A national dissemination of an evidence-based self-management program: a process evaluation study

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Abstract

While evidence exists regarding the effectiveness of many health education interventions, few of these evidence-based programs have been systematically or widely disseminated. This paper reports on the dissemination of one such intervention, the 6-week peer-led Chronic Disease Self-Management Program, throughout a large health-care system, Kaiser Permanente. We describe the dissemination process and, using qualitative analysis of interviews and surveys, discuss the factors that aided and hindered this process and make recommendations for similar dissemination projects. Six years after the beginning of the dissemination process, the program is integrated in most of the Kaiser Permanente regions and is being offered to several thousand people a year.

Introduction

I knew what I needed to do but I didn’t do it … until I took this class and realized that I had to do it. Now I’m doing much better. (A class participant)

In recent years, self-management for chronic diseases has been integrated into many comprehensive disease management programs [1]. Because patients with chronic disease make continuous self-management decisions, it is believed that informed patients improve their decisions by collaborating with their health-care providers. In turn, improved decision-making results in enhanced health-care outcomes and possibly reductions in health-care costs. This belief is borne out in documents such as the 2010 Health Care Objectives for the Nation, which includes goals of increasing the number of patients receiving self-management education [2]. In 2001 Medicare began to reimburse approved self-management programs for people with diabetes.

While there is widespread belief in the importance of self-management programs for people with chronic conditions, these programs will only fulfill their potential when programs that have been shown to be efficacious can be successfully replicated, disseminated, and implemented. Many programs have demonstrated their potential effectiveness in improving health status and/or reducing health-care utilization. Very little is known, however, about the factors that both help and hinder dissemination of these programs in “real-world” settings. This paper will discuss a qualitative study of dissemination within a large, nationwide health-care system of the Chronic Disease Self-Management Program (CDSMP), also known as “Healthier Living: Managing Ongoing Health Conditions”.

Kaiser Permanente is an integrated health-care system that serves over 8 million members in various regions across the United States. At initiation of this study, there were 12 regions in the system, ranging in size from tens of thousands of members to several million members. During the course of the study, Kaiser Permanente affiliated with Group Health Cooperative of Puget Sound, which was included as a region for the purposes of this project.

Section snippets

Background

People above the age of 60 have on average 2.2 chronic conditions, and many younger people also have co-morbid conditions [3]. Disease-specific patient education may not be the most efficient or effective means of meeting the growing problems associated with chronic disease in general and specifically co-morbidity. In an attempt to more effectively support these patients, the CDSMP was developed at Stanford University in the mid-1990s and evaluated in a 6-month randomized trial for over 1000

Study participants

Data are from 291 telephone interviews (conducted in two exploratory rounds), and 225 final round questionnaires administered to regional health education directors (who direct all health education activities in a region), regional coordinators (who coordinate all CDSMP activities in a region), site coordinators (who coordinate CDSMP in a group of hospitals and clinics in the three largest regions), master trainers (who train CDSMP peer leaders), and peer leaders (who actually teach the

Results

The results presented below are based on data collected in the final survey and the discussion section is supplemented by the experience of the research team, findings from the initial telephone interviews, review of the monthly interregional conference calls, and individual contacts between the researchers and the site staff.

At the beginning of the study in 1997 Kaiser Permanente had the potential of 12 participating regions. At the end of the study period in December 2001, four of these

Discussion

This study demonstrated that a proven patient education program can be successfully disseminated throughout a large health-care system. Based on a combination of hard data obtained from surveys and the experience with widespread dissemination of the program, conclusions can be drawn regarding key success factors. This discussion will contrast successful and not successful sites and include recommendations for dissemination of similar patient education programs.

While it is difficult to pinpoint

Acknowledgements

This study was supported by the Garfield Foundation. The authors wish to acknowledge the following persons: Lisa Morgan, MPH, Nancy Pepper-Burke, RN, CHE, and all of the other Kaiser Permanente staff members who effectively supported this project. Thanks also to the master trainers and peer leaders.

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1

Tel.: +1 314 516 6025; fax: +1 314 516 7235.

2

Tel.: +1 510 987 3579.

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