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8-2-2012

Stanford Self-Management Programs:

Evidence-Based Solutions to DSME/T Challenges

Robin D. Edelman, MS, RD, CDE Sandra A. Parker, RD, CDE Paula Ackerman, MS, RD, CDE Charlotte Hayes, MMSc, MS, RD, LD, CDE

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Session Learning Objectives: 1. Recognize characteristics of Stanford community based self-management programs.

2. Identify natural partners for CDEs among organizations offering and sponsoring Stanford programs.

3. Discuss outcomes of Stanford self-management programs and collaborative efforts.

4. Describe actual and potential cost-savings and system improvements.

5. Use web links for referring patients to online versions of the Stanford self-management programs.

6. Explain the differences between online and small group community-based Stanford programs.

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Tackling Diabetes: “All Hands on Deck”

Persons with Diagnosed Diabetes, United States, 1980–2010 http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm

Tackling Diabetes “All Hands on Deck”

• DSME • High tech & clinical

• DSMS • “High talk”

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Diabetes Self-Management Support

• Standard 8: – A personalized follow-up plan for ongoing

self-management support will be developed collaboratively by the participant and instructors. The patient’s outcomes and goals and the plan will be communicated to the referring provider.

National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

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Diabetes Self-Management Support

• Activities to assist the individual with diabetes to implement and sustain the ongoing behaviors needed to manage their illness.

–  Behavioral

–  Educational

–  Psychosocial

–  Clinical

National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

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Diabetes Self-Management Support

“The effectiveness of providing DSMS through disease management programs, trained peers and health community workers, community-based programs, use of technology, ongoing education and support groups, and medical nutrition therapy has also been established.”

National Standards for Diabetes Self-Management Education. Diabetes Care. 30(6), 2007.

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Tackling Diabetes “All Hands on Deck”

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Administration on Aging ARRA Grants - spreading Stanford self-management programs

• 2 year grant period ended March 2012 • 45 states, DC, and Puerto Rico participated • Grantees predominantly state units on aging (16 health departments)

• 98,468 went through the programs* –  73,657 completing (75% retention)

• 14 pilots focused on the diabetes program –  2 incorporated into accredited DSME/T programs (MI and MA) –  4 in the process of accreditation (San Diego, Houston, Chicago,

Dallas) *Stanford programs included Chronic Disease and Tomando Control de su

Salud, Diabetes, Tomando Control de su Diabetes, Chronic Pain, and Arthritis in English and Spanish

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Vermont’s Experience • Vermont’s Blueprint for Health - healthcare reform

–  Growth of Patient Centered Medical Homes –  CDE’s diverse roles in Stanford programs and reform efforts

• Chronic disease program spread starting 2005

• Diabetes program spread starting 2009

• ARRA self-management grant partners

• A vision for diabetes care using evidence-based self-management programs addressing diverse needs

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Improved Self-Confidence Vermont Outcome Data

37% 39% 41% 41%49% 52%53% 52% 57% 54%

62% 66%

Keep Fatigue FromInterfering

Keep Discomfort orPain FromInterfering

Keep EmotionalDistress From

Interfering

Keep OtherSymptoms or Health

Problems FromInterfering

Do Activities toManage Condition

Things Other ThanMeds Can Reduce

Illness Effect

Baseline 12 Month

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Impact of Health Problems Overall Outlook – VT Data

52%45%

38% 35%36%

26% 24% 24%

Frustrated By YourHealth Problems?

Discouraged By YourHealth Problems?

Fearful About YourFuture Health?

Health A Worry In YourLife?

Baseline 12 Month

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Cost Data • Recent CDC meta-analysis:

http://www.cdc.gov/arthritis/docs/ASMP-executive-summary.pdf

• Gordon C and Calloway T. Review of Findings on Chronic Disease Self-Management Program Outcomes: Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs. Centers for Disease Control and Prevention and National Council on Aging, 2008; ref 9 http://patienteducation.stanford.edu/bibliog.html

• Richardson G, et al. Cost Effectiveness of the Expert Patients Programme (EPP) for Patients with Chronic Conditions. Journal of Epidemiology and Community Health, 62:361-367, 2008.

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Lessons Learned: How CDEs Can Benefit

• Natural partners for referrals to DSME/T

• Scripting that drives people to their diabetes educators

• Incorporating action planning (Stanford style) into current practice

• Evaluating DSME re improved “dosing” of content to maximize patient retention

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Newer Kid on the Block: Online Stanford Programs

• Better Choices, Better Health (BCBH) - Diabetes

• Evidence-based (Lorig, K. et al, Diabetes Care 33:1275-1281, 2010)

• Participants register: http://www.restartliving.org/diabetes.php

• No cost to participate through January 2013

• Advantages for certain participants –  Working during day (or night) –  Not “group” people –  Enjoy more anonymity but benefit from connection to others

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Foundation of Better Choices, Better Health - Diabetes

As with all of Stanford’s Programs:

• Built on structured patient and professional needs assessments

• Systematically use strategies to enhance self-efficacy:

! Goal Setting ! Modeling ! Reinterpretation of Symptoms ! Peer support ! Social Networking

!"#

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BCBH-Diabetes What’s Taught? Healthy Eating 6 weeks Sharing/Problem Solving 6 weeks Action Planning 5 weeks Exercise 2 weeks Preventing Hypoglycemia 1 week Monitoring glucose 1 week Stress/Depression 3 weeks Medications 1 week Preventing Complications 1 week Communication skills 2 weeks Sick Days 1 week

!$#

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BCBH-Diabetes: More Information • Online curriculum in learning centers developed/reviewed by CDEs with content that complies with clinical standards of diabetes care endorsed by AADE and ADA

• 20-25 participants peer-led by two trained facilitators participating actively on discussion boards

• Peer facilitators are supervised by online mentor who has immediate access to CDEs

• Individual clinical advice is NOT provided • Posts with erroneous information and disrespectful posts can be removed

• Questions? Email Julie.Kosteas@vcoa.org

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