Living Well Alaska: Better Choices, Better Health
Chronic Disease Self-Management: Research
Benefits of CDSMP
Cost-effectiveness:
Frontiers in Public Health, Volume 3, Article 27. Cost-effectiveness of the chronic disease self-management program: Implications for community-based organizations [2015].
- Assuming 10 participants per class, the cost is approximately $350 per participant
- $50,000 to $75,000 per QALY according to national data
- Assuming, $350 saved per CDSMP participant, we could achieve potential national healthcare savings from $0.7 billion to $65.7 billion by averting from ER visits and hospitalizations if CDSMP reaches a minimum of 1% of adults with at least 1 chronic condition.
- Increase in health related quality of life (HRQOL) measures, creating a direct effect on QALYs
Healthcare Cost:
Frontiers in Public Health, Volume 3, Article 42. Healthcare cost savings estimator tool for chronic disease self-management program: A new tool for program administrators and decision makers [2015].
- National study of CDSMP showed potential savings of $3.3 billion in healthcare costs by reaching 5% adults with one or more chronic conditions
- Healthcare savings of $38,803 for a small county
- Healthcare savings of $732,290 for a metropolitan city
- Use the Healthcare Cost Savings Estimator Tool and customize your savings (Download Excel File)
Health-related Outcomes:
Preventing Chronic Disease, Volume 10, Issue 1. A Meta-Analysis of health status, health behaviors, and health care utilization outcomes of the chronic disease self-management program [2013].
- Improvements in self-efficacy
- Self-efficacy related to physical activity, healthful eating, pain-coping strategies, medication adherence, and improvement in function
- Direct correlation with improvements in physical activity
- Crucial for improvements in general health and overall well-being
- Reductions in depression noted
Clinical Outcomes
Self-management interventions showed benefits in health outcomes for patients suffering from Heart Failure, as well as an increase in health-related quality of life.
BMC Cardiovascular Disorders, Volume 13, Issue 60. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial [2013].
Self-management skills are seen as a standard component of pulmonary rehabilitation programs.
Chronic disease self-management is defined as a process that facilitates an individual’s confidence and capability to engage in health-promoting behaviors in order to deal with the impact of their condition on all aspects of their health – a sense of self, physical, emotional, social, and medical domains so as to maximize function and quality of life. The interactive format of the CDSMP deliberately fosters “self-efficacy or confidence” to manage one’s health condition through mastery, vicarious experiences, social persuasion, and reinterpretation of symptoms. CDSMP has been reported to increase self-reported exercise by 30 minutes, and decrease dyspnea (difficulty breathing).
International Journal of COPD, Volume 9, Issue 1. Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial [2014].
Educational programs aimed at increasing the skills and confidence for self-management can reduce pain, fatigue, disability, anxiety, and depression, and they can improve self-rated general health.
The benefits in health-related behaviors include increases in aerobic exercise and symptom management. Almost half of participants in a CDSMP class had substantial improvement within the first six months after completion of the six week program, both on anxiety and depression. About 40% of participants continued to show improvement one year after the completion of the program.
PLOS ONE, Volume 8, Issue 6. Decay of impact after self-management education for people with chronic illnesses: Changes in anxiety and depression over one year [2013].
This program provides patients with the necessary knowledge, skills, and confidence to manage life with a chronic illness and prepares patients to collaborate with their healthcare professionals and the healthcare system.
This program focuses on participants with chronic fatigue who have various forms of neuromuscular disease. The program in this study had a limited number of participants, however, 77% of them showed improvement.
BMC Neurology, Volume 15, Issue 1. Effectiveness and cost-effectiveness of a self-management group program to improve social participation in patients with neuromuscular disease and chronic fatigue: Protocol of the Energetic study [2015].
Specific Groups
Elders
Because of the increase in life expectancy, a greater number of older people will have age-related diseases and may suffer from difficulties due to health decline. In order to optimize well-being of the growing number of older persons in vulnerable health, it seems a priority to enhance coping resources, and by doing so, to empower older persons. CDSMP is a structured program that emphasizes the strengthening of self-management by older persons with deteriorating health in order to empower them to keep in control of their own body and life. CDSMP among this group, has been shown to:
- Increase physical exercise
- Lower health distress
- Improve self-care
- Improve self-efficacy or confidence
Among participants, with a mean age of 81 years, the program is effective, especially among those with low education. This study supports the applicability of the CDSMP among elders:
BMC Geriatrics, Volume 101, Issue 15. Benefits for elders with vulnerable health from the Chronic Disease Self-Management Program at short and longer term [2015].
Employers
Chronic diseases are multi-dimensional and affect all aspects of people’s lives, especially work. There is a growth in obesity and other cardiovascular risk factors, and related chronic conditions among working-aged Americans, interventions are needed to arm middle-aged and older employees with skills and strategies to manage their diseases and associated symptoms. Disease management is increasingly recognized as an important component of workplace health promotion given our again workforce, the prevalence of chronic conditions, and the importance of maintaining a productive and competitive American workforce. Evidence supports the effectiveness and growing importance of disease management programming in workplace settings. CDSMP has been developed based on over 20 years of research at Stanford University, CDSMP is currently offered in over 30 countries and a variety of languages. CDSMP has the advantages of being inexpensive and easy to disseminate. It is not disease specific and can be delivered effectively by lay leader with minimal training using a train-the-trainer model.
Frontiers in Public Health, Volume 2, Article 179. Chronic Disease Self-Management Program in the workplace: opportunities for health improvement [2015].
Rural Communities
Evidence suggests rural populations generally display a greater prevalence of less healthy behaviors that impact chronic illnesses, including:
- Sustained unhealthy nutrition
- Increased prevalence of smoking
- Lower levels of physical activity
- Greater levels of psychosocial distress
Rural elders have been reported to have worse physical and mental functional and more restrictions on activity due to chronic conditions. Encouraging self-management may be important in rural communities for a variety of reasons, such as:
- The greater effect of chronic diseases on morbidity and mortality in rural populations
- Preventive care is less available in rural areas
- Rural residents may be less educated about their chronic conditions due to lack of medical staffing
One of the main concerns regarding CDSMP in rural areas is confidentiality. This study showed people to feel more support among the group members in CDSMP. Several respondents stated they felt their CDSMP group was “a safe and comfortable space to share feelings about their conditions.”
Rural and Remote Health, Volume 14, Page 2886. Qualitative exploration of rural focus group members’ participation in the Chronic Disease Self-Management Program [2014].
Asian Communities
CDSMP is studied among foreign-born adults from China, India, and the Philippines. These subgroup makes the fastest-growing ethnic group in the US. CDSMP has been introduced and widely disseminated in the US as a method to empower patients with self-management skills to deal with their chronic conditions. CDSMP has resulted in improved healthcare and health, while potentially saving healthcare costs. Studies have shown that Asian-Americans complete CDSMP at a somewhat higher rate than the general participant population and at about the same rate as Caucasian participants. The study found engaging CDSMP leaders may instruct workshops in a way that provides participants with more enjoyment or educational benefit from each session, thus increasing the participants’ motivation to complete the program.
Frontiers in Public Health, Volume 2, Article 257. Factors associated with successful completion of the Chronic Disease Self-Management Program among middle-aged and older Asian-American participants: a national study [2015].
African-American Urban Communities
Currently, over 43 million US residents are 65+ years of age with that number projected to increase to approximately 80 million by the year 2040. Specifically, between the years of 2012 and 2030, it is projected that the non-Hispanic African American population aged 65 years and above will increase 104% in comparison to the 54% projected increase for non-Hispanic Caucasians in the same age group. African Americans are underrepresented in access to CDSMP as a result of a variety of biopsychosocial and sociocultural factors. In this study, African American CDSMP participants were found to be predominantly female, prevalent chronic conditions to be hypertension, arthritis, and diabetes, more likely to participate in senior centers, residential facilities and healthcare organizations.
Frontiers in Public Health, Volume 2, Article 174. Chronic Disease Self-Management Education (CDSME) program delivery and attendance among urban-dwelling African Americans [2015].
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