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SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program Initiative: Year 1 Meeting 1. Laying the Foundation for Success: SDPI Demonstration Projects Overview. November 17, 2010. Overview. Background Planning Year Implementation Transition. Background.

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laying the foundation for success sdpi demonstration projects overview


Diabetes Prevention Program Initiative: Year 1 Meeting 1

Laying the Foundation for Success: SDPI Demonstration Projects Overview

November 17, 2010

  • Background
  • Planning Year
  • Implementation
  • Transition
  • Special Diabetes Program for Indians
    • Balanced Budget Act 1997
      • Prevention/Treatment of Diabetes in AIANs
      • Administered by the IHS
    • 2002 Reauthorization
      • Congressional direction – develop a competitive grant program to demonstrate diabetes prevention and also address the most compelling complication of diabetes (cardiovascular disease)
      • Evaluation required
SDPI Competitive Grant Program
    • Tribal Consultation
    • IHS Director decision
      • $27.4 million/year x 5 years
        • Grants to 60-70 programs ($23.3 million)
        • Administration, Coordination, Evaluation ($4.1 million)
        • “Competitive”- programs compete for funding
      • Demonstration Projects
        • Programs implement activities in 1 of 2 areas
          • Diabetes Prevention; Cardiovascular Disease Risk Reduction
        • Collaborative development of activities
        • Comprehensive Evaluation, Coordinating Center

Special Diabetes Program for Indians

    • 2007 Reauthorization
      • Medicare, Medicaid, and SCHIP Extension Act
      • Extended SDPI for an additional year at the same funding level

Final Timeline

    • FY 2004 RFA, Selection of Programs
    • FY 2005 Planning Year
    • FY 2006-2009 Implementation of Activities Comprehensive Evaluation
    • FY 2009-2010 Transition to documentation of activities and outcomes with a smaller dataset and fewer forms
planning year
Planning Year
  • 6 meetings November 2004 – October 2005
    • Collaborative process involving grantees, IHS, and Coordinating Center
    • Developed a common set of activities and an evaluation to be implemented in a diverse group of communities and cultures by program staff with varying levels of experience and expertise
  • Operations Manual
    • Core Elements
    • Evaluation design and instruments
  • IRB application template
  • Names and Logos

Core Elements – Required Activities

  • Diabetes Prevention Program
    • Recruit and screen to find people with pre-diabetes
    • Goal: 48 people per year
    • Teach 16 session DPP curriculum in group sessions
    • Individual coaching on physical activity, weight loss
    • Retention/After Core
    • Community activities
    • Outcomes – weight loss, lifestyle changes, prevention of diabetes
Diverse set of 36 grant programs

One size doesn’t fit all!

Must implement and evaluate a common set of activities

Grant Programs encouraged to adapt to local setting, culture, circumstances

Technical Adaptations – format of curriculum, flexibility on timing, order of classes, adding content, adding pictures, local foods, interactive activities, local speakers

Cultural Adaptations – translation, prayers/blessings, local traditions, talking circles, traditional games, culturally-specific examples, encourage cultural perspectives, communication styles, local images/designs

Adaptation of Program Activities

evaluation design
Evaluation Design
  • Process – did programs successfully implement the activities, lessons learned?
  • Outcomes – did participants improve on short-term, intermediate and long-term outcomes? What factors were associated with successful participants and programs?

Evaluation Design – Participant Level




DPP Curriculum

(16 Sessions)

Baseline Assessment

Follow up Assessment

Annual Assessment

Annual Assessment

Lifestyle Coaching, Community Based Activities

Time 0 ---------------------------------------- 4-6 months ---------- 1 year --------------- -2 year ------------

evaluation design program level
Evaluation Design – Program Level
  • Measurements
    • Provider: demographic, professional background
    • Program: recruitment, retention, After Core, team activities
    • Organization: organization effectiveness
    • Community: community stakeholders’ perspective
planning year lessons learned
Planning Year - Lessons Learned
  • Grantees
    • Start vs. plan
    • Wide range of programs, experience, and expertise requiring diverse technical assistance and training needs
    • Communication/collaboration
    • Staff turnover
    • Stakeholder support
    • Common activities vs. local variation
    • Public health program evaluation vs. research
implementation continuing the collaborative process
Implementation - Continuing the Collaborative Process
  • Seven additional meetings
    • Technical assistance workshops, sharing challenges and solutions, group discussions by staff position, Operations Manual revisions
    • Semi-annual progress reports to provide feedback
  • Ongoing technical assistance
    • Coordinating Center visits, website, quarterly technical assistance conference calls, one-on-one conference calls, support by e-mail and phone, Tips of the Week (TOTW)
implementation challenges lessons learned
Implementation - Challenges & Lessons Learned
  • Organizational
    • Availability of specialized space, hiring and purchasing regulations, local stakeholder support (providers, management, and community leaders), communications, adequate computer hardware and software, internet access
    • Grants Management

- Access to funds, allowable items/incentives, carryover

  • Programmatic
    • Recruitment, retention, access to patient records, scheduling, staff turnover and re-training
  • Transition from program evaluation to program documentation with a smaller dataset and fewer forms
  • Program Evaluation
    • 12 types of participant-level forms
    • 8 types of program-level forms
  • Program Documentation
    • 5 types of participant-level forms
    • 5 types of program-level forms
  • SDPI Demonstration Projects are a success
  • Many lessons learned
  • Beyond the Demonstration Projects – SDPI Initiatives
    • 38 programs, including 9 new award recipients
    • Continue or newly implement Diabetes Prevention Program
    • Document activities and outcomes
    • Disseminate information and best practices from the SDPI Demonstration Projects to other IHS, Tribal, and Urban Indian health settings