Patient Self-Management Support Programs: An Evaluation
To supplement a limited evidence base, we examined the variation in the current state of self-management programs to better understand the programming options currently in use. We did so by reviewing the recent literature on existing programs and interviewing a diverse group of key experts in the field.
We conducted a systematic literature search of multiple bibliographic databases, including MEDLINE®, Cinahl, and the New York Academy of Medicine (NYAM) Grey Literature Collection, Sociological Abstracts, and Social Services Abstracts. Search terms included "self-management," "disease management," "chronic care management," "self-efficacy," "self-care," "telehealth," "telemonitor," "telemedicine," and "chronic disease," "chronic illness," "high risk obstetrics or pregnancy," "diabetes," "asthma," "health failure," "depression," "depressive disorder," and "program" and "support." We limited the search to English-language articles published in the last 5 years and studies conducted in the United States.
The search netted approximately 900 citations, which were screened first by topic and then by abstract and full review. To be included in our study, articles had to provide information on self-management support program design in real-world settings or describe evaluation measures used in real-world programs or in research on such programs. Reviews of the effectiveness of self-management support interventions were examined for the purpose of gathering background information; 80 articles met these inclusion criteria. From these studies, we abstracted information on the research design, self-management support program or intervention features, evaluation measures, and study setting and population.a
Interviews with Self-Management Support Experts
We interviewed 44 people knowledgeable about self-management support programs provided through health plans, insurers, employers, public providers, and payers. To produce a list of initial interviewees, we turned to our existing network of experts in the area of chronic disease self-management support, contacts from the 2005 Disease Management Leadership Forum, and the annual lists of DMAA awards for program performance in the field of disease management.37 A "snowball" approach was used to expand this group of interviewees with additional experts identified either in the initial interviews or through the literature review. We identified 55 people as potential interviewees; 44 consented to be interviewed.
We developed a comprehensive interview guide from which we selected items appropriate to each interviewee's expertise. The interview guide was structured to address the multiple domains of self-management support programming choices. Interviewees were recruited by email and interviewed by telephone. Each interview lasted approximately 60 minutes and was conducted by a two-person team consisting of an investigator and a research associate. The RAND Human Subjects Protection Committee approved the recruitment and consent procedures, interview guide, and data safeguarding procedures. Web site searches, articles identified in the literature review, and materials obtained from interviewees were used to supplement the interview data.
a The form used to abstract these data is available from the author on request: firstname.lastname@example.org.