Vohs Award Winner--Multiple-Region Category: Chronic Disease Self-Management Program: From Development to Dissemination

Abstract

Chronic disease—the principal cause of disability and the major reason for seeking health care—accounts for over 70% of all health care expenditures.1 Although the aging population has contributed to these increases, the prevalence of chronic disease has risen in virtually every age group. Almost 75% of people aged 65 years and older have at least one chronic illness, and about 50% of people aged 65 years and older have two chronic illnesses.2 Although major advances have been made in medical and surgical care of chronic disease, there are great opportunities to enable patients to manage chronic diseases over the long term. For example, patients must cope with discomfort and disability and must follow treatment regimens regularly. In addition, patients must modify their behavior to minimize undesirable outcomes; adjust their social and work lives to accommodate their symptoms and functional limitations; and cope with the emotional consequences. Although health professionals are primarily responsible for medical management of disease, patients are primarily responsible for day-to-day management of their illness. In one domain—living with a chronic disease—patients become the true experts. The highest-quality care for chronic conditions requires a strong, active partnership between informed health care professionals and active patients. However, two patients with the same disease and similar physical impairment may be very different in their ability to function, to enjoy life, and to partner with their physicians. Why? The difference often lies both in a patient’s attitude toward the disease and toward life and in the skills he or she uses for managing day-to-day challenges. Some of the skills and attitudes necessary to live a healthy life despite chronic medical conditions are best learned from other patients who have learned how to cope successfully. Building on the experience and evaluation of the Arthritis Self-Management Program, the Stanford Center for Research in Patient Education and Kaiser Permanente began, in 1990, to develop the Chronic Disease Self-Management Program (CDSMP). The program consists of a group patient education course led by specially trained lay leaders. The program was initiated in Northern California, has been extended to multiple Kaiser Permanente (KP) regions, and is known in different regions by various names. Examples of these names include Healthy Living with Chronic Conditions; Healthier Living: Managing Ongoing Health Conditions; Living Well with Chronic Conditions; and Ways to Feel Better: A Self-Management Course for People with Chronic Health Conditions. Development, implementation, and evaluation of the CDSMP were complex processes undertaken by a multidisciplinary, interregional team led by David S Sobel, MD, MPH, and coordinated interregionally by Mary Hobbs, MPH; in addition, each participating region had designated coordinators (Table 1). Physicians, nurses, health educators, volunteer coordinators, care managers, and Health Plan personnel have collaborated to review, implement, and recruit for this program. Table 1 Chronic Disease Self-Management Program project team