Empowering states to deliver evidence-based disease management and health promotion programs: National outcomes and best practices

Older adults and underserved racial and ethnic minorities disproportionately experience multiple chronic conditions and other preventable health risks, such as falls. The Administration on Aging (AoA) supported two major initiatives for states to build sustainable infrastructure to deliver chronic disease self-management (CDSMP) and prevention programs, with special emphasis on reaching underserved populations. Using secondary analyses, we documented successes, challenges, accomplishments, lessons learned, and products produced. In 2006-7, the AoA's “Empowering Older People to Take More Control of Their Health Through Evidence-Based Prevention Programs” funded 24 states that delivered 21 different programs to over 136,000 people. In 2010, 47states/territories received grants from the American Recovery and Reinvestment Act (ARRA) “Communities Putting Prevention to Work”. The ARRA grantees exceeded their goals by 181% and reached almost 91,000 older adults through more than 9,500 programs. The ARRA participant reach was 22.6% African American, 17% Hispanic/Latino, 1.7% Native American, and almost 5% Asian-Pacific Islander. For both AoA initiatives, indicators of success included supportive state leadership, effective public-private partnerships, strong delivery infrastructures, centralized or coordinated logistical processes, business and sustainability planning, and ongoing quality assurance and fidelity mechanisms. The results demonstrate that synergistic approaches are needed to significantly improve the health and quality of life of older adults, particularly those with multiple chronic conditions. Furthermore, the results have helped to identify numerous strategies, including strengthening public health/aging partnerships at the national level and building states' business acumen, to support sustainable evidence-based prevention programs.