1. Healthy Living (CDSMP) & Arizona Living Well Institute
AZ Living Well Institute
10/24/2013
Healthy Living (CDSMP) & Arizona Living Well Institute

2. AZ Living Well Institute
10/24/2013
Agenda
Background, structure and purpose of Healthy Living
Arizona Living Well Institute
Opportunities
Q & A
Arizona Living Well Institute
Arizona Living Well Institute

3. Nationwide Evidence-Based Initiative
AZ Living Well Institute
10/24/2013
Nationwide Evidence-Based Initiative
U.S. Administration on Aging funded Initiative 2006
To transform Aging Services Network to health impacting sites
Brings evidence-based programming to community-based organizations
Stanford University’s CDSMP is the core program
2010 American Recovery and Reinvestment Act (ARRA)
Communities Putting Prevention to Work: Chronic Disease Self- Management Program initiative - $27 million (45 states, District of Columbia and Puerto Rico)
2011 NASMHPD Peer Support Specialist Workforce Development Grant
2012 ACL-AoA 3rd Round of Self-Management Funding
22 States to continue to increase reach of EBP to ethnic minority groups and expand programs available
Arizona Living Well Institute

4. Evidence-Based Programs
AZ Living Well Institute
Evidence-Based Programs
10/24/2013
Promising Practice
Best Practice
Evidence-Based Model
A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues at an individual level and at a community level
A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues in an ecological context.
Evidence about the health issue that supports the statement “Something should be done;”
Evidence about a tested intervention or model that supports the statement, “This should be done;”
Evidence about the design, context and attractiveness of the program that supports the statement, “How this should be done.”
An evidence-based program has been demonstrated to be effective in basic research that involved the same target audience
Then it has been demonstrated to be effective in dissemination in the “real world.”
There are clear protocols for training and conduct of the program so that community programs can maintain fidelity and be successful
Evidence for positive health outcomes:
Physical activity
Sound diet & weight mgt
Social connectedness
Engagement & productivity
Enabling environments
Communities for All Ages
Healthy Communities for Active Aging
Smart Growth
Source: Altpeter, M., Schneider, E., Bryant, L. Beattie, B., & Whitelaw, N. (2004). Using the evidence base to promote healthy aging. National Council on the Aging Evidence-based Health Promotion Series, Vol. 1. Washington, DC: National Council on the Aging.
Arizona Living Well Institute

5. AZ Living Well Institute
10/24/2013
Healthy Living
Healthy Living Stanford University’s CDSMP
Arizona Living Well Institute
Arizona Living Well Institute

6. AZ Living Well Institute
10/24/2013
Disease
Tense Muscles
Fatigue
Symptom
Cycle
Shortness of Breath
Pain
Stress/
Anxiety
Referring back to the list of problems generated earlier or the previous slide :
1) Point out that often pain and fatigue seems to be one of the most common problems experienced by people with chronic health problems.
2) As you may already have experienced, one symptom can then lead to a series of other problems, which often creates more symptoms. It becomes a symptom cycle.
3) Let me give you an example of how the symptom cycle works.
Arthritis causes you pain because of inflammation or bone rubbing against bone. In response, to protect the hurting joint, you tighten the muscles in that affected area. As these are tightened for a long time, the muscles also begin to cause pain (ask them to make a fist or outstretch their hand and hold for a few minutes: as the time passes, they'll notice that it starts to ache). As your pain mounts, you become stressed and more tense, wondering if the pain will ever get better. You might even cut back on activities. This, in turn, causes weak muscles and emotions such as worry, anger, fear, frustration, and even depression. Stress, difficult emotions and lack of exercise can cause shortness of breath and fatigue, making the pain worse and completing the vicious cycle.
5) This vicious cycle can happen with any health problem, not just arthritis, and the cycle can start anywhere – depression, for example, can start the whole cycle, or fatigue.
6) How many of you have experienced aspects of this cycle (ask for a show of hands)? How many of you believe people can influence this cycle by using certain methods or techniques (ask for a show of hands)?
7) You can break this vicious cycle! There are a variety of ways to do this using physical exercises, mental exercises and more.
Depression
Difficult Emotions
Arizona Living Well Institute
Stanford Chronic Disease Self Management, 2006

7. AZ Living Well Institute
10/24/2013
Workshop Design
6 weekly sessions that meet 1 day per week for 2.5 hours each
Introduces tools needed in day-by-day life with chronic conditions
Practices using self- management skills
Focuses on goal setting
Shared experiences, emphasizes mutual support
Workshops Available
English & Spanish
Diabetes & Chronic Pain
2. Is it a support group? - Healthy Living is not a support group, even though participants share experiences, problem solve together, and support each other a great deal. It is facilitated from a set curriculum. Again very interactive in a workshop format rather than a traditional class format. It is a workshop where you learn and try new skills, and increase your ability to manage your health. There even is a wonderful reference book (show the book), that helps reinforce and expand on what is covered in the workshop. It is not, however, a textbook but just one more tool to tap into if you so chose.
3. The question could come up: “What if I have to miss a session because I get sick or have a doctor’s appointment or a planned trip?” These things do come up in daily life especially living with chronic conditions. If you are going to miss, you might suggest letting one of us know or giving us a call.
Arizona Living Well Institute

8. AZ Living Well Institute
10/24/2013
Topics Covered
Action Plans
Feedback/Problem Solving 
Getting a Good Night’s Sleep
Managing difficult emotions
Falls Prevention
Physical Activity/Exercise
Nutrition & Food Labels
Weight Management
Mind-Body Connection
Informed Treatment Decisions
Working with Health Care
Arizona Living Well Institute
Arizona Living Well Institute

9. AZ Living Well Institute
10/24/2013
Healthy Living Facilitators
T-Trainer
- Mentored by
Stanford
- Train Master Trainers
Master Trainers
- 4 ½ day training led by
2 T-Trainers
- Certified through Stanford after
facilitating 2 workshops
- Train Leaders – 1 training per year
- May facilitate workshops
- May assist in fidelity monitoring
Lay Leaders
- 4 day training led by 2 Master Trainers
- Facilitate workshops
- Preferably peers with chronic conditions
- May be volunteers or staff,
usually not health professionals
Three level of Facilitators
Workshop facilitators are the foundation of Healthy Living CDSMP, and the heart and sould of the program

10. Ideal Abilities of a Leader
Possesses good listening skills, is non-judgmental
Understands the importance and purpose of fidelity (following the curriculum)
Possesses good communication and
interpersonal skills
Exhibits enthusiasm
Is dependable and consistent
Comfortable in front of a small group
Possesses life experience resulting in empathy
to the needs and abilities of older adults.
Arizona Living Well Institute

11. AZ Living Well Institute
10/24/2013
What are the Outcomes?
Self-Management NOT Health Education
Purpose of self-management is to help people gain self confidence in their ability to:
- control their symptoms
- control how their health problems affect their lives
Health education- inform/increase knowledge, change behaviors
Self-management- Helps participant to: manage life with Disease, increase skills/self confidence, problem solve and make decisions
Outcomes-
Increased physical activity
Enhanced partnerships with physicians
Improved self-reported general health
Improved social/role activities
Better psychological well-being
Increased energy/reduced fatigue
Improved health-status
Health status -
• Less fatigue
• Less disability
• Improved role function
• 0.8 fewer days in the hospital
Self-management -
• Increased minutes of exercise
• Increased use of cognitive pain and stress management techniques
• Improved communication with their physicians
• More confidence in their ability to manage their conditions
5 year randomized study, 1000 people
Outcomes?
For more information on CDSMP outcomes, Review of Findings on Chronic Disease Self-Management Program (CDSMP) Outcomes: Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs,
Arizona Living Well Institute
Arizona Living Well Institute 11

12. AZ Living Well Institute
10/24/2013
Outcomes
Increased physical activity
Improved health-status
Improved social/role activities
Better psychological well-being
Decreased days in hospital
Improved self-reported general health
Enhanced partnerships with physicians
Increased energy/reduced fatigue
Reduced health care expenditures
For more information on CDSMP outcomes, Review of Findings on Chronic Disease Self-Management Program (CDSMP) Outcomes: Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs,
CDSMP has been extensively evaluated through repeated, randomized controlled trials. A review of major published studies found that CDSMP results in significant, measurable improvements in the health and quality of life of people living with chronic conditions. The program also appears to save enough through reductions in health care expenditures to pay for itself within the first year. Studies have indicated fewer emergency room visits, inpatient stays, and outpatient visits, fewer hospitalizations and a health care cost savings of approximately $590 per participant.
Arizona Living Well Institute

13. National Study of CDSMP (2010-2012)
AZ Living Well Institute
10/24/2013
National Study of CDSMP ( )
How does CDSMP affect the lives of participants and society as a whole?
What are the impacts on:
Symptom management and lifestyle behaviors?
Better care?
Improved health?
Reduced health care costs?
Study Participants
Baseline (n=1,170)
12 month (n=825)
Measures
Symptom management and lifestyle behaviors
Better Care
Experience of care
Better Health
Population health
Lower Health Care Cost
Symptom management and lifestyle behaviors: Pain, fatigue, shortness of breath, stress, pain, physical activity
•Better Care: Communication with MD, medication compliance, health literacy
•Better Health: Self-assessed health, depression, quality of life, unhealthy physical/mental days
•Lower Health Care Cost: ER visits, Hospitalization
83% Female
65.4 years
55% non-Hispanic White
3.0 Comorbidities
79% Completion Rate
Statistically Improved Symptom Management
-Fatigue, Pain, SOB, Stress, Sleep Problems
Increase in Moderate Activity minutes per week
Statistical analyses
•Examining change at baseline and 12-month follow-up controlling for key socio-demographics and chronic conditions
•Analytical models appropriate to type variables
•Findings in terms of percent improvement or adjusted ratios
Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease Self-Management Programs (CDSMP). Retrieved April 2, 2013, from
Berwick et al. (2008). The Triple Aim: Care, Health, And Cost. Health Affairs.
Arizona Living Well Institute

14. Estimated Cost Savings Related to Reduced ER Visits & Hospitalization
AZ Living Well Institute
10/24/2013
Estimated Cost Savings Related to Reduced ER Visits & Hospitalization
Preliminary Results:
~$740 per person savings in ER and hospital utilization
~$390 per person net savings after considering program costs at $350 per participant
Reaching even 10% of Americans with one or more chronic conditions would save ~$4.2 billion!
Calculating Potential Cost Savings
Examine the pattern of health care utilization use
Identify mean costs from national data (age-adjusted)
Estimate costs saved from reduced utilization
Estimate program costs in CDSMP Study
Deduct program costs for net savings
Extrapolate to national savings
Consider study limitations
Cost Calculation Limitations
Using self-reported data
There are prior studies indicating good concordance between self-reported and actual documented health care utilization but we acknowledge possible misreporting.
Generalizing from aggregate national data instead of exact expenses
We employed age-specific estimates but not link specific conditions to reported outcomes.
All of our participants were selected based on having a chronic disease
We extrapolate to the US population with chronic conditions although participants’ self-reports of chronic conditions are not an exact match to those in national data bases.
Arizona Living Well Institute

15. Workshop Types in Arizona
English
Spanish
Healthy Living
CDSMP
Healthy Living with Diabetes
DSMP
Healthy Living with Chronic Pain
CPSMP
Tomando Control de su Salud
Spanish CDSMP
Programa de Manejo Personal de la Diabetes
Spanish DSMP
Arizona Living Well Institute

16. What Else Do I Need to Know?
Healthy Living will NOT interfere with other programs - it will complement other programs!
Healthy Living is not a support group.
Even though participants share experiences and support each other, it is a workshop where you learn and try new skills, and increase your ability to manage your health.
To be most effective, it is important for participants to be present and contribute in all sessions.
2. Is it a support group? - Healthy Living is not a support group, even though participants share experiences, problem solve together, and support each other a great deal. It is facilitated from a set curriculum. Again very interactive in a workshop format rather than a traditional class format. It is a workshop where you learn and try new skills, and increase your ability to manage your health. There even is a wonderful reference book (show the book), that helps reinforce and expand on what is covered in the workshop. It is not, however, a textbook but just one more tool to tap into if you so chose.
3. The question could come up: “What if I have to miss a session because I get sick or have a doctor’s appointment or a planned trip?” These things do come up in daily life especially living with chronic conditions. If you are going to miss, you might suggest letting one of us know or giving us a call.
Arizona Living Well Institute

17. Arizona Living Well Institute
AZ Living Well Institute
10/24/2013
Arizona Living Well Institute
The mission:
to advance evidence-based programs for Arizona communities through structured communication, multi-level coordination and systematic coaching.
Arizona Living Well Institute

18. AZ Living Well Institute
10/24/2013
Arizona Living Well Institute
Empowerment Systems, Inc.
AZ Living Well Institute
Greater Valley AHEC
Community Outreach
Health Informatics
AZ Coalition for Military Families
The AZ Living Well Institute, the Greater Valley AHEC, and the AZ Coalition for Military Families are part of Empowerment Systems, Inc., a nonprofit family of health education and wellness programs.
Funds to launch the Arizona Living Well Institute were made available by grant funds from St. Luke’s Health Initiatives and the Arizona Department of Health Services through a grant from the Administration on Aging.
Arizona Living Well Institute

19. How AZLWI Provides Support
Coordination and leveraging of resources to create greater impact
A systematic approach to data collection and management
Coordination of training opportunities throughout the state, including coordination of self-management workshops
Educate employers, health care providers and community services organizations about the benefits of self-management programs and evidence-based health promotion programs
Arizona Living Well Institute
Arizona Living Well Institute

20. Community-Based Referral Network
AZ Living Well Institute
10/24/2013
Community-Based Referral Network
A comprehensive membership system of evidence-based wellness programs
Promoted and integrated with primary and behavioral health outpatient providers of service for those living with or at risk of developing chronic conditions.
In order to sustain and expand the impact of self-management programs, AZLWI is further developing, supporting and promoting a structured provider membership system to ensure quality evidence-based wellness services are provided at affordable prices.
In order to sustain and expand the impact of self-management programs, AZLWI is further developing, supporting and promoting a structured provider membership system to ensure quality evidence-based wellness services are provided at affordable prices.
Arizona Living Well Institute

21. AZ Living Well Institute
10/24/2013
Community-Based Referral Network
Community Outreach Navigators
Health & Human Service Providers
Insurance Providers
AHEC Interns
Self-Referral
Referrals
Evidence-based Self-Management Workshops
Referral to other needed services (e.g. ASHLine, WIC, etc.)
Assistance completing health & human service applications (e.g. AHCCCS)
Referral to potential Medical Home
Database Management
Invoicing & Billing Services
Services
Response to referral source of services provided to include:
Participation in Self-Management Workshop
Other completed referrals/services
Outcomes
Web-Based, Integrated Participant Referral & Tracking System

22. Benefits of Connecting Through AZLWI
Strategic Growth
Technical Assistance
Regional Collaboratives
County Coalitions
Improved Retention
Facilitators
Participants
Stay up to Date
CDSMP Updates
Meet & Retreats
Refresher Trainings
Improved Problem Solving
Local Mentors
Statewide Webinars
Leverage Funding Opportunities
Partners supporting Partners
System Infrastructure
Rather than person centered
Creation of infrastructure that was not person centered.
Our Mission
Coordination
Communication
Engage
Empower
Educate
Coaching
3 E’s of Communication
-Engage with conversation
-Empower with knowledge
-Education with reliable content
Arizona Living Well Institute

23. AZ Living Well Institute
10/24/2013
Opportunities
Arizona Living Well Institute

24. Partnership Opportunities
AZ Living Well Institute
10/24/2013
Partnership Opportunities
Partnering with CBOs to broaden the array of non-clinical services
New models of care delivery provide flexibility for service design and payment to include self-management programs
Greater focus on patient motivation and engagement
Growing awareness of effectiveness of self-management programs and value of partnering with community resources
Lachenmayr, S. National Council on Aging “Patient Self-Management As a Strategy to Reduce Hospital Readmissions”, September Slides
Arizona Living Well Institute

25. ACL CDSME Completer Payments
AZ Living Well Institute
10/24/2013
ACL CDSME Completer Payments
Limited funding associated with the ADHS’ Administration for Community Living CDSME grant
Primary goal to increase CDSMP/DSMP workshops to populations disproportionately impacted by chronic disease, specifically Spanish speaking, rural and minority populations.
$125 per completer payment.
September 1, 2013 and August 31, 2014
A “completer” is defined as a participant that has attended 4 or more of the 6 sessions per workshop.
One have one opportunity now for completer payments. The Arizona Department of Health Services/Office of Chronic Disease (ADHS) has limited statewide funding available for Local County Health Departments and community organizations to implement Chronic Disease Self-Management Education (CDSME) programs. These funds are associated with the ADHS’ Administration for Community Living grant with the primary goal to increase CDSMP/DSMP workshops to populations disproportionately impacted by chronic disease, specifically Spanish speaking, rural and minority populations.
Arizona Living Well Institute

26. AZ Living Well Institute
10/24/2013
Participant Comments
I feel that this class has been of great benefit to me which will stay with me in times of difficulty or when I feel myself slipping back toward depression or isolation from people. I will put forth an extra positive effort to continue the breathing techniques and especially the exercises learned or reinforced in a continued plan to control my painful condition in the best possible way without being dependent upon prescription drugs. Rebecca – Arizona City
We had experienced, or learned different parts of this program before, but no part alone was life changing. But with this program structure, I am a different person than I was just six- weeks ago and hope to stay motivated! MDC - Goodyear
Arizona Living Well Institute

27. AZ Living Well Institute
10/24/2013
Questions?
AZ Living Well Institute
(480)
Arizona Living Well Institute