Matthew Lee Smith, PhD, MPH, CHES, FAAHB College of Public Health The University of Georgia

Transcription

1 Matthew Lee Smith, PhD, MPH, CHES, FAAHB College of Public Health The University of Georgia Marcia G. Ory, PhD, MPH, FAAHB School of Public Health Texas A&M Health Science Center

2 1. Introduce the Frontiers volume* 2. Discuss some of what we have learned specific to CDSME programs 3. Discus some what we have learned about fall prevention programs 4. Describe cross-cutting issues and overarching lessons learned *

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4 ~25 commentaries and 35 full-length articles Impressive list of ~150 authors Perspectives National Stakeholders Program Developers Networks Program Implementers Program Delivery Dissemination through the ARRA Implementation and Outcomes Policy Research PROGRAMS Practice Falls, Physical Activity, and Mental Health Programs Cross-Cutting Issues

5 National Stakeholders Program Developers Networks Program Implementers ACL CDSME EBLC Aging NCOA AMOB FallsFree Public Health CDC Stepping On CDC HAN Healthcare CMS TCMBB SFPP Residential Archstone Otago Faith-based HFSF Fit & Strong! Workplace

6 1. What do we know about the growth of these programs over time? 2. Who are these programs attracting? 3. What types of organizations are adopting these programs? 4. What types of participants are attracted to programs hosted at different delivery sites? 5. What types of organizations have the most successful completion rates?

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8 Data were collected from middle-aged and older adults enrolled in CDSME programs nationwide Administrative records and brief questionnaires ARRA-Funded Workshops (2010 to 2012) First 100,000 participants enrolled Participant characteristics (age, sex, race/ethnicity, rurality) Delivery site types (e.g., senior centers/aaa, residential facilities, healthcare organizations, community/multi-purpose facilities, faith-based organizations)

9 On average, 67 years old (20% age 80+) 78% female 66% non-hispanic white 17% Hispanic; 22% African American On average, 2.2 chronic conditions (49% 3+) 22% resided in rural areas On average, 13 participants per workshop 75% successful completion

10 Total of 6,965 workshops 28.5% Senior Centers / AAA 19.7% Residential Facilities 18.2% Healthcare Organizations 10.5% Community or Multi-Purpose Facilities 9.4% Faith-Based Organizations

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15 First 25,000: Time to reach = 9.37 months (1,705 workshops) Second 25,000: Time to reach = 6.00 months (1,727 workshops) Third 25,000: Time to reach = 5.17 months (1,764 workshops) Fourth 25,000: Time to reach = 5.37 months (1,769 workshops) After reaching the first 25,000 participants: Workshops reached participants with more chronic conditions Workshops were delivered in ZIP Codes with more families below the federal poverty line

16 Older participants & those with more chronic conditions Senior Centers/AAA & Residential Facilities Male participants Healthcare Organizations Hispanic Participants Healthcare Organizations & Community/Multi-Purpose Facilities African American Participants Faith-Based Organizations Rural Participants Senior Centers/AAA & Faith-Based Organizations Less Successful Completion Healthcare Organizations & Residential Facilities

17 The majority of participants successfully completed the program (~75%) There was variability in attendance by delivery site type Contrary to expectation, high completion rates were seen in very small and very large workshops Must consider class size when estimating overall program costs

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19 Workshops with Zero Classes were more likely to have higher participant completion rates Offering a Zero Class may facilitate recruitment May develop support for and positive views about the program Opportunity to better understand workshop purpose, content, and expectations May allow participants to assess readiness for intervention May alleviates time constraints associated with data collection

20 5-year randomized trail funded by the National Heart, Lung, and Blood Institute (NHLBI) Awarded to The University of Georgia Principal Investigators: Matthew Smith & Mark Wilson Consultants: Kate Lorig & Marcia Ory The overall aims: Examine influence of tailored workshops on health outcomes, work performance, and productivity indicators Examine influence on biomarkers Assess cost-effectiveness and ROI for employers and communities Implemented in South Georgia in 9 to 11 worksites

21 Formative Evaluation: Survey of Master Trainers In-depth interviews with Master Trainers Focus groups with employees living with chronic conditions Expert review of leader manual and protocols Process has resulted in a translated version Modified format to facilitate embedment in worksites Modified content for applicability to younger, overweight workers Entering second year of funding Full implementation anticipated in January 2016 Next steps will occur after efficacy of RCT is established

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23 Policy and System Change Clinical Interactions Community Programs

24 Source: Adapted from Mahoney, et al. Otago 1-on-1 therapy Stepping On A Matter of Balance Tai Chi: Moving for Better Balance Traditional Forms of Exercise Dance, Golf, Bowling, Badminton, Strength Training

25 An ACL Title IIID Top-Tier Program Incorporates behavioral management techniques and exercise training Traditionally intended to increase falls efficacy and reduce the fear of falling New findings reveal the ability of AMOB to increase: Quality of life Physical functioning (Timed Up-and-Go) Applicability to the oldest-old

26 Two programs listed in the CDC Compendium of Effective Community-based Interventions Designed for and attract different participants Age and physical functioning Similar improvements observed Confidence to prevent falls Self-reported health status Walking one block Getting out of straight back chair Climbing a flight of stairs Physical functioning (Timed Up-and-Go)

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28 RE-AIM served as the guiding framework We wanted to know the uptake of the framework Survey of state leads indicated Deemed a useful tool for planning, implementation, and evaluation Concerns about using the framework as a whole, indicating the need for technical assistance

29 Interventions should meet the needs of a diverse aging population Ideally, a menu of EBPs should be available in a community Programs should be offered in areas with the greatest need, not simply based on the existing infrastructure Opportunities for GIS mapping for strategic planning Strive toward a coordinated repository of available programs

30 Adapt intervention for new settings CDSMP for the workplace Adapt intervention for new populations Fit & Strong! for cancer survivors Adapt the delivery mechanism Fit & Strong! for lay leaders CHW for hard to reach populations Adapt existing programs to meet evidence-based standards Formalization of Texercise

31 Community-based interventions are effective It takes time to build a training and delivery infrastructure and additional time to sustain it Without nurturing delivery systems can quickly vanish An integrated approach is needed Community programs will not see full potential unless coordinated with clinical and policy approaches Clinical approaches will be limited without available community programs for referral A love/hate relationship with data collection communities want results but don t want data collection burdens Need to align efforts with other past and ongoing initiatives

32 Available in English and Spanish To access online training and resources: edu/what-we-do/chwtraining-academy/

33 Streamlining fidelity checklists CDSMP Cost Estimator Tool