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The James A Vohs Award: ••Spring 2002/Vol. 6, No. 2 |
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Clinical Contributions Strengthening
Self-Care, Self-Management, and Shared Decision-Making Practices Throughout
Kaiser Permanente The following article is excerpted from the position paper, "Strengthening Self-Care, Self-Management, and Shared Decision-Making Practices Throughout Kaiser Permanente (KP)." The paper was written for use at an interregional symposium, in September 2001, on supporting member-centered care sponsored by the Care Management Institute and KP Online. Below is the executive summary. The three tables that follow summarize the key aspects of self-care, self-management, and shared decision making from the perspectives of the member (Table 1), the intervention (Table 2), and the delivery system (Table 3).
Executive Summary Self care, chronic disease self-management, and shared decision making are key components in the next wave of innovation within KP and throughout the American health care system. The challenges we face, as outlined in the recent Institute of Medicine report, "Crossing the Quality Chasm: A New Health Care System for the 21st Century," are immense.1 They include an outdated model of care, tumultuous but largely ineffective reform, the growing burden of chronic conditions, the difficulty of transforming clinical advances into improved health outcomes, and steadily rising health care expenditures. The traditionally passive role of the member is becoming a more active, involved one, fueled by a growing prevalence of chronic disease (with the associated need for a clinician-member partnership) and by increasing access to health information and decision support on the Internet. Supporting the central role members play in providing care and making health decisions can help bridge the "quality chasm" and build an effective health care system for the 21st century. This involves more than patching together programs and processes; it represents a basic shift in our culture and systems of caregiving.2 "Member-centered care" is an overarching theme and effective clinician-member communication a prerequisite. There is growing scientific evidence that self-care, self-management, and shared decision-making practices are linked to improvements in health-related outcomes and reduced costs. General self-care manuals, such as the Kaiser Permanente Healthwise Handbook, are valued; they increase self-care skills and satisfaction and are likely to improve access. Self-management interventions for remarkably different chronic conditions, such as adult asthma, diabetes, coronary artery disease, and heart failure, all bring about better health status and habits--and in several cases, lower utilization and costs. While the evidence on shared decision-making programs is evolving, we can conclude that they improve knowledge of treatment options and consequences, reduce decisional conflict, and stimulate greater participation in health decisions. The impact on treatment varies considerably by the type of health decision, with the most positive effects correlated with programs for major health decisions affecting quality of life. Innovative self-care, self-management, and shared decision-making programs based on the latest clinical and behavioral research and theory have already been tested and implemented throughout KP. Many have been successful. Others have faltered due to a lack of member participation or clinician support and inadequate administrative, logistic, or procedural systems. Considerable variation and duplication of effort exist. To accelerate progress and link efforts to further strengthen self-care, self-management, and shared decision-making practices, it is important to focus on a few strategic priorities. References
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