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Stanford Chronic Disease Self-Management Program

Stanford Chronic Disease Self-Management Program. 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. Original Research 1991-1996.

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Stanford Chronic Disease Self-Management Program

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  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

  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. 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 Thanks to Dr. Rachel Seymour for permission to use slides

  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 Physical Limitations Fatigue SYMPTOMS A Vicious Cycle Pain Shortness of Breath Stress/Anxiety Depression Difficult Emotions

  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

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