Overview: Evidence-based Health Promotion and Disease Management Programs

1. Overview: Evidence-based Health Promotion and Disease Management Programs

2. 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.

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

4. AoA Tiered Levels of EBHP • Minimal • Intermediate • Highest

5. 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

6. 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

7. “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.

8. 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

9. 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

10. 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

11. 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”

12. 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

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

14. Recovery Act CDSMP Goals Reach 50,000 completers March 31, 2010 - March 30, 2012 Establish sustainable program delivery system

15. 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

16. 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

17. CDSMP Participants Reached 160,000 + participants enrolled in CDSMP

18. Expanding Program Reach (NCOA, 2013) CDSME County Presence

19. Host Organization Types (NCOA, 2013)

20. Host Organization Types – Health Care (NCOA, 2013)

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

22. CDSMP Participant Characteristics

23. CDSMP Participants - Chronic Conditions

24. 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

25. Sustainable InfrastructureSelected 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

26. 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