
• Case Management
• Health Maintenance
• Health Screening
• Caregiver Support Services
• Evidence-based health promotion programs
• Medical, Dental, Behavioral Clinic
• Serve older adults (60+); Majority are immigrants

(n=526)

• Located in urban area
• 6 staff

To help elders improve their health, KKV has participated in Statewide Healthy Aging Initiative

• Invited to participate in Statewide Healthy Aging

Initiative in 2007

– Co-led by State Unit on Aging and Department of Health (partners from 64 organizations & 27 volunteers) – Goal is to improve the health status of older adults through evidence-based health promotion programs

Stanford’s Self-Management Programs (CDSMP)

• Three different types are available: Chronic

Disease, Diabetes, & Arthritis

• 2.5 hrs./wk. for 6 weeks
• Led by two-person

teaching teams

• Purpose

—To empower people with chronic conditions to take charge in managing and controlling their symptoms —To increase knowledge of techniques and improve skills for more effective symptom self-management

CDSMP is not only improving health, but also lowering costs, and reducing utilization

• Visits to doctors and ER = 8 %
• Hospital Days = 40 %
• Two year savings = $390 - $520 per participant

– Based on reduced hospitalizations and outpatient visits, using a program cost of $70 - $200 per participant.

• Data yield a cost to savings ratio of approximately

1:10. Many of these results persist for as long as three years.***

***OUTCOME DATA REPORTED IN: LORIG KR, SOBEL DS, STEWART AL, BROWN JR BW, RITTER PL, GONZÁLEZ VM, LAURENT DD, HOLMAN HR. EVIDENCE SUGGESTING THAT A CHRONIC DISEASE SELF-MANAGEMENT PROGRAM CAN IMPROVE HEALTH STATUS WHILE REDUCING UTILIZATION AND COSTS: A RANDOMIZED

• TRIAL. MEDICAL CARE, 37(1):5-14, 1999. & LORIG KR, RITTER P, STEWART AL, SOBEL DS, BROWN BW, BANDURA A, GONZÁLEZ VM, LAURENT DD, HOLMAN HR.

CHRONIC DISEASE SELF-MANAGEMENT PROGRAM: 2-YEAR HEALTH STATUS AND HEALTH CARE UTILIZATION OUTCOMES. MEDICAL CARE, 39(11),1217-1223, 2001. &

• IN HMO SETTING: LORIG KR, SOBEL DS, RITTER PL, LAURENT D, HOBBS M. EFFECT OF A SELF-MANAGEMENT PROGRAM ON PATIENTS WITH CHRONIC DISEASE.

EFFECTIVE CLINICAL PRACTICE, 4(6),256-262, 2001.

KKV has served 216 participants in CDSMP

Partnership Started Trained in CDSMP Implement CDSMP Trained in ASMP & DSMP Trained more staff in CDSMP Implement ASMP & DSMP Conducted CDSMP Training Trained more staff in DSMP DSMP Eval Project Trained more staff in CDSMP

Adaptation Process: Step 1 Examine the Program

• Does the program fit with our clients?

– What components do we need to modify?: Use “Track change tool”

• In addition to this, we used

“Adaptation traffic light tool”

– Red light adaptations – DO NOT CHANGE – Yellow light adaptations – ADAPT WITH CAUTION – Green light adaptations – GO AHEAD!

Adapted from: Peterson, E. W. (2003). Using cognitive behavioral strategies to reduce fear of falling: A matter of balance. Generations. 26(4): 53

Adaptation Process: Step 2 Try Out “Green & Yellow lights” Modifications

• Offer “informational session” before the

workshop

• Provide additional

support outside of class time

Supplemental booklet in their native language (Hawaiian, Ilocano, Chinese, etc)

• Encourage participants to complete the

workshop

Adaptation Process: Step 2 Try Out “Green & Yellow lights” Modifications

• Plan event to collect 6-month

follow-up data

Adaptation Process: Step 3 Evaluate program

• Ensure fidelity of program delivery

– Evaluator visits one session out of 6 sessions

2 pages evaluation: Assess 10 major components

Scored 1-4, higher score indicates high fidelity

Adaptation Process: Step 3 Evaluate program

• Ensure client profiles reflect our community (n=196)

– Mean Age was 72.7 years & 83% were female – 68% had English Limitation – 39% had Medicaid

Adaptation Process: Step 3 Evaluate program

Contacts in the past 6-months

Physician ER Hospital

Before 6-month

0-5 (lower number = less communication)

Minutes per week

Anecdotal Story From KKV’s participant

“I learned many things from KKV DSMP workshops, I am doing what I learned to help me better manage my emotions, my medications, and everyday

• tasks. With an action plan I am able to make choices, to eat healthier food,

and accomplished my goal of having a normal life. Setting my action plan and by eating healthy, exercising regularly, communicating with my doctor and my family members makes my life easier. I learned that eating healthy foods with smaller portions, in the right time, and eating healthy snacks, improved my health and for sure makes it easier for me in dealing with my

• Diabetes. I lost 8 pounds in the past six weeks by following and

accomplishing my action plan I set every week. I know that I can still live a healthy life even with Diabetes. KKV staff patiently teaches us to learn many helpful things and my fellow participants are very helpful because each member shares experiences how to make good choices that are applicable and meaningful in the many situations I face. I am very, very thankful and encouraged to continue these changes. I am very happy and I find a smile in my face”. Wilhelmina, 3/6/2012

Lessons Learned

• Beneficial to join with the Statewide partnership
• Using adaptation tools helpful in ensuring benefit of

CDSMP for our clients

• Monitoring is critical
• Potentially could save participants medical care costs

Questions?

• Contact Information:

– Merlita Compton – mcompton@kkv.net – (808) 848-0977