practitioners and the broader health care system support patients in the methodical exercise of self-management (Bodenheimer et al., 2002). Self-management encompasses problem-solving skills and patients’ collaborative involvement in establishing goals to manage their disease.
Participants proposed five key strategies for catalyzing the diffusion of self-management and self-management support: (1) identify and disseminate evidence-based self-management practices; (2) recognize the centrality of self-management to good patient care, and incorporate this recognition into the health care culture (including at the national level); (3) provide incentives for the appropriate use of self-management support integrated into the delivery of health care; (4) develop self-management programs and tools that are applicable to diverse populations; and (5) make better use of all members of the health care team.
Participants proposed that existing and future best self-management practices be consolidated and disseminated to providers, patients, and their families, perhaps through a centralized clearinghouse. The problem today is that those wishing to implement best self-management practices often cannot find information about them, or distinguish those that are evidence-based from those that are not. Session participants also supported the need for expansion of the existing evidence base on effective self-management practices. There was a call for responsive research that is practical and relatively rapid-cycle so as to provide a sufficient foundation for moving forward.
Participants suggested learning from practical models and, on a parallel track, developing a firmer scientific base. It was emphasized that the scope of this research should extend to all levels of the health care system, from working one-on-one with patients in the practice of self-management, to changing office environments, to revamping entire systems of care. Additionally, best practices must be appropriately tailored for different populations and age groups, particularly children and adolescents.
Two communities represented at the summit—Controlling Asthma in the Richmond Metropolitan Area (CARMA) and the Oregon Heart Failure Project (OHFP)—shared with session participants some of their accomplishments in self-management support and lessons learned in working with patients and their families to assist them in self-managing asthma and heart failure, respectively. Both rely on evidence-based guidelines as the foundation for their programs (see Boxes 5-1 and 5-2).