Overview: Evidence-based Health Promotion and Disease Management Programs

What are Evidence-based Health Promotion Programs?  A process of planning, implementing, and evaluating programs adapted from tested models or interventions  Uses an epidemiologic perspective that focuses on populations rather than individuals  It emphasizes both prevention and treatment.

Evidence-Based Models Best Practice Evidence- Based Model Promising Practice

AoA Tiered Levels of EBHP  Minimal  Intermediate  Highest

Translating “The Evidence” into Community-based Programs  Challenge: translate the intervention from its original application under controlled “laboratory-like” settings with tightly monitored protocols  Understand the core elements of the intervention that made it work

Evidence-based Evaluation  Occurs at two levels Implementation (process evaluation) Effects (outcomes evaluation)  Measure outcomes at both individual and community levels: Assess changes in program participants’ learning, health behaviors, and health status the effects of the program on community health status

“ Fidelity” in EBHP  Process of faithfully and accurately adhering to the core elements of an intervention  Fidelity, or the preservation of the evidence base, is central to evidence- based health promotion.

EBHP in Practice Tasks  To identify an important health issue and the population at risk  Identify effective intervention(s)  Establish broad-based partnerships  Select an intervention  Translate the intervention into a program  Evaluate the program  Sustain the program

Evidence-Based Change!  Administration on Aging  Centers for Disease Control and Prevention  AHRQ, NIH, SAMHSA and other federal agencies  John A. Hartford Foundation  Atlantic Philanthropies  Retirement Research Foundation  Archstone Foundation  Regional Foundations  States, regional and community-based organizations

National Council on Aging (NCOA)  NCOA is a national network founded in 1950  Over 3,800 members  Voluntary leadership network  Home of the Center for Healthy Aging

 2001: Demonstration projects (4)  2003: Model projects (14) served 5,000 people  2006: “Choices for Independence”–24 states  2007: Challenge grants (4 more states)  2010: AoA ARRA Projects: 48 states/territories  2013: AoA Empowering Older People–22 states The EBHP “Movement”

 Federal Partnership-DHHS (AoA, CMS, CDC, HRSA)  Nationwide systems approach  Strategic framework to strengthen coordinated efforts for optimum health and quality of life The Aging Network as the Delivery System

AoA’s Vision for EBHP Distribution & Delivery System Leadership Public Education/Awareness Infrastructure Capacity Building Enrollment/Registration Resource Coordination Quality Assurance Accounting/Financial Project Management, Data Collection & Reporting System

Recovery Act CDSMP Goals  Reach 50,000 completers  March 31, March 30, 2012  Establish sustainable program delivery system

Prevention and Public Health Fund CDSME Initiative  Build on success of ARRA initiative  $8.5 million awarded to 22 states  Two goals  Significantly increase the number of older and/or disabled adults who complete CDSME programs  Strengthen and expand integrated, sustainable service systems to provide access to CDSME programs

EBHP Programs for Older Adults Chronic Disease Self- Management Physical Activity:  Arthritis Exercise  Enhanced Fitness  Enhanced Wellness  Fit and Strong  Healthy Moves  Stepping On  Tai Chi  Active Living Every Day Caregiver Support Depression Management  Healthy IDEAS  PEARLS Falls  Matter of Balance Nutrition  Healthy Eating Behavioral Health  Brief Interventions for Alcohol Misuse  Medication Management

160,000 + participants enrolled in CDSMP CDSMP Participants Reached

Expanding Program Reach (NCOA, 2013) CDSME County Presence

Host Organization Types (NCOA, 2013)

Host Organization Types – Health Care (NCOA, 2013)

31.2% of CDSME participants compared to 21.7% of 60+ nationally Participant Diversity (NCOA, 2013)

CDSMP Participant Characteristics CharacteristicPercent of Total Age 60+73% Gender Female77% Living Alone46% Racial/Ethnic Minority Group32% Multiple Chronic Conditions62%

CDSMP Participants - Chronic Conditions

Sustainable Infrastructure Selected Best Practices  Title III D of the Older Americans Act Language requires that funds be used for “programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective.”  Embedding within systems Senior housing Department of Corrections Veterans Administration  Integration with other state and regional initiatives Department of Public Health Multicultural/Minority Health Mental Health and Substance Abuse SCSEP

Sustainable Infrastructure Selected Best Practices (cont.)  Partnerships with health care providers/systems State Health Insurance Assistance Program Federally Qualified Health Centers Care Transitions Initiatives Patient-Centered Medical Homes Other ACA Initiatives

It’s all about Systems Change Strategies  Broadly disseminate available EBHP  Dissemination best practices: Build infrastructure through partnerships Develop staffing capacity Embed EBHP into health care delivery Institute quality assurance systems Focus on program sustainability