Abstract
With a near 20-year developmental history as an evidence-based program, the suite of Chronic Disease Self-Management Education (CDSME) programs were selected in 2010 for grand-scale dissemination in a federally supported initiative to improve the health of older Americans. The primary charge of this national effort was to establish a sustainable program delivery system for empowering American adults with one or more chronic conditions to better manage their health. The current study focused on a series of dissemination and implementation science research questions to: (1) examine the geographic distribution of participation in this initiative across the Unites States; (2) describe workshop characteristics engaged to reach program participants in various settings; and (3) describe personal characteristics of the first 100,000 participants. Each subsequent entering cohort was descriptively examined to indicate whether there was constancy or change in delivery sites and populations reached over time. Findings show a strengthening of the workshop delivery infrastructure in that it took 9.4 months to reach the first 25,000 participants in 853 counties compared to 5.4 months to reach the last 25,000 participants in 1,109 counties. The workshop delivery characteristics and participant characteristics remained relatively consistent across increments of 25,000 participants reached, although general trends were observed for some variables. For example, after reaching the first 25,000 participants, subsequent groups of 25,000 participants were reached more quickly. Additionally, workshops were increasingly delivered in ZIP Codes with higher percentages of families residing below the federal poverty line. As more participants were reached, more participants with chronic conditions were enrolled. This national translational study illustrates the rapid expansion of CDSME programs throughout the United States and capability to reach diverse populations in a variety of settings.
Highlights
Seen as a critical part of primary care for the past 20 years [1, 2], disease self-management programs have been associated with a plethora of positive health outcomes among middle-aged and older adults in the United States [3]
CHRONIC DISEASE SELF-MANAGEMENT EDUCATION (CDSME) PROGRAMS As described previously, Chronic Disease SelfManagement Program (CDSMP) falls within a suite of Chronic Disease Self-Management Education (CDSME) programs that have been widely disseminated in the U.S as a method to empower patients with self-management skills to deal with their chronic conditions [12, 13]
DATA SOURCE AND STUDY POPULATION This study reports findings based on cross-sectional data collected from the first 100,000 participants enrolled in the nationwide delivery of CDSME programs as part of the American Recovery and Reinvestment Act of 2009 (i.e., Recovery Act) Communities Putting Prevention to Work: Chronic Disease Self-Management
Summary
Seen as a critical part of primary care for the past 20 years [1, 2], disease self-management programs have been associated with a plethora of positive health outcomes among middle-aged and older adults in the United States [3]. While the healthcare system is increasingly expected to provide chronic care [1], chronic disease self-management initiatives outside of the physician’s office are widely recognized as an effective complement to improve health indicators and quality of life while reducing overall healthrelated complications and associated costs [4]. While CDSMP remains the flagship program, Stanford has translated it to be delivered online, in multiple languages, and for specific diseases/conditions (e.g., diabetes, arthritis, chronic pain, HIV) [5]. This collection of interventions (including CDSMP) comprises the suite of Chronic Disease Self-Management Education (CDSME) programs
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