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Margery Konan, LHIN Priority Project ManagerSelf‐Management Training for Consumers & Caregivers
www.healthylifeworkshop.cawww.healthylifeworkshop.ca
Time spent over 1 year:
GP visits per annum = 1 hourGP visits per annum = 1 hour
Visits to specialists = 1 hourVisits to specialists = 1 hour
Nurse, PT, OT, Nurse, PT, OT, DietitianDietitian = 10 hours= 10 hours
Total = 12 hoursTotal = 12 hours
364½ days managing on their own
‘Chronic Disease’ Patient Contact with Health Professionals
191,000 (36%) of CE LHIN residents had at least one of cancer, diabetes, heart disease, hypertension, stroke, asthma, COPD or arthritis (2005).
Multiple chronic conditions increase with age:Age 45+: 156,000 (27%) had two or more Age 65+: 91,000 (46%) had two or more
In the CE LHIN, chronic conditions* accounted for:
1 in 4 inpatient hospital separations1 in 10 Emergency Department visits1 in 5 General Practitioner/Family Practitioner (GP/FP) visits
* diabetes, stroke, hypertension, depression, cancer, COPD, asthma, heart disease, arthritis
Chronic Disease in CE LHIN
What is Chronic Disease Self-Management?
Self-Management:
“Individual’s ability to manage the symptoms, treatment, physical, and psychosocial consequences and lifestyle changes inherent in living with a chronic condition.” LORIG
Self-ManagementActions taken by patients in caring for chronic conditions (e.g. taking medications, exercise, managing functional limitations)
Self-Management SupportActions by health care providers that strengthen and support self-management
Clinicians are present for only a fraction of the patient’s life.
Nearly all outcomes are mediated through the patient’s behaviour.
Knowledge / Motivation is not enough.
People also need self-confidence, and certain skills that can be modeled and taught – in group sessions or via one-on-one interactions.
Important Realizations
INDIVIDUALS AND FAMILIES
Improved clinical, functionaland population health outcomes
HEALTH CAREORGANIZATIONS
Informed,activated
individuals& families
Prepared, proactivepracticeteams
Activated communities &
prepared, proactivecommunity
partners
HealthyPublicPolicy
SupportiveEnvironments
CommunityAction
DeliverySystemDesign
ProviderDecisionSupport
InformationSystems
Ontario’s CDPM Framework
Productive interactions and relationships
PersonalSkills & Self-Management
Support
How Does Chronic Disease SelfHow Does Chronic Disease Self--ManagementManagementProgram (CDSMP) Work?Program (CDSMP) Work?
• Stanford University licensed Program, extensively researched and evaluated– Based on Albert Bandura’s Model of Self-Efficacy– Principles of Modeling, Goal Setting & Problem
Solving
• Group sessions of 8 to 16 persons– 2½ hours per week for 6 weeks – Co-led by Peer Leaders with chronic health
conditions
Treatment subjects when compared with control subjects, demonstrated improvements at 6 months in:
weekly minutes of exercisefrequency of cognitive symptom managementcommunication with physiciansself-reported healthhealth distressfatigue, disability, and social/role activities limitations.
They also had fewer hospitalizations and days in the hospital.Source: Lorig et al. Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status
While Reducing Hospitalization: A Randomized Trial. Medical Care. 37(1):5-14, Jan 1999.
Chronic Disease Self-Management Program’s Effectiveness
Year-End Summary Fiscal 2008-2009:
Self-Management Training for Consumers and Caregivers
CE LHIN Priority Project
9
Self Management Training for Consumers and CaregiversOne of 13 Projects Funded through LHIN’s Urgent Priorities Fund
Deliverables• Introduction of a consistent Chronic Disease
Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by end of year 2)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Funding at time of announcement
2007-08
97,507
2008-09 2009-10 Total
523,212 671,420 1,292,139
Decision-Making Framework:
88.0%
Alignment
• CDPM
• Primary Care
• Diversity
Due Diligence
• Durham North
Collaborative
• CDPM Network
10
Project Milestones: April 2008 – April 2010
Projec
t Tea
m Formed
Educa
tion S
essio
ns fo
r HCPs
First P
eer L
eade
rs Trai
ned
Inaug
ural W
orksh
ops
Master
Traine
rs Trai
ned
Web
site &
Com
unica
tions
Toolki
t Lau
nche
d
Area Im
plemen
tation
Teams I
denti
fied
Area P
rogram
Coo
rdina
tors I
denti
fied
Transit
ion to
Long
-Term
Deli
very
Model
Apr-08 Jun-08 Aug-08 Oct-08 Dec-08 Feb-08 Apr-08 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10
11
At March 2009 all major targets have been reached.Behind schedule in Evaluation Plan Progress; signing Agency Agreements.
• Equitable Access – regardless of where one lives in the LHIN
• Open Access, Inclusive – open to family members & caregivers; few requirements for participation
• Peer Led – group leaders do not speak as experts, rather as persons living with chronic conditions themselves
• Community Based – population health approach; not designed for acute care setting
12
Guiding Principles
Consistent• Common name, visual identity, and communications tools across
CE LHIN• Core guidelines for delivery, built into Agreements with health
service providers
Coordinated• Single registry of consumers, leaders & trainers• Linked to primary care & community programming
Sustainable• Client / Caregiver benefits sustained via follow-up -- and by aware /
supportive health service providers• Delivery Model can be sustained/supported over time
Guiding Principles
13
Self Management Program Accomplishments, 2008-2009
Deliverables• Introduction of a consistent Chronic
Disease Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by March 2010)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Budgets revised
2007-08
0
2008-09 2009-10 Total
380,000 761,420 1,141,120
14
CDSMP license obtained by CECCAC, valid Sept 2008-Sept 2011
“Living a Healthy Life with Chronic Conditions”program name adopted
Wordmark logo created and used consistently on all promotional materials
Over 30 HSP agencies have participated by training volunteers or staff and hosting programs.
Direct toll-free line and dedicated program website established.
Community Collaborators (selected)Yee Hong Centre for Geriatric Care
Carefirst Seniors
St. Paul’s Community Services
West Hill Community Services
Family Service Toronto
Providence Healthcare
Ross Memorial Hospital
Community Care Kawartha Lakes
Community Care Northumberland
Community Care Peterborough
The Arthritis Society
VON
Trent Hills Family Health Team
Fenelon Falls Family Health Team
Greater Peterborough FHT
Haliburton Highlands FHT
CHCs: Port Hope, Oshawa, Taibu & Brock
Northumberland Hills Hospital
Oshawa Senior Citizens Centres
Whitby Seniors
Activity Haven Senior Centre
Durham Region Diabetes Network
Curve Lake First Nation
Saint Elizabeth Health Care
15
16
Sample Promotional Flyer for Self-Management workshop(excerpt)
17
Sample Promotional Flyer for Self-Management workshop(excerpt)
18
Free reference book provided to all participants
Website live in April 2009
www.healthylifeworkshop.ca
Self Management Program Accomplishments, 2008-2009
Deliverables• Introduction of a consistent Chronic Disease
Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by end of year 2)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Budgets revised
2007-08
0
2008-09 2009-10 Total
391,500 761,420 1,152,920
20
38 self-management workshops for consumers and caregivers in 2008-09
460+ participants
Workshops in all 9 LHIN engagement zones.
19 in Scarb – 245 ppts
6 in Durham – 76 ppts
13 in North East – 145 ppts (Haliburton-Minden, Kawarthas, Peterborough, Northumberland-Havelock)
Self-Management Workshops 2008-2009
• Family Health Teams
• Hospitals
• Other Community Agency
• Seniors Centres
• Community Health Centres
• Retirement/LTC Homes
21
Self Management Program Accomplishments, 2008-2009
Deliverables• Introduction of a consistent Chronic Disease
Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by end of year 2)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Budgets revised
2007-08
0
2008-09 2009-10 Total
391,500 761,420 1,152,920
22
8 workshops offered in Cantonese; 2 in Mandarin; 3 in Tamil.
First-ever Tamil translation of CDSMP created in March 2009 by Jeyasingh David in partnership with Providence Healthcare
Chinese translation of Diabetes Self-Management Program has been produced.
Self Management Program Accomplishments, 2008-2009
Deliverables• Introduction of a consistent Chronic Disease
Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by end of year 2)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Budgets revised
2007-08
0
2008-09 2009-10 Total
391,500 761,420 1,152,920
24
20 new Master Trainer graduates in 2008-09, in 7 of the 9 LHIN engagement zones
72 new Peer Leaders graduated from 5 Leader Training Courses: Peterborough, Scarborough (2), Port Perry, Pickering. Oshawa
Total: 100+ Peer Leaders and 25+ Master Trainers currently active in CE
T-Trainerstrain Master Trainers
4 certified for province of Ontario
Master Trainerstrain Peer Leaders (in pairs)
36 Master Trainers to be trained (18 each yr)
Peer Leaderslead Self-Management Workshops (in pairs)
Goal: 225 leaders (60 + 165)
Participantsattend 6-week Workshop
Goal: 400 by Apr 2009; 1400 by Apr 2010
72 Peer Leaders Trained in 2008‐09
20 Master Trainers Trained in 2008‐09
460+ participants in fiscal 2008‐09
25
Self Management Program Accomplishments, 2008-2009
Deliverables• Introduction of a consistent Chronic Disease
Self-Management Program (CDSMP) across the Central-East LHIN
• Program Development and training coordination for English-speaking and Asian/other multi-cultural populations
• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by end of year 2)
• Self-Management Training Sessions for people with chronic conditions and their caregivers (target participants: 400 by April 2009, 1400 by April 2010)
• Education and consultation to promote integration of Self-Management Support within the practice of Health Service Providers
Budgets revised
2007-08
0
2008-09 2009-10 Total
391,500 761,420 1,152,920
27
Education sessions to 190 CECCAC Case Managers at all 7 branches
20+ HSP education sessions in all including 4 presentations to Diabetes Educators / Central East Diabetes Network
Presentations to CKD staff; Community Care; 4 Collaboratives; Primary Care Working Group; CDPM Steering Ctte
Self-Management Skills Training to All-Faculty Meeting of Trent/Fleming School of Nursing (40+ faculty)
• Chronic Pain Self-Management Workshops (CPSMP) in Scarborough, Minden & Peterborough
• Diabetes Self-Management Program Training in Whitby –still space available in 4-day Leader Training Course June 24-27 (Wednesday through Saturday, 9:00-4:00 each day)
28
What’s coming in 2009-2010
• Transition to a Long-Term & Sustainable Program – a major task of CE LHIN, Project Staff, Priority Project Leadership Team, and CECCAC.
• Program Evaluation Data to support the Triple Aim in CE LHIN
• Taking a Leadership Role with other Ontario LHINsalso developing regional models for Chronic Disease Self-Management
29
Opportunities ahead in 2009-2010
Central East LHIN Vision
Central East Self-Management VisionPeople with chronic conditions and their caregivers manage their health and quality of life with confidence.
30
What health care providers do..What health care providers do..
SelfSelf--management supportmanagement support is definedis definedas the systematic provision of educationas the systematic provision of educationand supportive interventions by healthand supportive interventions by healthcare staff to increase care staff to increase patientspatients’’ skills andskills andconfidenceconfidence in managing their healthin managing their healthproblems, including regular assessment problems, including regular assessment of progress and problems, of progress and problems, goal setting,goal setting,and problemand problem--solving supportsolving support..
“Patients as Partners: Strategies to Support Self-Management of Chronic
Conditions”
Importance of “Patients as Partners: Strategies to Support Self-Management
of Chronic Conditions” Best Practice Guideline
• Emerging prevalence of chronic conditions• Burden on individuals and families• Cost Canadian economy $80 million annually through
illness and disability• Aging population• Role and position of nurses
Registered Nurses’ Association of Ontario (RNAO)
• The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses in Ontario.
• Mission is to pursue healthy public policy and to speak out for nursing.
• Funded through RN membership.
International Affairs and Best Practice Guidelines Program
Purpose: to develop, pilot implement, evaluate, disseminate and support the uptake of nursing best practice guidelines.
Funded by the Government of Ontario, Ministry of Health and Long Term Care
Evidence-Based PracticeThe systematic application of the best available evidence to the evaluation of options and to decision-making in clinical management and policy settings
(National Forum on Health, 1997)
Best Practice Guidelines
“Systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical (practice) circumstances.”
(Field and Lohr, 1990)
32Nursing BPGs
Three Types of Recommendations
Practice
Education Organization
& Policy
What the HCP needs to do
What the Organization
needs in place for a Best Practice setting
What the HCP needs
to know
Expert Development PanelDevelopment Panel (15):Patrick McGowan, PhD (Panel Leader)Suzanne Fredericks, RN, PhD (Panel Co-
leader)Judith Schaefer, MPHMartha Funnell, RN, MS, CDEKim Lavoie, MA, PhDAnne Lyddiatt, (patient advocate)Angelique O’Donnell, RN, BScNColleen Stang, RN, MNNatacha Des Rosiers, RN, BScGail Beatty, RN, BScN, MN, ACNPRhonda Johnstone, RN, BScN, GNC, MNIrene Holubiec, RN, BScN, MEdKelly O’Halloran, RN, MScN, ACNP
Advisory Panel (9):Durhane Wong-Reiger, PhDRobert Donald Reid, BSc, MSc, MBA, PhDRobin Moore-Orr, DSc, R.D.Patti Staples, RN, MScN, TCNP, CNNJudy Murray, BSc (PT)Bo Fusek, RN, BA, BEd., Med, CDEDeborah Jenkins, RN, BScN, MNBarbara Cassel, RN, BScN, MN, GNC,
NCALynn Anne Mulroney, RN
RNAO Staff:Janet Chee, RN, BScN, MN (Senior
Program Manager)
SMS Strategies
Establish a RapportSetting the AgendaHealth Risk AppraisalsReadiness For ChangeAsk - Tell - AskClosing the LoopMaking Action PlansProblem-Solving ProcessFollow-up
Guideline Status
• Literature search and critical appraisal complete• Development panel has drafted 28 preliminary
recommendations and are in the process of developing the stakeholder draft
• Stakeholder review October 2009• Final publication January 2010
Contact Information
• Althea Stewart-Pyne, BPG Program Manager International Best Practice Guidelines astewart-pyne@RNAO.org
• Patrick McGowan, Associate Professor, University of Victoria – Centre on Aging, mcgowan@dccnet.com
Education is Just the Tip of the Iceberg
Margery KonanLHIN Priority Project Manager
Central East Community Care Access CentreScarborough Branch100 Consilium Place, Suite 801Scarborough Ontario M1H 3E3
margery.konan@ce.ccac‐ont.ca
www.healthylifeworkshop.ca
Telephone: 416‐701‐4828 or 1 866 779 1931 ‐‐ ext 5597
Contact Information
44
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