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ABOUT US
Background
Chronic Care Model (CCM)
Self-management Support
The CDSMP
Advisory Committee
Funding
Website
Background
In response to the
burgeoning older adult population in Jackson and Josephine Counties, the
Rogue
Valley Council of Governments’ Senior and Disability Services (RVCOG/SDS),
operating in partnership with Oregon State University Extension Services (OSUES),
and in conjunction with an advisory committee
composed of area partners in this community-based approach, will deliver and assess
the effectiveness of Chronic Disease Self-Management programs (CDSMP)
developed by Stanford University and explore the potential for broad-based use
in southern Oregon.
This effort responds to
the increasing presence of aging adults in the Rogue Valley and the accompanying
reality of increased longevity and its companion, chronic disease. According to
The State of Aging and Health in America, 2004, 80+% of people,
over age 65, have one chronic disease condition; 50% have two or more. In
southern Oregon, there has been a 40% increase in the older adult population
since the 2000 census, with half of all older adults expected to live to age
ninety or beyond. The projected cost of health care for an elderly, chronically
ill population challenges communities to explore new approaches.
Chronic disease self
management training has been used successfully throughout the United States and
internationally to address improved health status and overall health management
for aged, chronically ill individuals and their families.
Chronic
Care Model (CCM)
Providing self-management
support is an integral part of the CCM.
The
Chronic Care Model identifies the essential elements of a health care system
that encourage high-quality chronic disease care. These elements are the
community, the health system, self-management support, delivery system design,
decision support and clinical information systems. Evidence-based change
concepts under each element, in combination, foster productive interactions
between informed patients who take an active part in their care and providers
with resources and expertise. The model can be applied to a variety of chronic
illnesses, health care settings and target populations. The bottom line is
healthier patients, more satisfied providers, and cost savings.
Self-management support
Self-management training empowers
and prepares patients to manage their health and health care in the following
ways:
- Emphasizes the patient’s central role
in managing their health
- Uses effective self-management support
strategies that include assessment, goal-setting, action planning,
problem-solving and follow-up
- Organizes internal and community
resources to provide ongoing self-management support to patients
All patients with chronic illness make decisions and
engage in behaviors that affect their health (self-management). Disease control
and outcomes depend to a significant degree on the effectiveness of
self-management.
Effective self-management support means more than telling
patients what to do. It means acknowledging the patients' central role in their
care, one that fosters a sense of responsibility for their own health. It
includes the use of proven programs that provide basic information, emotional
support, and strategies for living with chronic illness. But self-management
support can't begin and end with a class. Using a collaborative approach,
providers and patients work together to define problems, set priorities,
establish goals, create treatment plans and solve problems along the way.
The CDSMP also has the
potential to become an integral component in a strategic approach to reducing
future public and private costs associated with an escalating aging population.
At a time when health care resources are stretched maximally, the CDSMP teaches
individuals to accept responsibility to manage or co-manage their own disease
conditions, and more innovatively resolve their own disease management problems.
It is built on a health promotion/wellness philosophy.
The CDSMP
The 6-week Chronic
Disease Self-Management Program (Living Well with Chronic Health Problems in
Southern Oregon)
was developed at Stanford University in the early 1990’s. It teaches individuals
with diseases such as diabetes, arthritis, osteoporosis, asthma, cardiac
difficulties and cancer how to more effectively manage their disease conditions.
The approaches taught include:
-
techniques to deal with
frustration, fatigue, pain and isolation
-
exercises for maintaining and improving strength,
flexibility and endurance
-
medication management
-
nutrition information
approaches for improving communication with family, friends and health care
professionals.
Stanford studies
demonstrate that participants in disease self-management training programs
develop the following:
Our CDSMP offering
uses the participation of local sites and trained
volunteers to evaluate the effectiveness of chronic disease self-management
approaches on participating individuals who attend the 6-week series. A
pre- and post-workshop participation survey will provide input for a database by
which to measure outcomes and effectiveness of the delivered program.
In addition, Spanish
speaking individuals will be sent to Stanford University to be trained to
present a version of the program specifically adapted to Hispanic populations
and will be licensed to provide the training. This will offer the opportunity to
deliver the program in the Spanish language community and lay groundwork for
additional on-going delivery.
Advisory Committee
The Advisory Committee (AC) to this
project includes administrative representatives of the Asante/Rogue Valley
Medical Center, Providence Hospital, Ashland Community Hospital, La Clinic de
Valle (a safety net community clinic system in Jackson County, serving Latino
families), Jackson County Public Health, the Retired Senior Volunteer Program
(RSVP) of Jackson and Josephine Counties, the Medford Senior Center, and the
Veterans Administration (White City).
Funding
Three grants have been
awarded to help defray the cost of program delivery.
-
Gordon Ellwood
Foundation
-
Oregon State University Extension Innovative Grants
-
State of Oregon
Department of Health Services
The grants funds will be
used to:
-
Create a talent pool of
individual instructors in the chronic disease self-management program, paying
them stipends for each 6-class series they teach and requiring them to teach a
minimum of two series of classes. Their instruction to become leaders will be
provided by two locally-available Certified Chronic Disease Self-Management
Master Trainers who have completed two levels of Stanford training.
- Train 500+ people with chronic diseases.
Dedicate grant resources to the purchase of teaching supplies as well as
refreshments for the training sessions. (Space in which to hold the classes
will be donated, as will a copy of the book Living a Healthy Life with
Chronic Conditions for each participant.)
- Send two Spanish-speaking individuals to
Stanford University to become Certified Chronic Disease Self-Management
Trainers. Hold chronic disease self-management classes for Spanish speakers,
taught by the newly certified Spanish language trainers.
- Establish and maintain a statistical
database for program monitoring and reporting.
For more information please contact us.
Click HERE for contact information.
Website
The Internet is a powerful way to communicate. We take steps to keep this site
easy to use and read. Content is presented using large type fonts and in a
straight-forward manner using simple English. We follow the rule -- if
it's blue and underlined, click on it. Other use of color is limited to black
(text in Tahoma 12 point), yellow (top and side banners), blue (hyperlinks and
top banner title), green (content page titles - Arial 12 point) and red
(advisories - often in italics). We use a white back ground to
enhance viewing. The use of flashing images will be avoided. When we have larger
pictures to share, they will always be presented as a small quickly downloaded
image that you then click on to to see the larger image.
We invite your comments.
Annual NCOA & AOA Grantee Meeting in Portland, OR. --
PHOTOS
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