title: Effect of a self-management program on patients with chronic disease.
abstract: BACKGROUND
  For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases.
  
  
  OBJECTIVE
  To evaluate outcomes of a chronic disease self-management program in a real-world" setting.
  
  
  METHODS
  Before-after cohort study.
  
  
  METHODS
  Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data.
  
  
  METHODS
  The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building.
  
  
  METHODS
  Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires.
  
  
  RESULTS
  At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant.
  
  
  CONCLUSIONS
  We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.
authors.affiliation: Stanford University School of Medicine, Calif, USA. lorig@stanford.edu
authors.forename: K R
authors.initials: KR
authors.lastname: Lorig
authors.forename: D S
authors.initials: DS
authors.lastname: Sobel
authors.forename: P L
authors.initials: PL
authors.lastname: Ritter
authors.forename: D
authors.initials: D
authors.lastname: Laurent
authors.forename: M
authors.initials: M
authors.lastname: Hobbs
mesh_terms: D002140:California; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003657:Decision Making; D019468:Disease Management; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States