Margery Konan, LHIN Priority Project Manager

Margery Konan, LHIN Priority Project ManagerSelf‐Management Training for Consumers & Caregivers

www.healthylifeworkshop.cawww.healthylifeworkshop.ca

http://www.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

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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

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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

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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

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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

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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

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Self Management Program Accomplishments, 2008-2009

Deliverables• Introduction of a consistent Chronic

Disease Self-Management Program (CDSMP) across the Central-East LHIN


• Establishment of a core group of Master Trainers and teams of Peer Leaders (target: 36 Master Trainers by March 2010)



Budgets revised

2007-08

0

2008-09 2009-10 Total

380,000 761,420 1,141,120

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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

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Sample Promotional Flyer for Self-Management workshop(excerpt)

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Sample Promotional Flyer for Self-Management workshop(excerpt)

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Free reference book provided to all participants

Website live in April 2009

www.healthylifeworkshop.ca








Budgets revised

2007-08

0

2008-09 2009-10 Total

391,500 761,420 1,152,920

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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

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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.








Budgets revised

2007-08

0

2008-09 2009-10 Total

391,500 761,420 1,152,920

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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

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Budgets revised

2007-08

0

2008-09 2009-10 Total

391,500 761,420 1,152,920

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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)

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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

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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.

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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 [email protected]

• Patrick McGowan, Associate Professor, University of Victoria – Centre on Aging, [email protected]

mailto:[email protected]


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

[email protected]‐ont.ca

www.healthylifeworkshop.ca

Telephone: 416‐701‐4828 or 1 866 779 1931 ‐‐ ext 5597

Contact Information

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http://www.healthylifeworkshop.ca/

Documents

Margery Konan, LHIN Priority Project Manager