Administration on Aging Helps Older Americans Manage Chronic Disease
A collaboration led by the U.S. Administration on Aging (AoA), part of the Administration for Community Living, is implementing the AHRQ-funded Chronic Disease Self-Management Program (CDSMP). AoA and the Centers for Disease Control and Prevention are successfully bringing CDSMP to older Americans in 45 States, the District of Columbia, and Puerto Rico. Since the first pilot was launched in two communities in 2002, more than 150,000 participants have participated in the program.
CDSMP features a 6-week workshop held in community settings, such as senior centers, churches, libraries, and hospitals. People with a variety of chronic health problems attend the workshops together. Workshops are facilitated by two trained leaders, one or both of whom are laypersons who themselves have chronic diseases.
Developed at Stanford University, CDSMP is based on AHRQ-funded research led by Kate Lorig, RN, DrPH, Director of the Stanford Patient Education Research Center and professor of medicine in the Stanford School of Medicine. AHRQ also played an extensive role setting the stage for widespread adoption of CDSMP and other evidence-based disease prevention programs. The AHRQ-funded research and subsequent articles have been used by national, State, and community partners to build the case for referral and potential reimbursement of CDSMP as part of various health care initiatives.
To assess the fiscal impact of the AoA program, researchers in Oregon analyzed State "reach" data (the number of people served by the program), estimating health care utilization and costs based on the results achieved in Stanford's original research. This study of 4,000 participants found that they avoided an estimated 557 emergency department visits, 557 hospitalizations, and 2,783 hospital days, saving more than $6.5 million in health care costs. The average cost to provide the 6-week program in Oregon is $455, a minimal expense compared with the thousands of dollars it costs to treat a preventable severe medical event.
With AoA funding, States and the aging services network are building sustainable distribution and delivery systems in order to launch evidence-based programs to address the increasing burden of chronic disease in the United States.
"AoA is working with thousands of community sites within the aging network to bring CDSMP to older and disabled adults. Individuals who have completed the educational workshop now understand that they have an important role in managing their own health, and they are equipped with the skills to take action on the issues that matter most to them," says Laura Lawrence, AoA Director of Nutrition and Health Promotion Programs.
She continues, "Equally important, AoA and its network of State and Area Agencies on Aging, community service providers, health care providers, and public health departments are working together to embed these evidence-based health promotion programs into the nation's health and long-term care infrastructure, to ensure a system of care that addresses the growing prevalence of chronic conditions."
Grants awarded to 45 States, the District of Columbia, and Puerto Rico in March 2010 set a performance goal of reaching at least 50,000 older adults while gathering evidence regarding the impact of the CDSMP programs on health behavior and the health outcomes of participants. States and local community organizations exceeded the goal, reaching 101,181 people in a 2-year period, with 75 percent (75,720) completing at least four of six sessions. The majority of program participants are female (77.6 percent), approximately 47 percent live alone, and the average age of participants is 67 years. About a third of the participants are racial minorities, with 17.1 percent identifying as Hispanic/Latino. In addition, 60.3 percent of participants indicate having multiple chronic conditions. The three most common conditions are hypertension (43.1 percent), arthritis (40.9 percent), and diabetes (30.3 percent).
Participants in the programs have benefited from the tools and education they have received. Here are two participants' stories:
- "I was a junk food junkie. Three to four Dr. Peppers a day, candy bars, and fried food for lunch. I never exercised, so I was really overweight. I had a stroke, and a few months later, I was very angry. I was floundering in doubt and self-pity. But after the CDSMP workshop, with proper nutrition and regular exercise, I lost 60 pounds. I've managed to keep it off for more than 3 years. Junk food is a thing of the past for me. My healthy lifestyle changes even allowed me to cut back on my hypertension medication." Walter, Central Texas.
- "I was one of those people who left my health care to the professionals. I felt it was their job to get my blood pressure down. When I attended the CDSMP workshop, those ideas were challenged. I began to see that my eating habits could be contributing to my high blood pressure. If I changed those habits even a little I could contribute to improving my health. My last check-up shows that my cholesterol levels have improved. Although I'd heard most of this stuff before, this workshop got me involved in actually making the changes. Nobody wants to wimp out in front of the group." Cynthia, San Diego.
For more information on community-based programs for older adults, visit http://www.ncoa.org/improve-health/center-for-healthy-aging/. For details about AoA programs, go to http://www.aoa.gov. More information on CDSMP is available at http://patienteducation.stanford.edu/programs/cdsmp.html.
Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, Gonz?lez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999;37(1):5-14.