Living with Chronic Conditions: Why Self- Management Works in the Community and Online Sue Lachenmayr and Katy Plant

2 A nonprofit service and advocacy organization © 2012 National Council on Aging NCOA - National Council on Aging NCOA is a nonprofit service and advocacy organization. Our mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged.

3 A nonprofit service and advocacy organization © 2012 National Council on Aging Look Who’s Already Here and Who’s Coming

4 A nonprofit service and advocacy organization © 2012 National Council on Aging Trend: Growing Epidemic of Chronic Diseases Source: Medical Expenditure Panel Survey, 2006

5 A nonprofit service and advocacy organization © 2012 National Council on Aging Key Risks for Chronic Conditions  Smoking  Poor diet & nutrition  Physical inactivity  Falls  Alcohol & substance abuse  Stress  Social isolation

6 A nonprofit service and advocacy organization © 2012 National Council on Aging Chronic Disease Self-Management Assumptions  People with different chronic diseases have similar self-management problems and disease- related tasks.  Individuals can learn to take day-to-day responsibility for their diseases.  Confident, knowledgeable people practicing self- management will experience improved health status and use fewer health resources.

7 A nonprofit service and advocacy organization © 2012 National Council on Aging Stanford University’s Chronic Disease Self-Management Program (CDSMP)  Background  Over 20 years of proven impact  ‘Gold standard’ of evidence-based programming  Offered locally and worldwide

8 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP – A Proven Program  Program basics  Six weekly sessions  Peer facilitated  Opportunities for discussion and problem solving  Workshop topics include:  Exercise and nutrition  Medication usage  Stress management  Talking with your doctor  Dealing with emotions and depression

9 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP – A Proven Program  Skill-building components  Goal setting  Brainstorming  Problem solving  Feedback and sharing

10 A nonprofit service and advocacy organization © 2012 National Council on Aging  160,000 + participants enrolled in CDSMP CDSMP Participants Reached

11 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP Implementation Sites  More than 11,500 workshops held at nearly 7,000 unique implementation sites

12 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP Participant Characteristics CharacteristicPercent of Total Age 60+73% Gender Female77% Living Alone46% Racial/Ethnic Minority Group32% Multiple Chronic Conditions62%

13 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP Participants - Chronic Conditions

14 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP: Better Care Baseline Mean 12-month Mean% Improvement† Communication with MD (0~5)  %** Medication compliance (0~1)  %** Health literacy (Confidence filling out medical forms) (0~4)  %** Notes. † These statistics control for covariates gender, age, race/ethnicity, education, number of chronic conditions.  Indicates that larger scores are better for this measure  Indicates that smaller scores are better for this measure. **p<0.01, *p<.05

15 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP: Better Outcomes Baseline Mean 12-month Mean % Improvement† Self-assessed health (1~5)  %** PHQ depression (0~3)  %** Quality of life (0~10)  %** Unhealthy physical days (0~30)  %** Unhealthy mental days (0~30)  %** Notes. † These statistics control for covariates gender, age, race/ethnicity, education, number of chronic conditions.  Indicates that larger scores are better for this measure  Indicates that smaller scores are better for this measure. **p<0.01, *p<.05

16 A nonprofit service and advocacy organization © 2012 National Council on Aging CDSMP: Lower Health Care Costs Baseline12-month Adjusted Ratios† Percentage with Emergency Room (ER) Visits in the Past 6 Months  * 18%13% 0.68** Number of ER visits among those with any ER visit Percentage Hospitalized in the Past 6 Months  14% 1.01 Number of hospitalizations among those with any hospitalization Notes. † Odds Ratio or Mean Ratio after controlling for covariates gender, age, race/ethnicity, education, number of chronic conditions.  Indicates that larger scores are better for this measure  Indicates that smaller scores are better for this measure. **p<0.01, *p<.05

17 A nonprofit service and advocacy organization © 2012 National Council on Aging Where To Go For Resources If You Are Offering Programs  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  State Units on Aging/Area Agencies on Aging  Department of Public Health  Multicultural/Minority Health  Mental Health and Substance Abuse  SCSEP

18 A nonprofit service and advocacy organization © 2012 National Council on Aging Where To Go For Resources If You Are Offering Programs  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

19 A nonprofit service and advocacy organization © 2012 National Council on Aging Where To Start If You Want to Get Involved  As a Participant  As a Workshop Leader  As a Program Provider

20 A nonprofit service and advocacy organization © 2012 National Council on Aging Suite of online self-management programs Cancer: Thriving and Surviving

21 A nonprofit service and advocacy organization © 2012 National Council on Aging Core Self-Management Concepts  Systematically use the following strategies to enhance self- efficacy: Goal Setting Modeling Reinterpretation of Symptoms Social Persuasion

22 A nonprofit service and advocacy organization © 2012 National Council on Aging Online workshop characteristics  Six-week workshop; new workshop session starts each week  participants  Highly interactive (discussion boards)  Participants log on several times a week for a total of 2-3 hours each week No “real time” commitment  Peer led by two Facilitators and monitored by a Mentor

23 A nonprofit service and advocacy organization © 2012 National Council on Aging Getting started at

24 A nonprofit service and advocacy organization © 2012 National Council on Aging Demo 24

25 A nonprofit service and advocacy organization © 2012 National Council on Aging Workshop Invitation 25

26 A nonprofit service and advocacy organization © 2012 National Council on Aging Secure Enrollment

27 A nonprofit service and advocacy organization © 2012 National Council on Aging Participant Consent

28 A nonprofit service and advocacy organization © 2012 National Council on Aging Workshop Demo Now we will take a look at a Better Choices Better Health workshop set to session 2 of 6 Interested in offering online workshops? 28

29 A nonprofit service and advocacy organization © 2012 National Council on Aging Visit Us Online! 

30 A nonprofit service and advocacy organization © 2012 National Council on Aging Questions? Katy Plant Sue Lachenmayr