Chronic Disease Self-Management Program

Stanford School of Medecine

Purpose:

To develop and evaluate, through a randomized controlled trial, a community-based self-management program that assists people with chronic illness

Target Population:

Adults with chronic diseases 

Program Goals:

• To enable participants to build self-confidence to assume a major role in maintaining their health and managing their chronic health condition

• To improve health behaviors (e.g., exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status of all program participants

• To reduce participants' health care utilization, including a reduction in emergency department visits

Years in Operation:

1992 - 1996 

Results:

The program assessed health status, health services utilization, and perceived self-efficacy to manage different aspects of health and functioning through questionnaires that were mailed to each participant. After the first year of participating in the program, participants had significant improvements in energy, health status, social and role activities, and self-efficacy; less fatigue or health distress; and fewer visits to the emergency room (ER). After two years, participants had no further increase in disability, reduced health distress, fewer visits to physicians and the ER, and increased self-efficacy. Researchers also found that the program saved between $390 and $520 per participant over a two-year study period because participants used fewer health care services. A study funded by Kaiser Permanente found that Kaiser paid approximately $200 per participant for training, materials and administration, costing $97,800. However, the cost for each participant decreased by about $990 because participants used fewer health care services, thereby creating a net savings for Kaiser Permanente of $400,000.

Funding:

A five-year research grant was awarded by the Agency for Healthcare Research and Quality and the State of California Tobacco-Related Disease Office. 

Key Partners:

Stanford School of Medicine; Kaiser Permanente Medical Care Program

What Works and Why:

The Chronic Disease Self-Management Program (CDSMP) provides flexibility to address all risk factors, including behavioral, and does not conflict with existing programs or treatment. Barriers to participation, including access and cultural differences, are addressed through the use of lay leaders and the location in a community setting, one of the major contributors to the success of the program.

Structure and Operations:

The CDSMP was taught at community sites, with 10 to 15 members participating in each session. Sessions ran for seven weeks and were held for two-and-a-half hours each week. Each session was taught by a peer leader, the majority of whom had one or more chronic diseases. Topics discussed at the sessions included adoption of exercise programs; fatigue and sleep management; nutrition; techniques to deal with problems such as frustration, fatigue, pain and isolation; appropriate use of medications; health-related problem solving and decision making; and others. All program content was published in Living for a Healthy Life with Chronic Conditions, which was provided to each participant as a guide. The program also addressed modeling and social strategies that have enhanced personal efficacy such as reinterpretation of symptoms and social persuasion through group support.

Barriers to Success:

A major barrier to success in CDSMP was the problem of participants dropping out of the program. By the end of year one, almost 20 percent of study participants dropped out of the program. It was found that most of these participants were young, nonwhite and unmarried. Additionally, the fact that the program was optional posed problems. Participants had the choice of whether or not to show up for classes, and they did not have to attend class every week.

More Information:

http://patienteducation.stanford.edu/programs/cdsmp.html

Download:

Download this program information in PDF format.