American Association of Diabetes Educators (AADE) Together on Diabetes Project Overview American Association of Diabetes Educators (AADE) is seeking partner sites for a project that will investigate a model for provision of diabetes self-management education and diabetes selfmanagement support to high disparity populations. We are seeking sites that have the capacity to carry out a multi-year project and have strong program delivery and data collection capabilities. We are also seeking sites that have the ability to reach and serve high disparity populations. Sites must either be Federally Qualified Health Centers (FQHC) or like FQHC s in that they are community-based and serve populations with limited access to health care. Sites must also be either an AADE accredited or ADA recognized diabetes self-management education program. Each site may potentially receive up to $320,000 for a four-year project period (approximately $80,000 a year for up to 4 years), contingent upon availability of funding and positive program performance. Payments to sites will be made in increments over the four-year period. The Project This Bristol-Myers Squibb Foundation is providing funding to AADE to carry-out a multi-year, multi-site research project under the Together on Diabetes TM Initiative. Together on Diabetes TM was launched by the Bristol-Myers Squibb Foundation to improve health outcomes of people living with type 2 diabetes in the United States by strengthening patient self-management education, community-based supportive services, and broad-based community mobilization. The Bristol-Myers Squibb Foundation s mission is to promote health equity, and Together on Diabetes TM specifically targets adult populations disproportionately affected by type 2 diabetes. The main goal of AADE s planned project is to implement and evaluate a model for delivery of integrated diabetes self-management education (DSME) and diabetes self-management support (DSMS) to high disparity populations utilizing a multi-level team consisting of diabetes educators and patient supporters. We hypothesize that persons with type 2 diabetes who participate in DSME and receive a year of semi-structured DSMS will be more likely to sustain improvements in diabetes-related knowledge, self-reported quality of life, self-care behaviors, and clinical measures than persons with diabetes who participate in DSME but do not receive ongoing DSMS. AADE plans to identify 4 sites to participate in the project. Each site will: Provide 128 participants with group diabetes self-management education (DSME). Provide half of the participants (64 individuals) with a full year of semi-structured diabetes selfmanagement support (DSMS). DSMS will consist of minimum monthly contacts with participants to provide them with support in maintaining self-care behavior goals. Support can be tailored to meet participants individual needs, goals, and preferences. 1
Collect outcome measures (behavioral, clinical, diabetes knowledge, self-reported quality of life and diabetes-specific quality of life) on all participants at multiple points over a 2.5 year period that will include a 6 month DSME period, a 12 month DSMS period, and a 12 month follow-up period. Ensure adequate staffing to carry-out program activities, including one or more diabetes educators (nurse, dietitian or pharmacist) and one or more patient supporters (community health workers, medical assistants, or other staff). o Our vision for this program model is that the diabetes educator(s) will provide curriculumbased DSME to participants. Under the direction of diabetes educators, the patient supporter(s) will provide support to participants while they are enrolled in DSME. The patient supporters will also provide individualized support to half of the program participants during the DSMS period. o Support provided by the patient supporters will be tailored to the needs and preferences of participants. For example, some participants may prefer phone calls or email contact, while others may prefer meeting with the patient supporters at places in the community such as grocery stores or parks. Some participants may need support focused on health eating goals, while others may need support for staying active. Therefore, although sites will be provided with some parameters for how the DSMS should be provided, the sites and patient supporters will have flexibility in how to work with and best support individual participants based on the participant s needs, self-care goals, and preferences for contact. Identify and leverage community resources that can be utilized to support participants. Participate in AADE surveys, focus groups, or other evaluation activities. Collaborate with AADE in dissemination of project results by participating in panel discussions, poster presentations, or other activities as requested by AADE. Each site will be required to receive Institutional Review Board (IRB) approval for the project before the site starts recruiting, enrolling, and serving program participants. After Sites are selected, but before they begin enrolling and serving participants, they will engage in a collaborative planning process with AADE to finalize the project methods and data collection procedures. The process will include review of the proposed outcomes measures for the project and finalization of data collection procedures. AADE wants to receive feedback from the selected sites on the study design and the protocol for collection of outcomes measures data. We will work collaboratively with sites to finalize project methods that can be implemented consistently across sites. After the study protocol is finalized, AADE will hold a live, multi-day training with sites to provide instruction on DSME curriculum, delivery of DSMS, and data collection and reporting procedures. Partner Sites and Selection Process AADE is specifically seeking partner sites that are Federally Qualified Health Centers or like FQHC s in that they are community-based and serve populations with limited access to care. Sites must also be providers of either an AADE accredited (DEAP) or ADA recognized (ERP) diabetes self-management education (DSME) program. If your organization is interested in serving as a partner site for this project, please complete the 2
attached Partner Site Assessment and Application Form (pages 4-14 of this document) and submit it to AADE by email (together@aadenet.org) by August 30, 2013. If you have any questions about the project or the partner site selection process, we strongly encourage you to contact us at this e-mail address before then. AADE will review all submissions. AADE will take the following factors into consideration when selecting partner sites: o Applicant history and mission of providing care to underserved populations o Programmatic capabilities o Data collection capabilities and research/program evaluation experience o Potential to succeed in carrying out a multi-year DSME/DSMS program that serves and actively engages 128 participants o Geographic location of sites and community served. AADE hopes to partner with a diverse group of sites o Preference will be given to FQHC s. However, AADE may consider partnering with a site that is not an FQHC if it is able to demonstrate that it is community-based and serves populations with limited access to health care. AADE may contact applicants to request additional information or to clarify responses provided in the Partner Site Assessment and Application Form. Sites that are preliminarily selected to participate in the project based on their responses to the Partner Site Assessment and Application Form will be asked to complete a Program Plan that provides more detailed information on: proposed staffing for the AADE Together on Diabetes Project, participant recruitment and retention methods, plan for leveraging community resources, and strategies for achieving health equity. Anticipated Timeline Organizations are required to complete and submit the Partner Site Assessment and Application Form (pages 4-14 of this document) to AADE by email (together@aadenet.org) by August 30, 2013. All organizations that complete the Partner Site Assessment and Application Form will be contacted by September 20, 2013. AADE plans to have partner sites selected and under contract by October 31, 2013. Included on page 15 of this document is a proposed timeline for the four-year project. 3
American Association of Diabetes Educators (AADE) Together on Diabetes Partner Site Assessment and Application Form Instructions Complete this Partner Site Assessment and Application Form and submit it to AADE by email (together@aadenet.org) by August 30, 2013. Please use the subject heading of AADE Together on Diabetes Completed Form in your e-mail correspondence. Your responses should be limited to the text boxes in this Form. Any text that does not fit in a text box and cannot be read when the Form is printed may not be reviewed or considered. Please utilize 11-point Calibri Font. You may find it helpful to read through the entire Form first before completing it, as information that you may want to provide in the early sections of the Form may be covered in later sections. If you have any questions about the Form or the selection process, please contact AADE by e-mail (together@aadenet.org). We appreciate your interest in this program. Part 1. Organization Organization Name Health Center Name Health Center Address City State Zip code 1a) Is your organization a Federally Qualified Health Center (FQHC)? 1b) Please describe your health center s history. 4
1c) Please describe your health center s mission. 1d) Describe the community that your health center serves Geographic area (urban, suburban, rural) within which center is located Community demographics (socioeconomic, cultural characteristics) of community residents Community resources and/or gaps in community resources or services. What gaps in care does your health center fill? 5
1e) Describe the population that your health center serves: Race/ethnicity Languages spoken Economic status Other characteristics of population served 1f) What is the health center s current annual operating budget and major sources of revenue? Part 2. Diabetes Self-Management Education (DSME) 2a) Is your center s DSME program accredited by AADE, recognized by ADA (American Diabetes Association), neither, or both? Indicate the year the program was first accredited or recognized. 6
2b) What DSME curriculum does your program utilize? Over what time period is the curriculum delivered? For example, do participants finish the curriculum in a 3 month period, 6 month period, 12 month period, etc? Is follow-up or any type of ongoing support offered to participants after they complete the curriculum? Please explain. 2c) Is DSME delivered to participants in groups, one-one-one, or both? What percentage of participants receive DSME in groups and what percentage receive DSME one-on-one? 2d) Describe current staffing for your DSME program number of diabetes educators, credentials, percent of time dedicated to DSME, number of support staff, etc. 7
2e) Does your DSME program currently utilize community health workers (CHW), medical assistants or other support workers to provide education or support to DSME participants? If so, how many? What are their roles? How are they trained and supervised? Are CHW s or other similar workers utilized to provide other types of services at your center? 2f) How are participants identified or recruited for the DSME program? 2g) How many participants were served by the DSME program each year in 2012, 2011, and 2010? 2h) What is the DSME program s current capacity number of participants that can be enrolled in DSME at a single point in time? 8
2i) What clinical measures do you collect for DSME participants and how are they collected? 2j) What behavioral measures do you collect for DSME participants and how are they collected? 2k) Provide evidence of an effective program (positive patient outcomes). When describing outcomes, be specific about number of participants and time frame covered. 9
2l) Do you measure participant retention? If so, please describe and indicate current program retention levels. 2m) Do you measures participant satisfaction? If so, please describe. 2n) Does your DSME program engage family members and/or friends of participants enrolled in DSME? For example, are family members included in classes, support groups, or other activities? 10
2o) Please describe any community resources that are leveraged to support people enrolled in DSME (for example walking clubs, linkage to farmers markets, food pantries, WIC, etc). If there are a lack of community resources, please explain. Part 3. Data Collection and Research Capabilities 3a) Has your health center previously carried out an IRB-approved research project? If yes, please describe the project(s) and indicate the name of the IRB that reviewed and approved the project(s). Please provide the names and titles of any individuals who have served as Principal Investigators on projects related to diabetes care. 11
3b) Describe your organization s capabilities for collecting and reporting patient-level data and outcomes. For example, describe reporting that is done for Health Resources and Services Administration (HRSA), Centers for Medicare & Medicaid Services (CMS), or other funders, or for internal quality control or planning purposes. 3c) Describe any electronic data collection or health records systems that are in use. 12
Part 4. Barriers, challenges, additional information 4a) Please describe any anticipated barriers or challenges to carrying out the proposed AADE project. We appreciate your feedback on this topic, and AADE plans to work collaboratively with sites to finalize the project methods and develop plans for overcoming any anticipated barriers or challenges. 4b) Please indicate your ideas for the resources or support that are needed to address any anticipated barriers or challenges. 13
4c) Please provide any additional information that you would like to share. Attachment A Proposed Timeline for Four-Year Project Part 5. Contact information for person completing this application Last Name First Name Title E-mail Address Phone Number 14
Period Activities Time frame 1) Planning AADE issues assessment, selects sites, and issues contracts with sites. Months 1-3 and Aug 2013 to recruitment Oct 2013 AADE hosts live multi-day planning meeting with sites. Finalizes project Months 4-6 methods, data collection tools, and data analysis plan based on collaboration with sites. Nov 2013 to Jan 2014 Partner sites apply for and obtain Institutional Review Board approval, Months 5-7 or AADE applies for and obtains IRB approval from a commercial IRB on behalf of one or more sites. Dec 2013 to Feb 2014 AADE trains partner sites on project methods, including protocol for Months 6 9 delivery of DSME, delivery of DSMS, and data collection. Will entail at least one multi-day live meeting. Jan 2014 to Apr 2014 Partner sites begin participant recruitment. Months 8-12 2) DSME delivery 3) DSMS delivery 4)Follow Up period 5) Analysis and dissemination Mar 2014 to July 2014 All participants complete DSME curriculum. The goal is for each Months 8 18 participant to finish DSME within a 6 month period. The DSME delivery period in the timeline is longer to allow for sites to start DSME classes Mar 2014 to at different points in time if needed to accommodate all 128 Jan 2015 participants. Half of participants at each partner site receive 12 months of DSMS that Months 13 30 consists of minimal monthly contact with patient supporters and personalized support for diabetes self-management goals. Data Aug 2014 to collection is completed on all participants on semi-annual basis. Jan 2016 Although DSME delivery will be over 12 months, the DSMS delivery period covers a longer time period (18 months) to accommodate participants who enter this phase at different points in time in the project period. Continued data collection for 12 month period to test impact of DSMS Months 25-42 delivery. Data will be collected for all participants. Depending on results and lessons learned from DSME and DSMS, support services may Aug 2015 to be extended during this period. Although individual participant followup Jan 2017 will be for 12 months, the follow-up period of the timeline covers a longer time period (18 months) to accommodate participants who enter this phase at different points in time in the project period. Data analysis and report compilation. Dissemination of results begins. Months 43-48 Feb 2017 to July 2017 15