Form 0920-1090 Evaluation Form for Sites

Formative and Summative Evaluation of the National Diabetes Prevention Program

0920 1090 Att 3B 1705 Evaluation Form for Sites Final.xlsx

Evaluation Form for Sites

OMB: 0920-1090

Document [xlsx]

Download: xlsx | pdf

Overview

Burden Statement
Instruction
Site-level Data
Coach-level Data
Class-level Data
Participant-level Data
Data Dictionary

Sheet 1: Burden Statement

	Form Approved OMB No. 0920-1090 Exp. Date xx/xx/xxxx
Spreadsheet for National DPP Grantees
Public reporting burden of this collection of information is estimated to vary between 5 and 7 hours with an average of 6 hours per affiliate delivery site response, and between 3 and 5 hours with an average of 4 hours per grantee response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the 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 the CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1090)

Sheet 2: Instruction

Instruction for Form Completion:

Worksheet Definitions:

The "Site-level Data" tab is used for affiliate delivery sites that are CDC-recognized organizations with assigned unique DPRP codes. It needs to be completed for each site receiving DP17-1705 funding in each year of the project period.

The "Coach-level Data" tab is used for all lifestyle coaches who deliver the CDC-recognized lifestyle change program offered at this site, as a result of the DP17-1705 cooperative agreement funding in each year of the project period.

The "Class-level Data" tab is used for all lifestyle change classes offered at this site, as a result of the DP17-1705 cooperative agreement funding in each year of the project period.

The "Participant-level Data" tab is used for all participants attending the CDC-recognized lifestyle change program at this site, as a result of the DP17-1705 cooperative agreement funding in each year of the project period.

Please note:

There are multiple boxes under each "response" column to allow for selection of more than one response per question.

For questions that require both a drop down response and a numeric value to be entered, there are two separate boxes that are next to each other.

Please complete your data submission by September 30th, 2019 through the 1705 National Evaluation Reporting Portal in the Data Reporting for Evaluation and Monitoring of DP17-1705 (1705 DREM) system with your assigned username and password.

PLEASE E-MAIL US AT [email protected] IF YOU HAVE ANY QUESTIONS. THANKS!

Sheet 3: Site-level Data

Question	Code	Response
Delivery Site (CDC-recognized organization with DPRP ORGCODE) Information
1. Grantee Name	GRANTEE
2. Site ORGCODE (MUST be the ORGCODE that is provided by the DPRP)	ORGCODE
3. Grant Year	GRANTYR
4. Fiscal Year	FISYR
Strategy 1: Increase the availability of CDC-recognized organizations in underserved areas
Activity 1: Identify new affiliate sites in underserved areas with the capacity to offer the lifestyle change program
5. Did your site complete the CDC's Organizational Capacity Assessment before applying for CDC recognition?	SITECAPASSESS
		If answered "Yes", please submit the results of your organization's capacity assessment as an attachment to [email protected].
6. In the current funding year, how did your site select class locations (if applicable) to deliver the lifestyle change program in underserved areas? Please select ALL that apply.	SITERECLOC		How did your site select class locations (if applicable) to deliver the lifestyle change program in underserved areas? Please select ALL that apply. (SITERECSTR)	For all the recruitment strategies selected, what types of locations were selected to deliver the lifestyle change program? Please select ALL that apply. (SITERECLOC)	Please describe why these locations were selected for program delivery (SITELOCWHY)	For each type of location selected, what was the number of locations selected to deliver the lifestyle change program? (SITELOCNUM)



		If you answered "Other", please specify.
Activity 2: Provide affiliate sites the financial and technical assistance required to become a CDC-recognized organization
7. What technical assistance (TA) did you receive during program start-up and/or for program implementation? Please provide up to 5 most helpful TA received for program implementation. Please select up to 5 that apply. Please also provide a brief description of additional TA that was needed but not received in the current funding year.	SITETA		Top 5 most helpful TA received (SITETA)	Please describe additional TA needed but not received, if any? (SITETANEED)



		If you answered "Other", please specify.
8. What resources did your site use for program implementation? Please provide up to 5 resources that were most needed for program implementation. For each resource used, please provide sources of funding. Please select ALL that apply.	SITERES		Top 5 resources needed for program implementation (SITERES)	Funding sources/In kind (SITERESFUND)	Please describe how all of the resources selected above were used (SITERESUSE)



		If you answered "Other", please specify.
9. In the current funding year, did your organization charge participants to attend the lifestyle change program (i.e. self-pay participants)? If able to report, what is the average annual enrollment cost for a participant who self-pays to participate in the National DPP lifestyle change program?	PARCHARGCOST		Did your organization charge participants to attend the lifestyle change program (i.e., self-pay participants)? (PARCHARGYN)	What is the average annual enrollment cost for a participant who self-pays to participate in the lifestyle change program? (PARCHARGCOST)

Strategy 2: Increase clinician screening, detection, and referral of adults with prediabetes or at high risk for type 2 diabetes to CDC recognized organizations
Activity 1: Provide technical assistance to CDC-recognized organizations on how to help health systems implement policy and practice changes to identify priority populations with prediabetes and refer them to the lifestyle change program
10. Did you conduct any marketing activities to health care providers (HCPs) or health care systems about identifying priority populations and referring them to your organization's lifestyle change program? If No, skip to question 11.	SITEMARKHCPSYN
11. If Yes to Q10, what marketing strategies did you use to reach HCPs or health care systems to refer priority populations to your organization's lifestyle change program? Please select ALL that apply and note additional strategies under “other.”			Marketing strategies used to reach HCPs or health care systems to refer priority populations (SITEMARKHCP)	Number of HCPs or health care systems exposed to each marketing strategy used (SITEMARKHCPNUM)




		If you answered "Other", please specify.
12. What tools/resources did you use to reach HCPs or health care systems to refer priority populations to your organization's lifestyle change program? If you provided additional resources beyond those listed, please note this under “other” and describe.	HCPTOOL		Tools/resources used to reach HCPs or health care systems to refer priority populations (HCPTOOL)	Number of HCPs or health care systems exposed to each tool or resource (if able to report) (HCPTOOLNUM)



		If you answered "Other," please specify.
13. Please select from the list all referral sources to the lifestyle change program. If able to report, please provide the total number of potential participants referred for each referral source. For referral sources from health care providers/systems, please provide mode of referral. Please select ALL that apply.	OREFLSOR		Referral sources (OREFLSOR)	For referral sources from health care providers/systems, please provide mode of referral (HCPREFMODE)	Total number of potential participants referred for each referral source (HCPREFNUM)




		If you answered "Other", please specify.
14.What were the recruitment places that your site used to reach priority populations of focus? For each place selected, please provide the total number of potential participants reached (if able to report). Among all of the recruitment places selected, please provide the recruitment methods you used. Please select ALL that apply.	RECRUTPL		What were the recruitment places that your site used to reach priority populations of focus? Please select ALL that apply (RECRUTPL)	Among all of the recuitment places selected, what were the recruitment methods you used? Please select ALL that apply. (RECRUMET)	Total number of potential participants reached for each recruitment place (RECRUTPARTNUM)




		If you answered "Other", please specify.
15. Please describe any factors that facilitated marketing to health systems and health care providers.	HCPSMARKFAC
16. Please describe any barriers you experienced in marketing to health systems and health care providers, and strategies you used to address barriers.			Barriers in marketing to health care providers/systems to screen, test, and refer priority populations (HCPSMARKBAR)		Strategies to address barriers reported (HCPSMARKSTR)

Strategy 3: Increase priority population awareness of prediabetes and enrollment in the lifestyle change program
Activity 1: Use the CDC National DPP Marketing Portfolio and other materials as appropriate to recruit, engage, and enroll priority populations in the lifestyle change program
17. For all priority populations of focus, what types of marketing strategies did you use to reach them? Please describe "Other" strategies used that don’t fit into the categories provided. Please select ALL that apply.	SMARKSTR		For all priority populations of focus, what types of marketing strategies did you use to reach them? Please select ALL that apply. (SMARKSTR)




		If you answered "Other", please specify.
18. What channels did you use to reach people to enroll in the National DPP Lifestyle Change Program? Please describe "Other" channels used that don’t fit into the categories provided. Please select ALL that apply. How many people did you reach with each channel? If able to report, please provide frequency per marketing channel used.	COMCHANNEL			What channels did you use to reach people to enroll in the National DPP Lifestyle Change Program? (COMCHANNEL)	If able to report, please provide frequency per marketing channel used. (COMCHANNELFREQ)	For each channel used, what was the total number of people reached? (COMCHANNELREACH)





		If you answered "Other", please specify.
19. For current funding year, did you use a pay for outcome (PFO) or other type of value-based payment plan to cover enrollment costs for priority populations supported with 1705 funds? Please select the type of payment plan, and provide details of the payment/reimbursement arrangement. Please select ALL that apply.	PFOMODEL	Did you use a PFO or other value-based payment plan? (PFOMODELYN)	What type of PFO payment plan was used to cover enrollment costs for priority populations supported with 1705 funds? Please select ALL that apply. (PFOMODEL)	Please describe how payment/reimbursement was arranged. (PFOMODELDES)



	If you answered "Other", please specify.
Strategy 4: Ensure high rates of retention for priority population participants in the lifestyle change program
Activity 1: Develop and/or adapt tools, materials, best practices, and advanced skills training for coaches to help CDC-recognized organizations support and retain priority population participants
20. How have you adapted the lifestyle change program to address the specific cultural needs or preferences of one or more of your priority populations or focus? Please select ALL that apply.	SITEADAPT			Type of delivery adaptation (SITEADAPT)




		If you answered "Other", please specify.
21. For all priority populations of focus, what types of incentives are provided to participants to encourage program participation or completion ? What are the funding sources for incentives provided? Please select ALL that apply. Please provide brief descriptions of how and when incentives were provided.	SITEINCENT		For all priority populations of focus, what types of incentives were provided? Please select ALL that apply. (SITEINCENT)	For each type of incentive selected, what are the funding sources for incentives provided? Please select ALL that apply. (SITEINCENTFUND)	Please describe how and when incentives selected were provided (SITEINCENTDES)




		If you answered "Other", please specify.
22. Which additional strategies or best practices (other than those reported in questions 20 & 21) did your site adopted in order to retain priority populations of focus? For all strategies or best practices adopted, please provide brief description of how and when they have been used to engage/retain priority populations of focus. Please select ALL that apply.	SRETAINSTR		Which additional strategies or best practices (other than those reported in questions 20 & 21) did your site adopted in order to retain priority populations of focus? Please select ALL that apply. (SRETAINSTR)	For all strategies or best practices adopted, please provide brief description of how and when they have been used to engage/retain priority populations of focus. (SRETAINSTRDES)





		If you answered "Other", please specify.
Strategy 5: Ensure that participation in the lifestyle change program is included as a covered benefit for priority populations
Activity 1: Work with employers and public and private payers to promote the lifestyle change program as a covered benefit for priority populations
23. Which types of payers reimbursed for the costs of priority populations enrolled in your lifestyle change program. Please select ALL that apply. For all types of payers selected, what were the names of the payers who reimbursed for the costs of priority populations enrolled in your lifestyle change program? What was the number of participants who received reimbursement from all payers (if able to report)?	SPAYTYPE		Which types of payers reimbursed for the costs of priority populations enrolled in your lifestyle change program. Please select ALL that apply. (SPAYTYPE)	For all types of payers selected, what were the names of the payers who reimbursed for the costs of priority populations enrolled in your lifestyle change program? (SPAYNAM)	What was the number of participants who received reimbursement from all payers (if able to report)? (SPAYPARTNUM)



		If you answered "Other", please specify.
Activity 2 . Provide technical assistance to CDC-recognized organizations serving priority populations on how to implement administrative systems required to bill and receive payment from payers
24. If your site received reimbursement from payers selected in Q23 in the current funding year, for all type of payers, please select from the list which types of billing and coding systems were used, or which entities your site contracted with to submit claims. If able to report, please also provide the name(s) of third-party administrators used and the date claims were initiated. Please select ALL that apply.	SMDPPBILL			For all type of payers, which types of billing and coding systems were used to submit claims to payers? Please select ALL that apply. (SMDPPBILL)	If contracted with a third-party administrator (TPA) to provide billing and payment services, what was the name(s) of TPA your organization contracted with? (SBILLTPA)	What date was the claims processing system implemented? (SBILLCLAIM)



		If you answered "Other", please specify.

Sheet 4: Coach-level Data

For all lifestyle coaches who deliver the CDC-recognized lifestyle change program offered at this site, as a result of DP17-1705 cooperative agreement funding in the current funding year, please provide the following information. Please provide one unique de-identified Coach ID per row. For lifestyle coaches who deliver the CMS's Medicare Diabetes Prevention Program (MDPP), please provide their National Provider Identifier (NPI) as their Coach ID.

Please enter a unique de-identified Coach ID for each of the lifestyle coach delivering the program at this site (Please do not include any personally identifiable information such as name, birth data, social security number for Coach ID)

What were the roles of the lifestyle coach? Please select all that apply. If you answered "Other", please specify.

Please describe other role(s) of lifestyle coaches.

What percent time did the lifestyle coach spend on each role selected?

What curriculum was the lifestyle coach trained? Please select all that apply. If you answered "Other", please specify.

Please describe other curriculum lifestyle coach was trained.

What types of additional trainings did the lifestyle coach receive? Please select all that apply. If you answered "Other", please specify.

Please describe other type(s) of additional trainings that the lifestyle coach received.

What types of qualifications (if applicable) does the lifestyle coach have? Please select ONE.

What are the types of funding sources for the lifestyle coach? Please select all that apply. If you answered "Other", please specify.

Please describe other type(s) of funding for the lifestyle coach.

If able to report, what is the average annual salary of the lifestyle coach?

GRANTEE

ORGCODE

COACHID

COACHROLES

COACHROLESOTH

COACH%TIME

COACHCURTRAIN

OTHERCURTRAIN

COACHADDTRAIN

COACHOTHTRAIN

COACHQUAL

COACHFUND

COACHFUNDOTH

COACHSAL

Sheet 5: Class-level Data

For all lifestyle change classes offered at this site, as a result of the DP17-1705 cooperative agreement funding in current funding year, please provide the following information. Please provide one unique de-identified class ID per row.
		Please enter a unique de-identified Class ID for this class.	Please select from the list of unique de-identified Coach IDs for the main lifestyle coach who delivered the program for this class.	What curriculum was used for this class?	If you answered "Other", please describe other type of curriculum used.	What language was used for this class?	If you answered “Other”, please describe the other language used.	What was the type of location (if applicable) for this class?	If you answered "Other", please describe other type of location.	What was the mode of delivery for this class?	If applicable, what is the address for this class?
GRANTEE	ORGCODE	CLASSID	COACHID	CURUSE	CURUSEOTH	LANGUSE	LANGUSEOTH	CLASSLOC	CLASSLOCOTH	CLASSMODE	CLASSADD

Sheet 6: Participant-level Data

For all participants attending the CDC-recognized lifestyle change program at this site, as a result of the DP17-1705 cooperative agreement funding in current funding year, please provide the de-identified participant IDs (PARTICIP) submitted to the Diabetes Prevention Recognition Program (DPRP) in the row below. Please provide one unique participant ID per row.
		Please provide de-identified participant IDs who were enrolled as a result of 1705 funds.	Does the participant have a visual impairment and/or physical disability? Please select only ONE.	Did the participant attend a Session Zero or Introductory Session before starting the lifestyle change program? Please select only ONE.	If able to report, what is the participants' ZIP code of residence?
GRANTEE	ORGCODE	PARTICIP	VPDIS	SESS0	PARTICIPZIP

Sheet 7: Data Dictionary

GRANTEE

ORGCODE

GRANTYR

FISYR

SITECAPASSESS

SITERECSTR

SITERECSTROTH

SITERECLOC

SITERECLOCOTH

SITELOCWHY

SITELOCNUM

SITETA

SITETAOTH

TAPROVIDER

TAPROVIDEROTH

TAHELPYN

SITETANEED

SITERES

SITERESOTH

SITERESFUND

SITERESFUNDOTH

SITERESUSE

PARTENRLCOSTYN

PARTENRLCOST

PARCHARGYN

(PARCHARGCOST

SCOVPOL

SCOVPOLOTH

SCOVPOLTYPE

SCOVPOLTYPEOTH

SCOVPOLDES

SITEMARKHCPSYN

SITEMARKHCP

SITEMARKHCPOTH

SITEMARKHCPNUM

SITEMARKHS

SITEMARKHSOTH

SITEMARKHSNUM

HCPTOOL

HCPTOOLOTH

HCPTOOLNUM

HSTOOL

HSTOOLOTH

HSTOOLNUM

OREFLSOR

OREFLSOROTH

HCPREFMODE

HCPREFMODEOTH

HCPREFNUM

HCPREFENRNUM

RECRUTPL

RECRUTPLOTH

RECRUMET

RECRUMETOTH

RECRUTPARTNUM

RECRUTPARTENR

HCPSMARKFAC

HCPSMARKBAR

HCPSMARKSTR

SMARKSTRPOP

SMARKSTRPOPOTH

SMARKSTR

SMARKSTROTH

SMARKSTRREACH

COMCHANNEL

COMCHANNELOTH

COMCHANNELFREQ

COMCHANNELREACH

PFOMODELYN

PFOMODEL

PFOMODELOTH

PFOMODELDES

SITEADAPTPOP

SITEADAPTPOPOTH

SITEADAPT

SITEADAPTOTH

SITEINCENT

SITEINCENTOTH

SITEINCENTFUND

SITEINCENTFUNDOTH

SITEINCENTPOP

SITEINCENTPOPOTH

SITEINCENTDES

SRETAINSTR

SRETAINSTROTH

SRETAINSTRPOP

SRETAINSTRPOPOTH

SRETAINSTRDES

SPAYTYPE

SPAYTYPEOTH

SPAYNAM

SPAYMARK

SPAYPARTNUM

SBILLPAYTYPE

SBILLPAYTYPEOTH

SMDPPBILL

SMDPPBILLOTH

SBILLTPA

SBILLCLAIM

CURUSE

LANGUSE

CLASSLOC

CLASSMODE

VPDIS

SESS0

COACHROLES

COACHCURTRAIN

COACHADDTRAIN

COACHQUAL

COACHFUND

1. AADE

Up to 25 alphanumeric characters; provided by DPRP

1. Year 1

1. 2018

1. Yes

1. Recruit via site organization's website

Open field for text

1. Local or community YMCAs

Open field for text

Number of locations selected per types of locations

1. Did not receive any TA for program start-up and/or for program implementation

Open field for text

1. Your National Organization grantee

Open field for text

1. Yes

Open field for text

1. Office space, location to hold classes, materials, equipment, supplies

Open field for text

1. 1705 funding

Open field for text

1. No, did NOT use 1705 funding for participant enrollment

Open field for text

1. No, do not charge a participant fee

Open field for text

1. No policy in place for financing/reimbursement for the lifestyle change program

Open field for text

1. Covered benefit

Open field for text

1. Yes

1. Conduct presentations about the National DPP lifestyle change program for health care providers at their practice sites or at health care organizations

Open field for text

Number of HCPs exposed to each marketing strategy used

1. Conduct presentations about the National DPP lifestyle change program for health care providers at their practice sites or at health care organizations

Open field for text

Number of health care systems exposed to each marketing strategy used

1. AMA/CDC STAT (Screen, Test, Act, Today) toolkit

Open field for text

Number of HCPs exposed to each tool or resource

1. AMA/CDC STAT (Screen, Test, Act, Today) toolkit

Open field for text

Number of health care systems exposed to each tool or resource

1. Health care providers/systems

Open field for text

1. Use CDC-developed bi-directional electronic-referral model/guidance via EHRs

Open field for text

Number of potential participants referred per each source of referrals

Number of participants enrolled (out of those referred) per each source of referrals

1. Did not conduct active recruitment from any places

Open field for text

1. Approaching participants one-on-one in their health care providers' offices

Open field for text

Number of potential participants reached per each recruitment method

Number of participants enrolled per each recruitment method

Open field for text

1. Not targeting specific priority populations

Open field for text

1. Advertising/ media campaign

Open field for text

Number of priority population participants reached with each marketing strategy

1. Broadcast media (radio, TV) – measure of frequency = number of spots or broadcast stories

Open field for text

Number of priority population participants reached with each channel

1. Yes, we used a pay for outcome (PFO) method

1. Pay-for-outcome model based on aggregated participant outcomes

Open field for text

1. Not targeting specific priority populations

Open field for text

1. Have not adapted the lifestyle change program

Open field for text

1. No incentives for participation or completion were offered

Open field for text

1. 1705 funding

Open field for text

1. Not targeting specific priority populations

Open field for text

1. Monitor participants' data to identify potential drop-outs

Open field for text

1. Not targeting specific priority populations

Open field for text

1. Private or commercial health plans

Open field for text

1. Private or commercial health plans

Open field for text

1. Did not use any billing and coding systems to submit claims to payers

Open field for text

1. CDC's Prevent T2 curriculum - English

1. English only

1. Employer worksite

1. In-person only

1. Has visual impairment

1. Yes, attended a Session Zero or Introductory Session before starting the lifestyle change program

1. Deliver the National DPP lifestyle change program only

1. CDC's Prevent T2 curriculum - English

1. CDC's DPRP webinar: Welcome to the DPRP

1. Certified Diabetes Educator

1. No additional funding needed: volunteer

2. AAPCHO

2. Year 2

2. 2019

2. No

2. Recruit via email blast to partners

2. Community-Based Organizations

2. TA on how to apply for CDC recognition

2. CDC

2. No

2. Labor/Personnel: lifestyle coaches and program coordinators and funding for staff training to deliver the lifestyle change program

2. Employer/ Insurer reimbursement

2. Yes, used 1705 funding for participant enrollment and able to report (please report)

2. Yes, and able to report

2. Employer

2. Wellness program/benefit

2. No

2. Distribute Prevent Diabetes STAT (Screen, Test, Act Today) toolkit's print materials at health care providers' practice facilities

2. Community Clinical Linkages Guide

2. Employers or employer’s wellness programs

2. Use CDC-developed bi-directional referral model/guidance via fax, phone, or paper

2. Hospitals or health care systems (including hospital owned practices)

2. Call potential participants from contact list provided

2. Hispanics

2. Print campaign or dissemination

2. Newspapers/newsletters – measure of frequency = number of stories published

2. Yes, we used a value-based method

2. Pay-for-outcome model based on individual participant outcomes

2. Hispanics

2. Used bilingual coaches to deliver the lifestyle change program to non-English speaking participants

2. Pedometers

2. Employer/ Insurer reimbursement

2. Hispanics

2. Use participants' data to intervene with people at risk to prevent them from dropping out before the end of the yearlong program

2. Hispanics

2. Fully-insured employers

2. Used grantee's developed billing and coding systems to submit claims to payers

2. CDC's Prevent T2 curriculum - Spanish

2. Spanish only

2. Faith-based location

2. Online only

2. Has physical disability

2. No, did not attend any Session Zero or Introductory Session

2. Serve as Program Coordinator or help with administration related to the National DPP lifestyle change program

2. CDC's Prevent T2 curriculum - Spanish

2. CDC's DPRP webinar: Submit for Success (data collection and monitoring)

2. Licensed Nutritionist or Dietitian

2. No additional funding needed: site-level staff responsibility added without pay increase

3. ADA

3. Year 3

3. 2020

3. Don't know/Not sure

3. Recruit via leveraging pre-existing relationships with community-based organizations

3. Universities/Schools

3. TA on how to collect and submit the required DPRP data elements to the CDC

3. Your national organization grantee's contractors

3. N/A

3. Incentives from other sources (not from 1705 funds) to health care providers/systems for participant referrals

3. Other governmental funding

3. Yes, used 1705 funding for participant enrollment but NOT able to report

3. Yes, but not able to report

3. Private Insurer

3. Enrollment fee waiver

3. N/A

3. Distribute grantee's developed print materials at health care providers' practice facilities

3. CDC PreventT2 marketing resources for health care providers

3. Insurers or Third-party administrators (TPAs)

3. Use national organization grantee-developed bi-directional electronic-referral system via EHRs

3. Physician practices not affiliated with a health care system

3. Mail promotional materials to potential participants from contact list provided

3. African-Americans

3. Public relations

3. Web (web pages, banner ads, videos, pdfs) – measure of frequency = number of materials posted

3. No, we used another method to cover enrollment costs for priority populations

3. Use Medicare's value-based-payment model

3. African-Americans

3. Used cultural themes, images, or sayings

3. Digital physical activity trackers or wearables (e.g. FitBit)

3. Other CDC coopertive agreement funding

3. African-Americans

3. Send emails or text message reminders about upcoming scheduled sessions

3. African-Americans

3. Self-insured employers

3. Contracted with a third-party administrator (TPA) to provide billing and payment services

3. 2012 CDC's National DPP curriculum- English

3. English but supplemented with Spanish materials

3. Community center

3. Distance learning

3. Has visual impairment and physical disability

3. Don't know/Not applicable

3. Help with data collection and monitoring related to the National DPP lifestyle change program

3. 2012 CDC's National DPP curriculum- English

3. CDC's 1705 data system: Data Reporting for Evaluation And Monitoring

3. Pharmacist

3. Insurance reimbursement

4. APhA

4. Year 4

4. 2021

4. Recruit via phone outreach to potential partners

4. State/Local Health Departments

4. TA on how to select a CDC-approved lifestyle change program curriculum

4. Partners

4. Funding to offer an information session/session zero to potential participants

4. Other non-governmental funding

4. N/A

4. Public Insurer

4. Pay for outcomes

4. Place media (TV, radio) or video ads targeting health care providers in delivery sites' markets or at their practices or systems

4. Handouts/materials developed by the grantee

4. State or local health departments or other government entity

4. Use national organization grantee-developed bi-directional referral system via fax, phone, or paper

4. Federally Qualified Health Center (FQHC)

4. Conduct or participate in health fairs and/or other community outreach activities (including blood glucose screening events at worksites)

4. Asian-Americans

4. Digital marketing

4. Social media (Facebook, Twitter) – measure of frequency = number of posts made

4. No, we didn't use any PFO or value-based method to cover enrollment costs for priority populations

4. Other

4. Asian-Americans

4. Used a culturally adapted curriculum or supplemental materials to address specific needs of priority populations

4. Gym memberships

4. Grant/cooperative agreement funding (other governmental)

4. Asian-Americans

4. Offer flexible schedules for make-up sessions

4. Asian-Americans

4. Medicaid agencies

4. Established own invoicing method for billing directly to payers

4. 2012 CDC's National DPP curriculum- Spanish

4. Chinese only

4. Government building (non-community center)

4. Combination

4. Does not have visual impairment and/or physical disability

4. Help with participant recruitment and engagement related to the National DPP lifestyle change program

4. 2012 CDC's National DPP curriculum- Spanish

4. Training to comply with federal Health Insurance Portability and Accountability Act (HIPAA)

4. Registered Nurse

4. Cooperative agreement funding (CDC)

5. Balm in Gilead

5. Year 5

5. 2022

5. Recruit via press release

5. Hospitals/Health Care Systems/Medical Groups/Physician Practices

5. TA on how to implement the CDC-recognized lifestyle change program to meet the DPRP Standards requirements

5. Other 1705 grantees

5. Travel budget for site visit

5. Participant fees (for self-pay participants)

~~5. Grant Funds~~

5. Don't know/Not sure

5. Conduct promotional activities at professional conferences targeting health care providers

5. Other

5. Faith-based organizations or other non-profit/ community-based organizations

5. Use one-way referral systems via EHRs

5. Indian Health Service (IHS) or tribal health systems

5. Conduct presentations about evidence-based lifestyle change program to promote recruitment and enrollment activities at employer worksites

5. American Indians

5. Interpersonal approaches (talking with people individually or in groups)

5. Print materials – measure of frequency = number of different materials produced and number actually disseminated

5. N/A

5. American Indians

5. Incorporated cultural dietary restrictions or preferences

5. Physical activity videos or CDs

5. Grant funding (other nongovernmental)

5. American Indians

5. Offer additional modes of delivery for make-up sessions such as video conference, phone, online interaction with lifestyle coaches

5. American Indians

5. Medicaid managed care organizations (MCOs)

5. Established a claims billing method (using a combination of ICD-10 and CPT codes) to submit claims directly to payers

5. Y-DPP (Plan Forward) curriculum

5. English but supplemented with Chinese materials

5. Small business worksite where participants are not employed (i.e., car dealership, grocery store, etc.)

5. Other role related to National DPP lifestyle change program

5. Y-DPP (Plan Forward) curriculum

5. Motivational interviewing training

5. Physician/Physician Assistant

5. Grant/cooperative agreement funding (other governmental)

6. BWHI

6. Recruit via collaborating with other 1705 grantees and/or affiliate sites

6. Community Health Centers

6. TA on how to interpret participants' data to monitor program progress and address challenges in meeting the DPRP Standards

6. Other 1705 affiliate sites

6. Marketing materials; resources for marketing campaigns

6. In-kind from partner organization

5. Organizational: in-kind support via participant fee waiver

6. Other

6. Colloborate with local medical societies to conduct promotional activities targeting health care providers

6. N/A

6. Self-referral or referral via org website/online participant portal or from family/friends

6. Use one-way referral systems via fax, phone, or paper

6. Employers/worksites (including employer wellness programs)

6. Use alumni champion from previous lifestyle change classes (through word-of-mouth, phone, or email)

6. Alaska Natives

6. Using champions

6. Billboards, bus or bus shelter ads – measure of frequency = number of billboards or ads displayed

6. Alaska Natives

6. Provided incentives to retain participants

6. Athletic gear or clothing

6. Participant fees (for self-pay participants)

6. Alaska Natives

6. Engage participants outside of class settings such as field trips to grocery stores, cooking demo, group physical activities

6. Alaska Natives

6. Medicare via MDPP

6. National grantee organization submitted claims on behalf of sites to payers

6. Group Lifestyle Balance (U Pitt) curriculum

6. Native Hawaiian or Other Pacific Islander language or dialect only

6. Health care or medical center/practice/clinic (non-hospital)

6. Other role within the organization not related to National DPP lifestyle change program

6. Group Lifestyle Balance (U Pitt) curriculum

6. Additional refresher training or training to develop new skills needed to effectively manage and deliver the yearlong lifestyle change program

6. Health Educator

6. Grant funding (other nongovernmental)

7. HealthInsight

7. Select based on demographics of participants targeted

7. Federally Qualified Health Centers

7. TA on how to collect and submit the 1705 performance measurement data to CDC

7. Other

6. Don't know/Not sure

7. N/A

7. Use social media to conduct marketing campaigns targeting health care providers

7. Community Health Workers

7. Receive a contact list of potential participants with prediabetes/at risk

7. State or local health departments

7. Distribute grantee's developed print marketing materials at recruitment places

7. Pacific Islanders

7. Working through healthcare providers

7. Events (health fairs, health screenings, group meetings) – measure of frequency = number of health fairs, health screenings, etc. held

7. Pacific Islanders

7. Other

7. Calorie King or other types of diet tracking books

7. In-kind from partner organization

7. Pacific Islanders

7. Use social media platforms such as Facebook or Twitter for participants to share tips and challenges in meeting their lifestyle change goals

7. Pacific Islanders

7. Other public payer: TriCare (Veteran Affairs)

7. Other

7. Native Lifestyle Balance - Preventing Diabetes in American Indian Communities curriculum

7. American Indian or Alaska Native language only

7. Hospital or building on hospital campus, not affiliated with university

7. Native Lifestyle Balance - Preventing Diabetes in American Indian Communities curriculum

7. Participate in lifestyle coach mentoring or a community of practice within the grantee's National DPP network

7. Exercise Specialist

7. Participant fees pay part of lifestyle coach salary

8. NACDD

8. Partner with employers to offer the program on-site

8. Pharmacies/Drug Stores/Compounding Pharmacies

8. TA on how to collect and submit the 1705 national evaluation data elements to CDC

8. N/A

7. Other

8. Use health care provider champions to conduct promotional activities among their peers

8. Pharmacists or pharmacies

8. Other

8. Other government entity

8. Other

8. People with visual impairments or physical disabilities

8. Working through employers or insurers

8. Presentations (e.g., at community centers) - measure of frequency = number of presentations given

8. People with visual impairments or physical disabilities

8. MyPlates; food scale or measuring devices

8. Other

8. People with visual impairments or physical disabilities

8. Use CDC retention tool application to engage participants in the yearlong lifestyle change program

8. People with visual impairments or physical disabilities

8. Other

8. N/A

8. Help Prevent Diabetes (Wake Forest) curriculum

8. English but supplemented with Native Hawaiian or Other Pacific Islander language or dialect materials

8. University hospital building

7. Help Prevent Diabetes (Wake Forest) curriculum

8. Training on a specific technology platform to be used to deliver the online lifestyle change program and engage participants

8. Community Health Worker

8. In-kind from partner organization

9. NAHH

9. Partner with third-party network to identify locations to deliver CDC-recognized lifestyle change program

9. Indian Health Service/Tribal/Urban Indian Health Systems

9. TA on how to tailor implementation of the lifestyle change program to meet the needs of specific priority populations

9. N/A

9. Provide incentives (from other sources, not from 1705 funds) to health care providers to screen, test, and refer their patients to grantee's delivery sites

9. Other

9. N/A

9. Community center (i.e., library, Rotary Club, Lions Club, senior center, etc.)

9. N/A

9. Men

9. Offering monetary incentives

9. Community members (e.g., CHWs, pastors) – measure of frequency = number of times CHW contacted people, number of sermons given

9. Men

9. Cookbooks or kitchen tools

9. N/A

9. Men

9. Use other applications (please describe in text field) to engage participants in the yearlong lifestyle change program

9. Men

9. N/A

9. Other (please specify)

9. English but supplemented with American Indian or Alaska Native language materials

9. YMCA facilities

9. Other (please specify)

9. Other lay coaches without any academic credentials

9. Other

10. Trinity Health

10. Other selection criteria

10. Business Coalitions on Health/Cooperative Extension Sites

10. TA on how to recruit and enroll targeted priority populations

10.Direct contact via phone, email or face-to-face interaction

10. N/A or No referral sources

10. YMCA facilities

10. Geography: rural or frontier

10. Offering non-monetary incentives

10. Other

10. Geography: rural or frontier

10. Vouchers for farmers markets or grocery stores

10. Geography: rural or frontier

10. Conduct group celebrations (with/without family and friends) at certain milestones of the program (i.e. at 3, 6, and 9 months) to celebrate participants' successes

10. Geography: rural or frontier

10. Other (please specify)

10. Other fitness centers/gyms, not YMCA

10. N/A

10. Prior experience working with priority populations served

10. N/A

11. N/A

11. Worksites/Employee Wellness Programs

11. TA on how to retain targeted priority populations in the yearlong lifestyle change program

11. Other

11. Other fitness centers/gyms, not YMCA

11. Medicare Beneficiaries

11. Other

11. N/A

11. Medicare Beneficiaries

11. Discount coupons (e.g. for healthy food)

11. Medicare Beneficiaries

11. Provide non-monetary tokens such as trophies or plaques to individual participants who meet milestones/achieve progress in the program

11. Medicare Beneficiaries

11. Pharmacies/ drug stores/ compounding pharmacies

11. N/A

12. Senior/Aging/Elder Centers

12. TA on how to interpret the 1705 performance measures and evaluation data to address challenges in meeting the 1705 goals/objectives

12. N/A

12. Faith-based organizations

12. Other

12. N/A

12. Other

12. Gift cards

12. Other

12. Indian Health Service/tribal/ urban Indian health systems

13. Health Plans/Insurers

13. TA related to the MDPP (e.g., how to become an MDPP supplier, submitting claims, etc.)

13. Other

13. N/A

13. Program access incentives such as transportation passes or parking passes

13. N/A

13. University Cooperative Extension Program

14. Faith-Based Organizations/Churches

14. Other

14. N/A

14. Free or reduced price child care

14. Other (please specify)

15. For-profit Private Businesses

15. N/A

15. Healthy food snacks or samples

15. Not Applicable

16. Telehealth

16. Certificates or plaques/trophy for program completion

17. Other (please specify)

17. Cash prizes

18. N/A

18. Commitment contracts

19. Other

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