Evidence Based Health Programs Learning to Live Well Mary Hertel, - - PowerPoint PPT Presentation

Evidence Based Health Programs Learning to Live Well

Mary Hertel, RN

EBHP Coordinator/Trainer T-Trainer CDSMP, Master Trainer CPSMP and Matter of Balance Central MN Council on Aging (Area Agency on Aging) Thursday May 16, 2013

Information to be presented:

 What are Evidence Based programs and why are they important  Research and demonstrated outcomes  How EBP can fit within the patient engagement model, compare/contrast with patient education  Overview of specific EBP’s including Stanford Self-Management programs and A Matter of Balance  Describe how you or your organization can get more involved

What is Evidence Based health promotion programming?

• Simply put it is:

programs based on research.

What evidence do we need?

Evidence based:

Why the interest in Evidence Based Programs?

Informed, Empowered Patient and Family Productive Interactions Prepared, Proactive Practice Team

Improved Outcomes

Delivery System Design Decision Support Clinical Information Systems Self- Management Support

Health System

Resources and Policies

Community

Health Care Organization

www.improvingchroniccare.org

Patient Centered Timely and Efficient Coordinated Evidence-based and Safe

EBPs have Demonstrated Outcomes

Consider:

“people with chronic conditions rarely spend more than 1% of their life at a healthcare facility. It is the other 99%

• f one’s life ‐

when an individual is at home ‐ that determines whether they return to full health or not.”

Chronically ill patients make many daily health decisions:

• Diet, exercise, medication, when to seek

medical care

• Sometimes make unwise decisions
• may not fully understand implications of

particular health decision

• may lack support to make better choices

Can Clients Be Engaged?

23% adopted new health behaviors (but unsure could maintain if stressed) Remaining 77%: Remain passive recipients (12%) Lack basic facts to follow treatment recommendations (29%) Have facts, but no skills, confidence (36%)

Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self‐management behaviors? Health Services Research, 42, 1443‐1463.

How can Evidence Based Programs help?

Advantages of Evidence Based Programs:

• First, they can significantly improve the health and well‐

being of older adults in the community.

• Second, they can help attract new participants and

funders through innovative programming.

• Third, they can create powerful partnerships with other
• rganizations, including health care providers

Evidence‐based programming provides value

Evidence Based Programs (using Stanford as example)

Stanford University Self Management Programs:

• Chronic Disease Self Management (Living Well with

Chronic Conditions)

• Chronic Pain Self Management
• Diabetic Self Management

Additional programs:

• A Matter of Balance
• Tai Chi Moving for Better Balance

(Bold= training and technical assistance available from all Area Agency’s on Aging)

Self-Management Differs From Patient Education (but we need both)

Self‐management

• Manage life with

disease

• Problem solve and

make decisions

• Improve clients

confidence in abilities to make changes

• Increase skills & self-

confidence

Patient Education

• Change behaviors
• Information,

technical skills

• Disease–specific

knowledge

• Use specific tools

(e.g., Care Plans, Action Plans)

Self-Management Also Encompasses:

• The patient and health professional working

together.

• Often involves the family.
• An holistic approach to care (i.e., medical

and psycho-social components of a condition).

• Pro-active and adaptive strategies that aim

to empower the individual.

What is the Stanford Chronic Disease Self‐Management Program (CDSMP) “Living Well with Chronic Conditions”



Developed by Stanford University’s patient education program



Structured 10-15 participants in a six-week workshop series done by 2 certified leaders



Participative instruction with peer support



Designed to enhance medical treatment



Outcome-driven: impacts show potential for reduced or avoided costs



Evidence-based: a tested model (intervention) that has demonstrated results

• Curriculum including:
• Exercise and nutrition
• Medication usage
• Stress management and managing

fatigue

• Talking with your doctor or health

professional, family and friends

• Evaluating treatment choices
• Dealing with emotions, frustration and

depression

Living Well With Chronic Conditions Workshop

Living Well With Chronic Conditions Workshops (CDSMP)

CDSMP Techniques

• Goal setting and action planning
• Feedback/ problem solving
• Cognitive Symptom Management
• Symptom management
• Physical
• Psychological
• Emotional

• The format addresses specific problems and

goals for people with ongoing health

• problems. It is not a drop-in support group.
• The workshops are not prescriptive.

Participants choose their own goals and track their own progress toward success.

• Pair of trained peer leaders offer guidance

and support, but participants find practical solutions individually and together.

Keys to Success

Living Well With Chronic Conditions Workshop

Stanford’s CDSMP is Evidence-based



Found to benefit targeted populations. Including a decrease in health care costs



Demonstrated it does not cause harm.



Demonstrated it does not waste

• resources. CDSMP can facilitate the

Triple Aim Goals

Evidence CDSMP participants experienced the following outcomes 6 months after starting the CDSMP program

• Increased exercise;
• Better coping strategies

and symptom management;

• Better communication

with their physicians;

• Improvement in their

self‐rated health, disability, social and role activities, and health distress;

• More energy and less

fatigue;

• Decreased disability;
• Fewer physician visits

and hospitalizations. Lorig et al., 1999

Chronic Conditions Reported and compiled by MDH

• Arthritis/other

54%

• Hypertension

51%

• High Chol

36%

• Chronic Pain

30%

• Diabetes

24%

• Heart Disease

22%

• Osteoporosis

20%

• Cancer

15%

• Depression

14%

• Lung disease

12%

• AMD

9%

• Stroke

8%

• Asthma

6%

• Emphysema or

COPD 3%

• Parkinson’s

Disease 3%

• Kidney disease 2%
• MS

2%

• Other

21%

Implementation of CDSMP in Minnesota

Current license holders include:

• Central MN Council on Aging(Area Agency on Aging)
• 5 Area Agencies on Aging covering all of Minnesota
• Minnesota Department of Health
• Native American Community Clinic: “Living in Balance”
• Sanford Health: “Better Choices, Better Health”
• Veterans’

Administration Health System

Additional Evidence based programs

Stanford programs:

• Chronic Pain Self Management Program
• Diabetic Self Management Program

Other programs:

• A Matter of Balance, Managing Concerns about Falls
• Tai Chi, Moving for Better Balance

Highest Tier Evidence‐Based Health Promotion/Disease Prevention Programs http://www.ncoa.org/improve‐health/center‐for‐healthy‐aging/content‐library/Title‐IIID‐ Highest‐Tier‐Evidence‐FINAL.pdf

A Matter of Balance(falls

prevention)

Developed by: Boston University Matter of Balance is an 8 session/ 2 hours per session, workshop designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. Through these classes, participants learn to:

• view falls and fear of falling as controllable,
• set realistic goals for increasing activity,
• change their environment to reduce fall risk factors and
• promote exercise to increase strength and balance.

This program has been adapted from the original intervention to be more suitable for community‐dwelling older adults by allowing small group sessions to be led by a trained facilitators. Requires 2 Certified trained Leaders Leader training is 2 days

Reference: Healy, T. C., Peng, C., Haynes, P., McMahon, E., Botler, J. & Gross, L. The Feasibility and Effectiveness of Translating A Matter of Balance into a Volunteer Lay Leader Model. Journal of Applied Gerontology. (2008) 27 (1): 34‐51. [Online]: http://www.mmc.org/workfiles/mh_PFHA/JAGarticle.pdf

Chronic Pain Self‐Management

CPSMP is a 6 week, 2.5 hours per week workshop developed for people who have a primary or secondary diagnosis of chronic pain. Pain is defined as being chronic or long term when it lasts for longer than 3 to 6 months, or beyond the normal healing time of an injury. During this workshop a variety of topics important to those with chronic pain are covered including: goal setting, relaxation, nutrition, medication management, exercise, communication and problem solving Requires 2 Certified trained Leaders Training is either 4 days or 2 days if CDSMP trained

Diabetic Self‐Management Program

DSMP is a 6 week, 2.5 hours per week. This workshop is for people with type 2 diabetes. It teaches the skills needed in the day‐to‐day management of diabetes and to maintain and/or increase life’s activities. Requires 2 Certified trained Leaders Training is either 4 days or 2 days if CDSMP trained

Tai Chi‐ Moving for Better Balance

8 Tai Chi form that emphasizes weight shifting, postural alignment, and coordinated movements. Synchronized breathing aligned with Tai Chi movements was integrated into the movement routine 1 hour 3 times/week for 12 weeks Requires certified leader Leader Training is 2 days

Options for Involvement

• Offer the program(s) at your clinic/organization

with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies

• n Aging
• Offer the program at your clinic/organization in

partnership with a community provider

• Refer your patients to programs that your
• rganization offers or to community partners;

visit www.mnhealthyaging.org for a listing of workshops

• or call Senior Linkage Line 1-800-333-2433

MN Healthy Aging website

Resources

• Minnesota Board on Aging: http://www.mnaging.org/
• National Council on Aging (NCOA): http://www.ncoa.org/
• NCOA: Center for Healthy Aging
• http://www.ncoa.org/improve‐health/center‐for‐healthy‐aging/
• Online Training Modules:
• http://www.ncoa.org/improve‐health/center‐for‐healthy‐aging/online‐training‐

modules/

• Highest Tier Evidence‐Based Health Promotion/Disease Prevention Programs
• http://www.ncoa.org/improve‐health/center‐for‐healthy‐aging/content‐library/Title‐

IIID‐Highest‐Tier‐Evidence‐FINAL.pdf

• Stanford Patient Education Research Center:
• http://patienteducation.stanford.edu/
• SAMHSA National registry of Evidence Based Programs and Practices:
• http://nrepp.samhsa.gov/Index.aspx

Questions ?

“Those things that we do for

• urselves, day-to-day that

improve or maintain our health and make us feel better”

Contact Info

Mary Hertel , RN EBHP Coordinator/Trainer Central MN Council on Aging Direct:320-202-6945 Agency: 320-253-9349 Mary.hertel@cmcoa.org