Bright Spot: Chronic Disease Self-Management Program (CDSMP)

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This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Overview

Detailed Description

The CDSMP is a low-cost program that helps individuals with chronic conditions learn how to manage and improve their own health, while reducing health care costs. The program focuses on problems that are common to individuals suffering from any chronic condition, such as pain management, nutrition, exercise, medication use, emotions, and communicating with doctors.

Workshops are two and a half hours long, conducted once a week, for six weeks and facilitated by two trained leaders, one or both of whom are non-health professionals with chronic diseases themselves. During the program, approximately 10-15 participants focus on building the skills they need to manage their conditions by sharing experiences and providing mutual support.

CDSMP: Helps people with diverse medical needs such as diabetes, arthritis, and hypertension develop the skills and coping strategies they need to manage their symptoms.

Employs action planning, interactive learning, behavior modeling, problem-solving, decision making, and social support for change.

Is offered through in-person, community-based settings such as senior centers, churches, community health clinics, and libraries.

Is available in Spanish for the chronic disease and diabetes self-management programs, and the Stanford-developed CDSMP trainer manual is available in over 19 different languages.


Expected Outcomes

The overall goal is to enable participants to build self-confidence to take part in maintaining their health and managing their chronic health conditions. The desired outcomes are:

  • Increase in healthy behaviors (i.e., exercise and cognitive symptom management techniques, such as relaxation)
  • Positive changes in health status (less pain, fatigue, and worry; less health distress)
  • Increased self-efficacy
  • Better communications with health providers
  • Fewer visits to physicians and emergency rooms

Key Principles

The general steps for implementation are: Identify two people to become CDSMP Master Trainers or partner with an organization that has Master Trainers. Identified persons above get trained (unless partnering with existing Master Trainers).

Master Trainers facilitate two workshops within a one year period.

Hire a CDSMP coordinator

Obtain a license from Stanford University or partner with an organization that already has a license.

Schedule a CDSMP lay leader training.

Recruit participants for lay leader training.

Hold a lay leader training Identify sites to host CDSMP.

Advertise the program and recruit participants for the program.

Create and manage a fidelity plan.

These steps may differ depending on whether you work with an organization with a license, with master trainers, or with lay leaders. A list of licensed organizations in North Carolina is available at the Evidence-Based Leadership Collaborative.

Cost Details

As of July 2014, the cost for this intervention is as follows: The CDSMP costs between $70 and $200 per person to administer.

Training fee: Costs for group training at Stanford for the 4½ day CDSMP Master Training: $1700 per health professional $1000 for a lay person with chronic disease CDSMP books (~$19 each) and relaxation tapes/CDs (~$12 each) are required for each CDSMP class participant. $0-$200 for lay leader training Training given by Stanford at a site other than Stanford for CDSMP is $15,000 for 4 days (for Leaders' training) or 4½ days of training (for Master training).

License fee: Every organization offering a Stanford program must have a license for that program. If more than one program is being offered, the organization must have a license for each program offered. Each license if good for 3 years from the date of issue. After each three year interval, licenses must be renewed. The fees are: $500.00 for offering 30 or fewer workshops and 2 Leader trainings $1000 for offering 70 or fewer workshops and 3 Leader trainings $1500 for offering 110 or fewer workshops and 5 leader trainings.

Every licensed organization must make a yearly report (due on the anniversary of original license agreement) to Stanford stating the number of workshops and number of participants offered during the past year, number of leader trainings conducted, and the names of all leaders trained with contact information. A multi-programs license (CDSMP and DSMP, or others) is $1000 for 65 workshops and 4 leader trainings or $1500 for 100 workshops and 6 leader trainings. This is more cost-effective if a site wants to offer more than just one program. For additional cost details, please contact the CDSMP directly.

Key Steps for Implementation

The general steps for implementation are:

  • Identify two people to become CDSMP Master Trainers or partner with an organization that has Master Trainers. Identified persons above get trained (unless partnering with existing Master Trainers). Master Trainers facilitate two workshops within a one year period.
  • Hire a CDSMP coordinator.
  • Obtain a license from Stanford University or partner with an organization that already has a license
  • Schedule a CDSMP lay leader training
  • Recruit participants for lay leader training
  • Hold a lay leader training Identify sites to host CDSMP
  • Advertise the program and recruit participants for the program
  • Create and manage a fidelity plan

These steps may differ depending on whether you work with an organization with a license, with master trainers, or with lay leaders. A list of licensed organizations in North Carolina is available the Evidence-Based Leadership Collaborative.

Partnerships

The following are the details on the program savings:

  • The CDSMP saved from $390 to $520 per patient over a 2-year study period because participants used fewer health care services.
  • CDSMP participants used less hospital and physician services than they had used before participating in the program, and less than those who had not participated in the CDSMP control group (Lorig et al., 1999; Lorig et al., 2001a).
  • Researchers found that hospitalization rates for CDSMP participants did not increase over the 2-year duration of the study. For example, during the first 6 months, CDSMP participants were hospitalized fewer days than they had been during the 6 months before they began the program. (Lorig et al., 2001a).
  • CDSMP participants also had 2.5 fewer visits to the emergency room and their physicians (Lorig et al., 2001a).
  • CDSMP cost between $70 and $200 per person to administer. After subtracting costs from the savings due to lower health services use, the total amount saved as a result of the CDSMP over a 2-year period was estimated at $390 to $520 per person (Lorig et al., 1999; Lorig et al., 2001a).
  • CDSMP saves enough money in healthcare in the first year to pay for the program. evidence also suggests that CDSMP results in more appropriate utilization of healthcare resources.

Required Staffing (FTEs)

Depending on the number of workshops, the program coordinator position can be anything from a 25% time position to a full-time position. Also every organization does not needMaster Trainers. If the plan is to train lay leaders less than twice a year, then it is advised to work with a nearby organization and train leaders together to cut costs. Lay leaders are usually volunteers but it is suggested that they receive a small stipend. A list of licensed organizations in North Carolina is available at here.

Special Infrastructure

Program sites must meet several minimal criteria. They must be:

  • Handicap accessible (this includes not requiring the use of stairs)
  • Safe
  • Be able to accommodate up to 20 people in a circle or U
  • Have parking if this is a consideration
  • Be near public transportation if this is a consideration
  • Have well lighted exteriors if the program is after dark
  • Be open to having anyone from the community attend
  • Have a room that provides privacy and provides enough space for the leaders, participants, flip charts, white board and still moving around
  • Have insurance
  • The site should also be in the same community you want to serve so that in most cases participants will need to travel a very few miles or sometimes blocks to reach the site.

Training

Instructor training: Facilitator trainings run 4.5 days for initial program training. It is strongly suggested that health professionals bring a lay person with chronic disease with them. All workshops and trainings are designed to be facilitated by 2 people. Each trainee receives a detailed leader's manual, and a copy of the workshop's textbook and audio CDs (if applicable).

Those being trained as Master Trainers (trainers of leaders) will also receive a trainer's manual and a program implementation tool kit.All Master Trainers must be certified. To become certified, a person must complete a 4.5-day Master Training conducted by two certified T-trainers. These can take place at Stanford University or can be arranged through Stanford to take place anywhere in the world.

In addition to completing training, potential Master Trainers must lead two complete six-week courses for persons with chronic illness. These workshops can be led with a trained leader, a potential Master Trainer, a certified Master Trainer or a T-trainer. Once these requirements have been met, the potential Master Trainer notifies Stanford and they are sent a letter of certification.

If an agency wants to have their own Master Trainers, it is best if they train more than two people, preferably three or four. Before sending someone to a Master Training, it is best if the workshops they are to teach for certification are already planned with dates, sites, and recruitment.

These workshops should take place within six months of initial training and never more than one year after training. If a potential Master Trainer has not taught one workshop within a year of their Master Training, or two workshops within 18 months, they are no longer eligible to become certified by Stanford as a Master Trainer. Lay leaders are trained in groups of 10 to 25 over 4 days by certified Master Trainers.Skilled Master Trainers can handle up to 25 participants but this is the maximum. During the four days, the Lay Leader Trainees experience every activity in the workshop six sessions, set and report success on their own action plans, practice teach two activities with a co-leader, and practice handling difficult people in groups. In addition they learn about licenses and the process for becoming certified as a Master Trainer.

The training is offered over four, six-hour days. Lay leaders are required to facilitate at least one 6-week workshop series within 12 months of training and one 6-week workshop series every 12 months to remain certified. The costs for training are as follows:

Types of Staff

Instructors must be health professionals, or lay leaders/caregivers or with a chronic health problem. Instructors must be able to complete the CDSMP training. It is suggested that at least one leader be a non-health professional.

Return on Investment Details

  • Local health departments
  • Local hospitals
  • Faith-based organizations
  • Senior centers
  • Community agencies

Outcome Measures

The outcome measures are:

  • Health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health)
  • Health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes)
  • Self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, and communication with physician)

Process Measures

Stanford Patient Education Research Center has set forth very specific guidelines in which to implement this scripted program. If an organization is licensed under an entity other than Stanford University, they still need to create and manage a fidelity plan. However, the licensed entity would have oversight of the fidelity plan.

The North Carolina Division of Aging and Adult Services (DAAS) and the Division of Public Health (DPH) have mobilized a statewide campaign to implement and sustain the Chronic Disease Self-Management Program (CDSMP). The ultimate goal of implementing Living Healthy (i.e., CDSMP) is to reduce the risk and occurrence of disease and disability among the rapidly increasing number of adults 60 and older.