Form 0920-0909 Evaluation Data Form

Form Approved

OMB No. 0920-0909

Exp. Date: 12/30/2020

Diabetes Prevention Recognition Program

Evaluation Data Elements: Definitions and Guidance

Public reporting burden of this collection of information is estimated to average two hours per response for the submission of Evaluation Data, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30329; ATTN: PRA (0920-0909)

Changes/Additions/Deletions from the currently approved (in 2014) 2015 DPRP Standards

Revisions:

New elements: 1) Enrollment Source, 3) Payer Type, 4) Education, 5) Delivery Mode, 6) Session ID, 7) Session Type

Deleted elements (these elements will no longer be collected and are not shown below):

No elements are being deleted

Each CDC-recognized organization (full, preliminary, or pending) must transmit evaluation data to CDC every 6 months. This requirement begins 6 months from the organization’s effective date, the first day of the month following the approval of the organization’s application by the DPRP.

Each data submission must include one record for each session attended by each participant during the preceding year. The first data submission must also include records for any sessions attended between the approval date and the effective date. Subsequent data submissions should not include data from earlier submissions.

All of the data elements listed below must be transmitted to CDC. Data must be transmitted as a data file using the comma separated value (CSV) format, which is compatible with the majority of statistical, spreadsheet, and database applications. Each row in the data file should represent one session attended by one participant (i.e., participant will have new row for each session). If a participant is absent from a session, then no record should be submitted for that participant for that session. Each column in the data file should represent one field containing specific data for the evaluation data elements listed below. There should be no empty fields and no empty cells. When a data value is unknown, a default value should be entered, if applicable.

Transmitted data must conform to the specifications in the data dictionary that is included below. The variable names, codes, and values, contained in the data dictionary must be used. Do not make any changes in the spelling. Variables (columns) in the data submission file should have the same names (column headings) and appear in the same order as in the data dictionary. Applicant organizations should take time to become familiar with all of the data elements and specifications.

No information in identifiable form (directly or indirectly identifiable) (IIF) about lifestyle program coaches or participants should be transmitted to CDC. All identifiers (except the organization code, which is provided by CDC) will be assigned and maintained by the applicant organization according to the specifications outlined in the data dictionary.

Evaluation Data Elements (Numbers correspond with Table 4. Data Dictionary: Evaluation Data Elements)

1. Organization Code. Will be assigned by the DPRP when the organization’s application is approved. Each applicant will have a unique organization code. This code must be included by the applicant organization on all data records submitted.

2. Participant ID. Will be assigned by the organization to uniquely identify and track participants across sessions. The participant ID must be included on all session attendance records generated for an individual participant. The participant ID should not be based on social security number or other PII. If a participant re-enrolls in a new class, the organization should assign this participant a new participant ID.

3. Enrollment Source. Will identify the source (person, place, or thing) which led the participant to enroll in the yearlong program (see data dictionary for the appropriate code).

4. Payer Type. Will identify one, main payment method that participants are using to pay for their participation in the yearlong program (see data dictionary for the appropriate code).

5. Participant State. The state in which a participant resides should be recorded at enrollment and included on all session attendance records generated for that participant. The two-letter postal abbreviation for the U.S. state or territory should be used. Organizations choosing to deliver the lifestyle program to U.S. citizen participants residing outside of the U.S. or its territories should default to the participant’s U.S. resident state or U.S. Army Post Office (APO) address state.

6- 8) Participant’s Prediabetes Determination. Should be recorded at enrollment and included

on all session attendance records generated for an individual participant. This indicates whether a participant’s prediabetes status was determined by a blood test, a previous diagnosis of GDM, or by screening positive on the CDC Prediabetes Screening Test (see guidance titled CDC Prediabetes Screening Test) or the ADA Type 2 Diabetes Risk Test. Multiple responses are allowed and may be added. For example, if a participant was originally enrolled on the basis of a risk test and then subsequently received a blood test indicating prediabetes, the risk test value remains the same, and the blood test value is changed to a positive.

9) Participant’s Age. Should be recorded at enrollment and the recorded age used throughout all records regardless of a birthday occurring during the yearlong program. If the participant’s age is incorrectly recorded at enrollment (or at the first session), then the age should be corrected on all records. If an organization’s recordkeeping system automatically adjusts the age on a participant’s birthday, then the two recordings of age are okay.

10) Participant’s Ethnicity. Should be recorded at enrollment and included on all session attendance records generated for an individual participant. The participant should self- identify and have the opportunity to choose one of the following: Hispanic/Latino, Not Hispanic/ Latino, or not reported.

11–15) Participant’s Race. Should be recorded at enrollment and included on all session attendance records generated for an individual participant. The participant should self-identify and have the opportunity to choose one or more of the following: American Indian or Alaska Native, Asian or Asian American, Black or African American, Native Hawaiian or Other Pacific Islander, and White. Multiple responses are allowed. This element requires responses for five fields, and each field includes a response for not reported (refer to Table 2, the data dictionary).

16) Participant’s Sex. Should be recorded at enrollment and included on all session attendance records generated for an individual participant. The data record should indicate male, female, or not reported.

17) Participant’s Height. Should be recorded at enrollment and included on all session attendance records generated for an individual participant. Height may be self-reported (i.e., it is not necessary to measure the participant’s height; the participant may simply be asked, “What is your height?” or “How tall are you?”). The participant’s height should be recorded to the nearest whole inch.

18) Education. Will identify the highest grade or year of school the participant completed. This information should be recorded at enrollment and included on all session attendance records generated for an individual participant.

19) Delivery Mode. Will identify the delivery mode, as defined in the Applying for Recognition section, for this specific participant and session (i.e., in-person, online, distance learning).Please note that since this is a session level variable, combination mode does not apply.

20) Session ID. Will identify weekly sessions offered throughout the yearlong program. Session IDs in months 1-6 could be numbered 1 through 26 depending on the frequency of weekly offerings. Session IDs in months 7-12 will all be numbered as 99, and sessions in ongoing maintenance months (for Medicare DPP supplier organizations or other organizations that choose to offer ongoing maintenance sessions) will all be numbered as 88. If a 7-12 month curriculum module (such as one from PreventT2) is used in months 1-6, it should be coded as 1 through 26, since it is being delivered during that timeframe. If a 1-6 month curriculum module is used in months 7-12, it should be coded as 99, since it is being delivered during that timeframe.

21) Session Type. Will identify the session attended within months 1-6 (scheduled core sessions) as “C”, core maintenance sessions attended within months 7-12 as “CM”, or ongoing maintenance sessions as “OM” in the second year (post-yearlong lifestyle change program) for Medicare DPP suppliers or other organizations that choose to offer ongoing maintenance sessions. Medicare DPP suppliers must collect and report data for ongoing maintenance sessions in the same way they do for core and core maintenance sessions, including recording participant weights. CDC will collect these data for Medicare to assist with their continued implementation and assessment of the Medicare DPP expanded model.

Make-up sessions will be identified as “MU” and should be used with the corresponding Session ID that was previously missed by the participant (i.e., the session they are making up). If a 7-12 month curriculum module (such as one from PreventT2) is used in months 1-6, it should be coded as a “C”, since it is being utilized as a core session. If a 1-6 month curriculum module is used in months 7-12, it should be coded as a “CM”, since it is being utilized as a core maintenance session.

22) Session Date. Each time a participant attends a session, the actual date of the session should be recorded. The date should be recorded in mm/dd/yyyy format. A participant should not have more than one record (line of data) for any specific session date, with the exception of make-up sessions. One make-up session per week may be held on the same date as a regularly scheduled session for the convenience of the participant. For online sessions, organizations should record the date each session is completed.

23) Participant’s Weight. Each time a participant attends a session, his or her body weight should be measured and recorded to the nearest whole pound. The weight should be included on the record for that participant and session. For online programs, organizations should record the weight associated with the session completion date.

24) Participant’s Physical Activity Minutes. Once physical activity monitoring has begun in the curriculum, participants will be asked to report the number of minutes of moderate or brisk physical activity completed during the preceding week. This information should be included on the record for that participant and session. If a participant reports doing no activity during the preceding week, then zero (0) minutes should be recorded. Note: Zero (0) minutes reported will not count as documented physical activity minutes.

Table 4. Data Dictionary: Evaluation Data Elements

Data element description	Variable name	Coding/valid values	Comments
1. Organization Code	ORGCODE	Up to 25 alphanumeric characters*	Required, provided by DPRP
2. Participant ID	PARTICIP	Up to 25 alphanumeric characters*	Required. Participant ID is uniquely assigned and maintained by the applicant organization and must not contain any PII.
3. Enrollment Source	ENROLL	1 Non-primary care health professional (e.g., pharmacist, dietitian) 2 Primary care provider/office or specialist (e.g., MD, DO, PA, NP, or other staff at the provider’s office) 3 Community-based organization or community health worker. 4 Self (decided to come on own) 5 Family/friends 6 An employer or employer’s wellness program 7 Insurance company 8 Media (radio, newspaper, billboard, poster/flyer, etc.), national media (TV, Internet ad), and social media (Twitter, Facebook, etc.) 9 Other 10 Not reported	Required. At enrollment, participants are asked by whom they were referred to this lifestyle change program. If a participant’s referral source is not provided, this variable will be coded as ‘9’.
4. Payer Type	PAYER	1 Medicare 2 Medicaid 3 Private Insurer 4 Self-pay 5 Dual Eligible (Medicare and Medicaid) 6 Grant funding 7 Employer 8 Other 9 Not reported	Required. At enrollment, participants are asked “Who is the primary payer for your participation in this lifestyle change program?” If a participant’s payer source is not provided, this variable will be coded as ‘9’.
5. Participant State	STATE	Two-letter abbreviation for the U.S. state or territory in which the participant resides	Required
6. Participant’s Prediabetes Determination (1 of 3)	GLUCTEST	Prediabetes diagnosed by blood glucose test Prediabetes NOT diagnosed by blood glucose test (default)	Required; acceptable tests include FG, oral glucose tolerance test (OGTT), A1c, or claim code indicating diagnosis of prediabetes.
7. Participant’s Prediabetes Determination (2 of 3)	GDM	Prediabetes determined by clinical diagnosis of GDM during previous pregnancy Prediabetes NOT determined by GDM (default)	Required
8. Participant’s Prediabetes Determination (3 of 3)	RISKTEST	Prediabetes determined by risk test Prediabetes NOT determined by risk test (default)	Required
9. Participant’s Age	AGE	18 to 125 (in years, rounded with no decimals)	Required
10. Participant’s Ethnicity	ETHNIC	Hispanic or Latino NOT Hispanic or Latino 9 Not reported (default)	Required; if ethnicity is not reported by the participant, this variable will be coded as ‘9’.
11. Participant’s Race (1 of 5)	AIAN	American Indian or Alaska Native NOT American Indian or Alaska Native (default)	Required; if race is not reported by the participant, all of the 5 race variables will be coded as ‘2’.
12. Participant’s Race (2 of 5)	ASIAN	Asian or Asian American NOT Asian or Asian American (default)	Required; if race is not reported by the participant, all of the 5 race variables will be coded as ‘2’.
13. Participant’s Race (3 of 5)	BLACK	Black or African American NOT Black or African American (default)	Required; if race is not reported by the participant, all of the 5 race variables will be coded as ‘2’.
14. Participant’s Race (4 of 5)	NHOPI	Native Hawaiian or Other Pacific Islander NOT Native Hawaiian or Other Pacific Islander (default)	Required; if race is not reported by the participant, all of the 5 race variables will be coded as ‘2’.
15. Participant’s Race (5 of 5)	WHITE	White NOT White (default)	Required; if race is not reported by the participant, all of the 5 race variables will be coded as ‘2’.
16. Participant’s Sex	SEX	Male Female 9 Not reported	Required
17. Participant’s Height	HEIGHT	30 to 98 (in inches)	Required
18. Education	EDU	1 Less than grade 12 (No high school diploma or GED) 2 Grade 12 or GED (High school graduate) 3 College- 1 year to 3 years (Some college or technical school) 4 College- 4 years or more (College graduate) 9 Not reported (default)	Required
19. Delivery Mode	DMODE	1 In-person 2 Online 3 Distance learning	Required
20. Session ID	SESSID	1 to 26 Core or makeup session —or— 99 Core maintenance or makeup session —or— 88 Ongoing maintenance or makeup session (for Medicare DPP supplier organizations or other organizations that choose to offer ongoing maintenance sessions)	Required. Core sessions and any core make-up sessions should be numbered 1 through 26. The session ID should correspond to the specific session attended. Core maintenance and any core maintenance make-up sessions should all be coded as ‘99’. Ongoing maintenance and any ongoing maintenance make-up sessions should all be coded as ‘88’.
21. Session Type	SESSTYPE	C Core session CM Core maintenance session OM Ongoing maintenance sessions (for Medicare DPP supplier organizations or other organizations that choose to offer ongoing maintenance sessions) MU Make-up session	Required. Any session delivered in months 1-6, even if pulled from months 7-12 of the PreventT2 curriculum content, for example, must be coded as a Core session, C. Any session delivered in months 7-12, even if pulled from months 1-6 of curriculum content, must be coded as a Core Maintenance session, CM.
22. Session Date	DATE	mm/dd/yyyy	Required. Each data record represents attendance by one participant at one session; must specify actual date of the session. One make-up session per week may be recorded on the same session date as a regularly scheduled session.
23. Participant’s Weight	WEIGHT	70 to 997 (in pounds) —or— 999 Not recorded (default)	Required. At each session, participants are weighed; weight must be included on the record for that session and participant. Weight may be obtained by the Lifestyle Coach or participant or a Bluetooth-enabled scale. For Medicare DPP suppliers, participants cannot self-report weight.
24. Participant’s Physical Activity Minutes	PA	0 to 997 (in minutes) —or— 999 Not recorded (default)	Required. At some or all program sessions, participants are asked to report the number of minutes of brisk physical activity they completed in the preceding week. If the number of minutes is greater than or equal to 997, 997 should be used. If a participant reports doing no activity during the preceding week, then zero (0) minutes should be recorded. The default value of 999 should only be used until physical activity monitoring begins in the curriculum.