O R I G I N A L R E S E A R C H A five state dissemination of a community- based disability prevention program for older adults Elizabeth A Phelan1 Barbara Williams2 Susan J Snyder3 Sally Sizer Fitts1 James P LoGerfo4 1Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA; 2Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA; 3Senior Services of Seattle/King County, Seattle, WA, USA; 4Department of Medicine, Division of General Medicine, University of Washington, Seattle, WA, USA Correspondence: Elizabeth A Phelan Division of Gerontology and Geriatric Medicine, University of Washington, 325 9th Avenue, Box 359755, Seattle,WA 98104-2499, USA Tel +1 206 744 9112 Fax +1 206 744 9976 Email phelane@u.washington.edu. Objective: To describe challenges in disseminating the Health Enhancement Program (HEP), a community-based disability prevention program for community dwelling elders, and to examine program effectiveness in geographically dispersed sites. Methods: Within-group, pre-test–post-test comparisons of disability risk factors, health and functional status, and hospitalizations for 115 participants completing one year in HEP, and primary care provider awareness and perceptions of the program. Results: Most (77%) participants were women, with an average age of 73 years and an average of 3.5 chronic conditions. At one-year follow-up, compared with enrollment, fewer participants were depressed (8.8% vs 15.9%), physically inactive (15.8% vs 38.6%), at high nutritional risk (24.3% vs 44.1%), or experiencing restricted activity days (35% vs 48%). Severity scores on most measures also improved significantly. The proportion hospitalized was unchanged from the year prior to HEP, although risk factors predicted an increase in hospitalizations as for the control group in the randomized trial. Conclusions: HEP reduced participants’ disability risk factors. Sites varied on numbers enrolled and time to implement the program, likely due to differing referral bases, degree of physician awareness of HEP, and site readiness. However, the benefits of HEP participation were comparable with those reported previously. Keywords: aged, risk factors, outcome and process assessment (healthcare), chronic disease self-management, diffusion of innovation, program evaluation Introduction The Health Enhancement Program (HEP) is a community-based wellness intervention designed to preserve the health and functioning of older adults who reside in the community and have a high risk of functional decline due to chronic health problems (Leveille et al 1998). In a departure from traditional interventions, which emphasize disease-specific knowledge, specialty expertise, and technical skills (Bodenheimer et al 2002; Grumbach and Bodenheimer 2002), and which have had mixed results in changing health behaviors and outcomes (Norris et al 2001), HEP emphasizes collaborative, patient-centered, disease self-management. Recent studies among individuals with various chronic diseases suggest that teaching patients disease-related self-management skills and increasing their self-efficacy, or confidence in their ability to manage their chronic disease, may be a beneficial way to improve health outcomes (Rimal 2000; Bodenheimer et al 2002; Bandura 2004). As part of the HEP intervention, trained staff (nurses and social workers) identify potentially modifiable risk factors for disability (eg, depression, poor nutrition, sedentary lifestyle) for each participant and employ motivational strategies to promote behavior change to reduce those risk factors in order to prevent subsequent functional decline. HEP staff deliver the program in community settings and maintain ongoing communication with each participant’s primary care physician (PCP). A randomized trial conducted at one Clinical Interventions in Aging 2006:1(3) 267–274 © 2006 Dove Medical Press Limited. All rights reserved 267