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Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial

Lorig, Kate R. RN, DrPH*; Sobel, David S. MD, MPH; Stewart, Anita L. PhD; Brown, Byron William Jr. PhD*; Bandura, Albert PhD§; Ritter, Philip PhD*; Gonzalez, Virginia M. MPH*; Laurent, Diana D. MPH*; Holman, Halsted R. MD*

Original Articles

Objectives. This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities.

Methods. The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured.

Results. Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being.

Conclusions. An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.

*From Stanford University School of Medicine, Stanford, California.

From Kaiser Permanente, Northern California Region, Oakland, California.

From University of California, San Francisco, Institute for Health & Aging, San Francisco, California.

§From the Department of Psychology, Stanford University, Stanford, California.

Supported by the University of California Tobacco-Related Disease Research Program grant no. TR156 and AHCPR grant no. 5 RO1 HS06680.

Address correspondence to: Dr. Kate Lorig, Stanford Patient Education Research Center, 1000 Welch Road, Suite 204, Palo Alto, CA 94304; e-mail:

Received December 23, 1997; initial review completed February 3, 1998; accepted May 26, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.