AHRQ Program Helps Japanese Health Group Address Self-Management for Patients With Chronic Diseases

Prevention and Care Management
October 2008

The AHRQ-funded Chronic Disease Self-Management Program (CDSMP) was influential in the development of the Japan Chronic Disease Self-Management Association (J-CDSMA), a non-profit organization established in 2005. Since that time, the J-CDSMA has offered 52 workshops, with some 450 participants in Japan.

The CDSMP, an evidence-based program developed at Stanford University, was brought to the attention of the Japanese people in a number of ways, including the following:

  • A textbook used in the CDSMP was translated in 2001 into Japanese by Fusae Kondo Abbott, DNSc, a U.S.-residing RN, and published through the Japanese Nurses' Association Publishing Company.
  • "International Symposium 2003 on Patient-Centered Healthcare: The Work of Patients' Groups-Making the Patient's Voice Heard in Society," was held in Tokyo. Sponsored by the Japan Pharmaceutical Manufacturers Association (JPMA), the conference included information on how the CDSMP has been implemented in the United Kingdom in partnership with the National Health Service.
  • A delegation of Japanese patients' groups, sponsored by the JPMA, visited Stanford University to meet Kate Lorig, RN, DrPH, developer of the CDSMP. Lorig introduced Abbott to the delegation, and a project team was formed in collaboration with several patients' groups, the JPMA, and Abbott.

The project team wanted to maintain the patient-centered focus in providing CDSMP workshops. The team believed that people with chronic conditions should be able to take a workshop by choice, not because they were told to do so by professionals. Under the traditional Japanese health care delivery system, most health services are offered by professionals in accordance with physicians' orders.

In order to incorporate the principles of the CDSMP into the current Japanese health care system, the J-CDSMA was established. It was approved by the Japanese government as a not-for-profit organization in 2006.

Masaharu Ito, MD, board chairman of the CDSMA states, "After learning about the CDSMP developed at Stanford University, I strongly felt that this could trigger a change in the physician-centered health care delivery system in Japan."

Ito was executive director of the Health Policy Bureau in the Ministry of Health, Welfare, and Labor. Reflecting on his more than 30 years of experience as head of health care administration, he says, "I accepted the chairmanship of the J-CDSMA in order to move the Japanese health care system towards a patient-centered system. We needed to develop a core organization to disseminate the CDSMP in Japan and to build evidence of the effectiveness of the program."

Research funded by Japan's Ministry of Health, Welfare, and Labor has examined the effectiveness of the CDSMP in Japan. The work has been conducted by the Health Sociology Department in the Graduate School of Health Sciences and Nursing at the University of Tokyo. The preliminary report indicated results very similar to those presented by other published studies about the effectiveness of the CDSMP.

The J-CDSMA has 14 board members from various sectors, including representatives of patients' groups, health care professionals, academicians, an economist, a representative of the JPMA, representatives of health insurance groups, and an attorney. The organization has two paid staff members, with three divisions: operations division, public relations committee, and program committee.

The program committee ensures the quality of the CDSMP program. Its activities include translation of teaching materials, support for research activities and support for attending Master Trainers' training at Stanford, as well as providing leaders' training in Japan. The committee has also developed a quality assurance program for leaders.

For more information on the Chronic Disease Self-Management Program at Stanford, visit http://patienteducation.stanford.edu/programs/cdsmp.html.

Impact Case Study Identifier: 
AHRQ Product(s): Research
Topics(s): Chronic Care: Self-Management
Geographic Location: Japan
Implementer: Japan Chronic Disease Self-Management Association
Date: 10/01/2008

Lorig KR, Sobel DS, Stewart AL, Brown Jr BW, Ritter PL, Gonz?lez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care 1999 37(1):5-14. (HSO6680)

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