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Optimizing Chronic Disease Care in
Southeast Minnesota
Implementation of the chronic disease self-
management program
Aaron Leppin, MD
Dissemination and Implementation Research Core
Knowledge and Evaluation Research Unit; Mayo Clinic

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Half of all
American adults
have a chronic
disease and
prevalence is
increasing2
One in four
Americans live
with multiple
chronic
conditions2
Chronic diseases
account for 80% of
all medical care
costs in the United
States1
Seven out of
every ten deaths
in the US are the
result of chronic
disease1
1Kansas Health Institute, 2014; 2Robert Wood Johnson Foundation, 2010;

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Treatment costs
of chronic
diseases in
Minnesota are
estimated at $5
billion annually2
Lost productivity
from chronic
illness adds $17
billion in costs to
Minnesota
businesses2
In 2010, chronic
diseases
accounted for the
seven leading
causes of death
and 57% of
potential years of
life lost in MN1
In Southeast Minnesota, Community
Health and Needs Assessments
consistently identify chronic
disease management as an area of
priority
1Minnesota Center for Health Statistics, 2012; 2Milken Institute, 2007;

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DHHS, AHRQ, and CMS
identified four goals:
1. Foster systems change
2. Empower individuals
3. Equip clinicians
4. Enhance research
Parekh, JAMA, 2014.

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The Stanford Chronic Disease Self-
Management Program (CDSMP)

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MIndfulness
Dealing with pain
Communication strategies
Making decisions
Problem solving
Dealing with emotions
Healthy eating
Exercising
Self-Management Tasks
1. Take care of health
condition
2. Carry out normal activities
3. Manage emotional
changes1
1Chart 1 from the CDSMP Program Leader’s Manual, Stanford University, 2012

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“I’ve developed a new
relationship with my doctors.
I’m not afraid to ask
questions…I’m a member of the
team.”
“The class helps
you live life, not
just endure it.”
“I am not so isolated.”
“My health happens
between visits,
outside the hospital
and office.”
“I learned new strategies for
keeping depression and pain at
bay, ways to relax my mind
and body, and eye-opening
ideas for exercise that I
could do.”
CDSMP Fact Sheet, National Council on Aging

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Randomized Trial Outcomes
6 months follow-up: exercise, cognitive symptom
management, communication with physicians,
self-reported health, distress, fatigue, disability,
social/role activities, hospitalizations and days in
hospital all improve1
2 years follow-up: reduced health care utilization,
improved self-efficacy2
1Lorig, Med Care, 1999; 2Lorig, Med Care, 2001;

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National observational study
Replicated findings among 1170 participants
in 22 sites across 17 states
1 year follow-up: self-reported health, depression,
fatigue, pain, stress, sleep, communication with
physician, medication adherence, health literacy,
healthcare utilization all improve1
1Ory, Med Care, 2013;

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National observational study
Net savings of $364 per person1
Potential saving of $6.6 billion by
reaching 10% of Americans with one
or more chronic conditions2
1Ory, Med Care, 2013; 2Ahn, BMC Public Health, 2013

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ASMP/CDSMP Meta-Analysis Project Team, Center for Disease Control and Prevention, 2011;
“at the population level, these interventions could have a
considerable public health effect due to the potential scalability of
the interventions, the relative low cost to implement them, wide
application across various settings and audiences, and the
capacity to reach large numbers of people”

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ASMP/CDSMP Meta-Analysis Project Team, Center for Disease Control and Prevention, 2011;
As result of findings, executive summary identified
several key strategies to move forward:
• Incorporate CDSMP referral into standards of care,
care protocols, and other policies that guide high-
quality chronic disease care
• Invest resources to support wide-scale implementation
• Encourage CDSMP participation as part of routine
care of individuals with chronic disease
• Research: explore differential effectiveness by
participant characteristics

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Why now?

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Prepared by Health Promotions and Chronic Disease Division and the Office of
Statewide Health Improvement Initiatives; MDH, 2012;
“No single organization can accomplish the
goals and objectives set forth in this
framework. But every organization or entity
whose mission entails improving the health of
Minnesotans should be able to see itself
somewhere in this framework.”

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Why here?
Rice
Houston
Dodge
Mower Fillmore
Goodhue
Olmsted Winona
Wabasha Steele
Freeborn
Regional infrastructure to
support program
implementation, oversight,
and participation

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MCHS Site Elder Network Site

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How has this been done?

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Current Status/Next Steps
• Stakeholders engaged at
multiple levels
• Finalizing protocol and
approach to CBPR project
• Evaluating key strategies
and funding opportunities

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Questions & Discussion
leppin.aaron@mayo.edu