1. ORIENTATION SESSION Strengthening Chronic Disease Prevention & Management

2. PURPOSE OF THE MEETING Why the Tool is being introduced How it may be helpful to your group/committee Goals of the meeting

3. OUTLINE Regional Context How and Why the Tool was Developed What the Tool Looks Like –Basic Concepts –Critical Success Factors for Strengthening Chronic Disease Prevention & Management –How the Tool Might Be Used

4. REGIONAL CONTEXT Add in appropriate info for your region: Regional strategies or goals for preventing chronic disease, risk factors and underlying determinants Framework or model guiding regional chronic disease prevention and/or management efforts Relevant stats or targets –Eg. reducing number of new cases of type 2 diabetes by x % –Eg. increasing % of population eating recommended daily fruits and vegetables –Eg. increasing access to diabetes education and self- management program for high risk population group(s)

5. HOW AND WHY THE TOOL WAS DEVELOPED

6. CONTEXT  The importance of reorienting health services towards health promotion, disease prevention, community-based care and chronic disease management has been repeated in every major health report and consultation in the past 10 years, including the Health Council of Canada’s 2006 annual report* *Health Council of Canada. 2006 Annual Report “Health Care Renewal in Canada: Clearing the Road to Quality.” Available online at: http://www.healthcouncilcanada.cahttp://www.healthcouncilcanada.ca

7. CONTEXT  Moving toward Integrated System for Chronic Disease Prevention and Management  Addressing common risk factors  Individual and population health approaches  Intersectoral policy, building environments that support health  Reducing inequities  Improving system integration (policy, planning and program delivery levels)

8. CONTEXT  Changing environment  Wide range of disease-specific, risk factor-specific and age-specific strategies  Efforts are underway to better align and better coordinate strategies and services along the full continuum  to improve health outcomes  to sustain health system

9. RESEARCH QUESTION “What are the critical success factors for integration of chronic disease prevention and management?”

10. METHOD/APPROACH Evidence-Based The Tool was developed through: Extensive multi-disciplinary research  Peer-reviewed, indexed journal articles  Grey literature (websites)  Key Informants  Focus Groups  Four pilots

11. NS Chronic Disease Prevention Framework Leadership Public Policy Community Capacity and Infrastructure Knowledge Development and Transfer Health Communication

12. INTERFACE: PUBLIC HEALTH AND PRIMARY CARE  Limitations in:  Infrastructure and capacity for both areas  Interface: integration, coordination, communication  Opportunities through renewal efforts in primary health care towards  Disease prevention  Health promotion  Chronic disease management

13. RESEARCH RESULTS A collaborative planning and assessment tool –Eight Critical Success Factors –Guiding Questions for each

14. THE TOOL

15. AIMS TO: Engage planners and policy-makers in dialogue Promote information exchange Assess current policy, planning and practice Identify actions, roles and shared responsibilities for strengthening prevention and management of chronic disease

16. TARGETS: Policy-makers and planners With shared responsibility for preventing and/or managing chronic disease Working in: –public health –primary care –home care and acute care –non-governmental –non-health sectors

17. WHAT THE TOOL IS NOT: NOT an accreditation-style tool NOT a prescriptive tool detailing what should be in place IS a resource to stimulate thinking about what better or promising practices “MIGHT” look like

18. WHAT DOES IT LOOK LIKE?

19. A TOOL KIT… – Assessment tool, including worksheets and rating scales – How-To Guide Case Studies

20. ASSESSMENT TOOL –Purpose and Use of the Tool –Ideas about who could use it –Basic Concepts –Intro to Critical Success Factors –Worksheets with Guiding Questions

21. BASIC CONCEPTS –CDPM Framework –Building prevention into the health system –Integration of CDPM –Collaborative Action –Capacity-building

22. INTEGRATED MODELS FOR CHRONIC DISEASE PREVENTION AND MANAGEMENT

23. NOVA SCOTIA ’ S Adopted & Adapted CDM Model HEALTH SYSTEM Self Management/ Develop Personal Skills Delivery System Design/ Re-orient Health Services Decision Support Information Systems COMMUNITY Build Healthy Public Policy Create Supportive Environment Strengthen Community Action Activated Community Informed Activated Patient/ Family Prepared Proactive Practice Team Prepared Proactive Community Partners Productive Interactions & Relationships Functional & Clinical Outcomes Population Health Determinants of Health

24. BUILDING PREVENTION INTO THE SYSTEM

25. Chronic Disease Prevention and Management Continuum Well Population Primary Prevention At Risk Population Secondary Prevention Established DiseaseControlled Chronic Disease Surveillance of diseases & risk factors Promotion of healthy behaviours Creation of supportive environments Universal & targeted approaches Screening Case finding Periodic health examinations Early intervention Medication to control Universal & targeted approaches Treatment and acute care Complications management Self-management Continuing Care Maintenance Rehabilitation Self-Management Health Promotion Prevent movement to at-risk group Prevent progression To established disease Prevent progression to complications and/or hospitalizations Tertiary Prevention

26. INTEGRATING OF PREVENTION AND MANAGEMENT Better aligning strategies, vision and goals Linking individual & population-level approaches Shared planning to coordinate efforts and/or resources Mechanisms to support information-sharing, communication and coordination Service-level integration to improve comprehensiveness, continuity of care

27. COLLABORATIVE ACTION –Shared responsibility for CDPM –Range of stakeholders –Building system capacity for CDPM requires collaborative action

28. CAPACITY-BUILDING –Organizational development –Workforce development –Resource allocation –Leadership –Partnership development Reference: A Framework for Building Capacity to Improve Health, NSW Health, 2001.

29. CRITICAL SUCCESS FACTORS

30. 1.Common Values and Shared Goals 2.Focus on Determinants of Health 3.Public Health Capacity and Infrastructure 4.Primary Care Capacity and Infrastructure 5.Community Capacity and Infrastructure 6.Integration of Chronic Disease Prevention and Management 7.Monitoring, Evaluation and Learning 8.Leadership, Partnership and Investment

31. Common Values and Goals Leadership, Partnership and Investment Focus on Determinants of Health Public Health Capacity/ Infrastructure Evaluation Monitoring Learning Community Capacity/ Infrastructur e Primary Care Capacity/ Infrastructur e Integration Clinical- based Prevention (Primary Care) Chronic Disease Management (1°, 2°, 3° care) Population- based Prevention (Public Health)

32. ASSESSMENT QUESTIONS –Cues to help assess current capacity in the Critical Success Factors Where are we now in our practice? What opportunities are there to build capacity/improve practice?

33. WORKSHEETS AND RATING SCALES The assessment questions are also presented in worksheet format. The questions include a rating scale that outlines a possible range of practice for this component of the Critical Success Factor Additional resources and a more complete description of each Factor is also provided in these sections of the Tool.

34. HOW MIGHT THE TOOL BE USED?

35. MULTIPLE APPROACHES –No one right way to use the Tool –Keep it manageable, e.g. Do an assessment of all eight critical success factors, but focus in on a particular risk factor, e.g. obesity Choose a few critical success factors to focus on Focus on a setting, e.g. workplace and choose the appropriate factors

36. HOW-TO GUIDE –The Tool is meant to initiate and guide a process of engagement – it is neither a one-time event, nor an end it itself. To assist in this process, a series of how-to supports have been developed. –Includes case studies