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Chronic Disease Self Management Education Initiative

Why Is This Important?

Of the 100 counties in North Carolina, 60 already have more people age 60 and over than 0-17, and by 2033, 96 of the 100 counties will have more people age 65 and older than under age 18. According to the NC State Center for Health Statistics, 27.2% of adults age 65 and older have one chronic condition and an additional 53.5% have two or more chronic diseases. Results of the 2013 Behavioral Risk Factor Surveillance System (BRFSS) Survey indicate that 29% of adults age 65+ rate their health as fair or poor. Projections show that by 2030 more than 6 of every 10 North Carolinians ages 47-65 will be managing more than one chronic condition. The top three health conditions reported for the 8750 participants enrolled in Chronic Disease Self Management Education (CDSME) programs in NC since 2010 include Hypertension (54%), Diabetes (45%), and Arthritis (44.1%), with 69.5% reporting multiple chronic health conditions. Just one chronic condition, like Hypertension, which causes or contributes to at least 30% of all deaths in NC, costs $189 million Medicaid dollars ($1100 per beneficiary) annually.

The Chronic Disease Self-Management Education Program (CDSME) was developed by Stanford University and is a two-and-a-half-hour workshop offered once a week for six weeks in community settings. People with different chronic health problems attend this evidence-based program together. Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, and pain, 2) appropriate exercise for improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, and 6) decision making.

The research behind CDSME programs show that they improve patient outcomes through increasing self-efficacy regarding personal health behaviors and by providing individuals with the skills and information necessary to manage their chronic disease outside of the clinician’s care. Research shows that participants demonstrate significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and trended toward fewer outpatients visits and hospitalizations.

Strategy

NCCHW received a 2015 Prevention and Public Health Fund (PPHF) Chronic Disease Self-Management Education (CDSME) Programs grant, awarded by the Administration for Community Living (ACL), to embed CDSME programs into the Healthy Aging NC ﴾HANC﴿ Resource Center (housed at NCCHW).  In January 2016, the Healthy Aging NC statewide hub launched, with a goal of centralizing support for communication, program registration, data management, data reporting, and technical assistance for CDSME program activities ﴾www.healthyagingnc.com﴿. The CDSME initiative also seeks to increase and expand the reach and sustainability of CDSME across the state. This involves increasing the number of older adults and adults with disabilities in underserved populations who participate in CDSME; creating clinical‐community connections that promote CDSME; and developing a sustainable and integrated centralized network across the state that implements CDSME.

BUILD CAPACITY 

  • NCCHW, through its Healthy Aging NC initiative, partners with the Centralina Area Agency on Aging to maintain a statewide CDSME programs Training Academy that provides CDSME master trainings, professional development, and resources at reduced or no cost to participants.
  • NCCHW, through its Healthy Aging NC initiative, raises awareness of CDSME programs and supports linkages to clinical partners, such as Federally Qualified Health Centers (FQHCs), hospital wellness departments, and local physicians. A CDSME programs grant allowed NCCHW to test pilot a program sustainability model with the FQHC Western NC Community Health Services.
  • NCCHW staff support community-based organizations across North Carolina to expand outreach and capacity to provide CDSME programs to low‐income, rural, minority, and disabilities populations.
  • NCCHW staff, through the Healthy Aging NC initiative, supports statewide access to data and resources through software, website, and media options. This includes the website www.healthyagingnc.com; the on‐the‐cloud data management software Workshop Wizard; access to the National Council on Aging CDSME database, and the ongoing partnership with the N.C. Division on Aging and Adult Services.

IMPACT POLICY

  • NCCHW staff, through the Healthy Aging NC initiative, creates “systems changes” within agencies so that they are able to maintain CDSME lay leaders, share program licenses through formal agreements, afford CDSME materials, and provide CDSME workshops in an ongoing and sustained way. This occurs through NCCHW staff capacity, the CDSME Programs Training Academy, access to the website, regular programmatic data results, and resource development.
  • NCCHW staff, through the Healthy Aging NC initiative, works on strategies for health care providers and insurance providers to include CDSME in the provision and reimbursement of services. This occurs by raising awareness of the benefits of CDSME, establishing clinical and community partnerships, supporting Medicare reimbursement processes, and developing business acumen tools like value propositions. NCCHW staff conduct research on these topics and offer trainings to support our partners in achieving long-term sustainability.

IGNITE COMMUNITY INITIATIVES

  • NCCHW staff, through the Healthy Aging NC initiative, work to ignite communities by supporting the scaling of CDSME programs in communities needing the programs. This is done through regional convening, providing access to low-cost leader training, offering marketing and registration online via healthyagingnc.com, conducting research on program best practices and developing requested toolkits. 
  •  NCCHW staff, through the Healthy Aging NC initiative, focus on expanding CDSME program access to those with disabilities, minority populations, rural populations, and low‐income populations.

What We Do

Please see the attached file for a detailed listing of the work that the CDSME Program provides in the areas of program management and statewide leadership, partnership development, statewide infrastructure development, centralized coordinated logistical processes for recruitment, referral, enrollment and marketing, business planning and financial sustainability and quality assurance and fidelity. 

Partners

WNCCHS: Western North Carolina Community Health Services, Inc. is a private, non-profit, tax-exempt corporation based in Asheville, North Carolina. WNCCHS is a non-governmental social enterprise providing primary health care to residents of the service area. Its core principles are: Equity, Solidarity, Inclusivity and Responsibility. During the last decade of the 20th century, Buncombe County experienced significant growth. The decade was also marked by explosive growth in health care costs. These trends were accompanied by sustained increases in the number of uninsured persons, placing the local health care safety net under unrelenting strain. This combination of factors made clear our community needed additional financial resources - particularly for preventive and primary health care. WNCCHS is a Federally-Qualified Health Center (FQHC).

http://www.wncchs.org/

Centralina Area Agency on Aging: With the enactment of the Older Americans Act (OAA) in 1965, AAAs were mandated in every state. Centralina AAA is part of Centralina Council of Governments. As one of the 16 Area Agencies on Aging in North Carolina its purpose is to: advocate for improvement in aging programs, resources and long term care facilities; plan and develop long-range plans for Livable Senior-Friendly Communities; develop and administer an area plan that is a comprehensive and coordinated system of service delivery in our area; provide technical assistance to service providers, community agencies and interested others; provide employment for seniors through the Title V Senior Community Service Employment Program; and coordinate, train for, fund and monitor evidence based Title IIID programs for health promotion and disease prevention.

http://centralina.org/centralinaaging/

Land of Sky Area Agency on Aging: Land of Sky AAA promotes the highest level of well-being of older adults and their families by partnering with organizations to provide a comprehensive system of opportunities, services, and protective services. The AAA is a leader and catalyst in helping older adults in our four county region lead more independent, vibrant lives. As part of the national network of AAAs established by the OAA, the AAA works to strengthen home and community care for older adults.

http://www.landofsky.org/aaa.html

NC Division of Aging and Adult Services: The Division of Aging and Adult Services works to promote the independence and enhance the dignity of North Carolina's older adults, persons with disabilities, and their families through a community-based system of opportunities, services, benefits, and protections.

http://www.ncdhhs.gov/divisions/daas

Area Agencies on Aging: Area Agencies on Aging are offices established through the Older Americans Act that facilitate and support programs addressing the needs of older adults in a defined geographic region and support investment in their talents and interests. In North Carolina, the 16 AAAs are located within regional Councils of Government.

http://www.ncdhhs.gov/assistance/adult-services/area-agencies-on-aging

NC Office of Minority Health and Health Disparities: The North Carolina General Assembly established OMHHD (OMH) in 1992 with a vision that all North Carolinians will enjoy good health regardless of race/ethnicity, disability or socioeconomic status. OMH’s mission is to promote and advocate for the elimination of health disparities among all racial and ethnic minorities and other underserved populations in North Carolina. OMH’s major focus areas include: research and data, culture and language, policy and legislation, partnership development and advocacy.

http://www.ncdhhs.gov/

NC Office on Disability and Health: The North Carolina Office on Disability and Health (NCODH) was a partnership effort between the Women's and Children's Health Section of the Division of Public Health and the Frank Porter Graham Child Development Institute. The mission of NCODH was to promote the mhealth and wellness of children, youth, and adults with disabilities in North Carolina and to address health disparities experienced by persons with disabilities across the life span.

http://www.ncdhhs.gov/

Administration for Community Living: All Americans—including people with disabilities and older adults— should be able to live at home with the supports they need, participating in communities that value their contributions. To help meet these needs, the U.S. Department of Health and Human Services (HHS) created a new organization, the Administration for Community Living (ACL). ACL brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the Federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan. ACL is the funder for the CDSME grant program at UNC Asheville.

http://www.acl.gov/About_ACL/Index.aspx

National Council on Aging: The National Council on Aging (NCOA) is a respected national leader and trusted partner to help people aged 60+ meet the challenges of aging. NCOA partners with nonprofit organizations, government, and business to provide innovative community programs and services, online help, and advocacy. NCOA provides technical support and assistance to the CDSME grant program at UNC Asheville.

https://www.ncoa.org/about-ncoa/


Story Behind the Curve

One of the challenges in raising awareness across the state about chronic disease and the Chronic Disease Self Management Education programs (CDSME), especially in underserved populations, has been the decrease in funding of statewide partners and the high turnover in staff at the Area Agencies on Aging (AAAs).  Both the NC Office on Disability and Health and the NC Office on Minority Health and Health Disparities lost significant funding for staff and activities, and AAAs have lost staff who were trained and experienced in providing CDSME workshops. The CDSME program continues to lead the Training Academy and has recruited new partners to fulfill deliverables.

Another challenge to the CDSME program has been raising the statewide level of awareness and use of Healthy Aging NC resources, including the website. The CDSME program continues to promote the website and resources through conference presentations, regional meetings and calls, and awareness events; assess and respond to resource and capacity-building needs; and differentiate services from other providers.

Internal challenges to the CDSME program include data management problems, including the national database as well as the software developer Workshop Wizard, as well as lay leader management, access/transportation to CDSME workshops, and lack of current referrals from clinical providers.   

How We Impact

The partnership with Centralina Area Agency on Aging and the NC Division on Aging and Adult Services has made the Training Academy effective in fulfilling needs of the 16 Area Agencies on Aging (AAAs) and other organizations by providing Chronic Disease Self Management Program (CDSMP), Diabetes Self Management Program (DSMP), and Chronic Pain Self Management Program (CPSMP) master trainings, contributing to sustainability within the leadership of the programs, supporting annual lay leader trainings, and sharing requested information and resources across the state.

The partnership with the local Federally Qualified Health Center (FQHC) of WNC Community Health Services has resulted in the creation of a referral process, CDSMP workshops onsite and in partnership with fellow community-based organizations, and follow-up measures. This work has been a case model for other FQHCs and clinical partners to replicate.

The partnership with the Land of Sky Area Agency on Aging has resulting in the expansion of CDSME topics, such as Tomando, DSMP, and CPSMP, while developing partners in underserved populations such as the African American faith community (Asheville Buncombe Institute of Parity Achievment), migrant workers (the Migrant Education Program), low-income populations (YWCA), and rural communities within the western region.

The partnerships with ODH and OMHHD have led to trainings on cultural competence, health disparities, accessibility options, and accommodations. The Inclusion Toolkit was developed and shared, a test pilot CDSMP at a CIL took place, and case studies are  being created on reaching out to minority populations.

The www.healthyagingnc.com website has been established as a resource to raise aweareness about CDSME, find workshop dates and locations, register on-line, and explore resources. This has helped in promoting CDSME across the state. In addition, NCCHW is viewed as the data collection and entry site.

NCCHW has been attending a variety of meetings and conferences in order to promote the www.healthyagingnc.com website and hub, and the value of the evidence-based programs of CDSME. This includes collaborations with NC 211 to increase referrals to CDSME, regional meetings across the state to seek input and next steps using the Results-Based Accountability framework, and participation in the ACL Network Development Learning Collaborative to explore sustainability options. 

Map of Counties Impacted by CDSME Trainings (Updated July 2018)

Measures

Time
Period
Current Actual Value
Current Target Value
Current
Trend
Baseline
% Change

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Scorecard Container Measure Action Actual Value Target Value Tag S A m/d/yy m/d/yyyy