1. Stanford Chronic Disease Self-Management Program

2. Kate Lorig, RN, DrPH  Joined Stanford in 1979 as a Cal Public Health graduate student  Developed the Arthritis Self- Help Course  Directs the Stanford Patient Education Research Center

3. Original Research 1991-1996  RCT funded by Agency for Health Care Research & Policy and CA Tobacco Money  Purpose: To develop and evaluate a community-based, self-management program that assists people with chronic illness

4. Tested Program Features  Based on self-efficacy: the confidence one has that he/she can master a new skill or affect one’s own health  Workshop content was derived from focus groups of people with CI

5. Tested Program Process  17-hour program taught by a team  CI Content: Manage symptoms Adhere to medication regimens Communicate with providers Maintain functional abilities

6. Tested Outcomes  Health Status  Health Utilization  Self-efficacy  Self-management behaviors

7. Original Study Results at 6 Months  Increased Exercise  Better Coping Strategies and Symptom Management  Better Communication with Physicians  Improved Self-Rated Health, Disability, Social & Role Activities and Health Distress  More Energy, Less Fatigue & Decreased Disability  Fewer MD Visits and Hospitalizations

8. Original Study Results at 1 Year  Significant improvements in energy, health status, social & role Activities and self-Efficacy  Less fatigue or health distress  Fewer visits to the ER  No decline in activity or role functions

9. Original Study Results at 2 Years  No Further Increase in Disability  Reduced Health Distress  Fewer Visits to MDs and ERs  Increased Self-Efficacy

10. Original Study Demonstrated Cost Savings  Reduced hospitalizations, hospital days, ER visits and MD visits resulted in reduced health care costs  Program costs = $70 to $200 per person  Program savings = $320 to $520 per person

11. CDSMP Outcomes Outcome CategoryHealth Outcome Self-efficacy Greater self-efficacy Improvements in C1 self efficacy Psychological Health Status Better psychological wellbeing Improvements in mental stress management Improvements in frequency of cognitive symptom management Physical Health Status Greater energy Lower health distress Considerably greater health-related quality of life Significant improvements in mental stress Significant improvements in shortness of breath Significant improvements in pain/physical discomfort Significant improvements in activity limitation Improvement in disability Improvement in depression Health Behaviors More exercise and relaxation Significant improvements in eating breakfast Significant improvements aerobic exercise Healthcare utilization Fewer hospitalizations Fewer days of hospitalizations Fewer visits to physicians and ERs Self-rated health Significant improvements in self-reported health Social role / limitations Fewer social role limitations Better communication with physicians Improved participation in social/role activities Greater partnership with clinicians

12.  Chronic Disease Self-Management Program  Diabetes Self-Management Program  Arthritis Self-Management Program  The Chronic Pain Self-Management Program  The Positive Self-Image Program  Spanish language programs Stanford Chronic Disease Self- Management Education Programs

13. Delivery of CDSMP  Program is scripted and delivered by trained leaders T-Trainers Master Trainers Program Leaders

14.  Designed to help people better manage chronic health conditions and live a happier, healthier life  Six-week workshop  Highly scripted and structured to protect fidelity  Group format–typically led by 2 peers CDSMP “HEALTHIER LIVING”: About the Program

15.  Managing symptoms  Dealing with difficult emotions  Improving communication  Relaxation techniques  Tips for eating well  Effective problem-solving  Develop a tool box  Setting weekly goals Workshop Overview

16. Thanks to Dr. Rachel Seymour for permission to use slides  Make the new behavior as easy to do as possible and help participants develop individualized action plans or routines  Provide structured reinforcement to monitor (and celebrate!) progress  Provide support through group and facility-based programming  Use peers to help reinforce desired behavior Supports “Healthy Behavior” Change

17. Participants Learn and Practice Action Planning  Something YOU want to do  Reasonable  Behavior-specific  Answer the questions: What? How much? When? How often?  Confidence level of 7 or more

18. Program Tool Box  Physical Activity  Better Breathing  Medications  Managing Fatigue  Problem Solving  Planning  Using Your Mind  Managing Pain  Communication  Healthy Eating  Understanding Emotions  Working with Health Professionals

19. Participants Learn How to Manage the Symptom Cycle Poor Sleep Fatigue Depressio n Pain Stress/Anxiet y Difficult Emotions SYMPTOMS A Vicious Cycle Physical Limitations Shortness of Breath

20. CI Symptom Management Techniques  Relaxation  Changing their diets  Managing sleep and fatigue  Using meds correctly  Exercise  Communication with health providers

21. Other CDSMP Content  Sexual Relations  Advance Directives  Nutrition  Pain Management  Text: Living a Healthy Life with Chronic Conditions

22. CDSMP Covers Multiple CI  Focuses on common problems  Coping Strategies: Action planning & feedback Behavior modeling Problem-solving techniques Decision-making

23. Problem Solving 1. Identify the problem 2. List ideas to solve the problem 3. Select one method to try 4. Check the results 5. Pick another idea if the first one didn’t work 6. Use other resources 7. Accept that the problem may not be solvable NOW

24. Decision-Making Tool ProRatingConRating Total Points