Introduction and Purpose
Chronic illnesses require ongoing attention that differs from traditional, encounter-based care for acute
illnesses. Patients with chronic illnesses such as asthma, cardiovascular disease, depression, diabetes, heart failure, and migraine headaches play a central role in managing the broad array of factors that contribute to their health. Individuals with diabetes, for example, provide close to 95 percent of their own care.1 It makes sense, then, that one way to improve health outcomes for individuals with chronic illness is to provide them with the support they need to manage their illnesses effectively. Indeed, given that the health care system is overburdened and clinician time is limited, some experts regard patient self-management as the only arena where there is available capacity within the U.S. health care system for improving quality of care and reducing costs.
Many "self-management support" programs have been developed in recognition that treating chronic illness requires a new model of care. These programs are intended to prevent the costly health crises (for example, trips to the emergency room) that result from poor management of chronic conditions and to improve long-term outcomes for patients. Recent reviews suggest that self-management support can improve outcomes for different chronic conditions, but much remains to be learned about the relative effectiveness of specific program components. There is little information available to those who are interested in implementing or purchasing such programs to help them decide how to design or structure their programs. Similarly, evaluating program success is complex, and there is little guidance for choosing a set of measures that can reasonably assess whether the program is accomplishing what it was designed to do.
The purpose of this report is to present a number of key considerations for developers and purchasers of programs to take into account when deciding on program components. We examined the current state of patient self-management support programs, including what is known about the programs and what remains unknown. We reviewed relevant research literature and interviewed individuals who have knowledge of self-management support programs.
This report describes the variety of commercial and "home grown" self-management support programs used by health plans, insurers, employers, public providers, and payers such as Medicaid to improve the quality of care for patients with chronic diseases. The goal is to:
- Identify how self-management support programs are structured and describe the most common models and basic features of the programs. Four basic models and specific examples of each are described.
- Outline the choices faced by developers and providers of the programs.
- Identify measures that are used both in research and by existing programs to evaluate the effectiveness and efficiency of self-management support programs.
- Suggest research priorities to both develop the empirical basis for self-management support programs and to assist program sponsors in making program design decisions.
Better understanding of programming options and program evaluation measures should help those implementing or purchasing self-management support programs to better choose components that are appropriate to their goals and to better evaluate the impact of these programs.
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