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Diabetes Prevention Program RecognitionStandards for CDC recognition include:
Use of a CDC‐approved curriculum.
Offer lifestyle program within 6 mo’s of receiving pending approval from CDC.
Capacity and commitment to deliver program over 1 year, including at least 16 sessions during the first 6 mo’s and at least 6 sessions during the last 6 mo’s.
Ability to regularly submit data on participants’ progress—including attendance, weight loss, and physical activity
Trained lifestyle coaches who can help build participants’ skills and confidence to make lasting lifestyle changes.
Possess the skills, knowledge, and qualities to provide content. Lifestyle coaches may have credentials (e.g., RD, RN), but credentials not required.
Designated individual(s) to serve as diabetes prevention program coordinator.
Criteria for referral to Prevention Program
Pts must meet the following requirements: At least 18 years old and
Overweight (BMI≥25; ≥23 if Asian)
Have no previous diagnosis of diabetes and
50% must have a blood test result in the prediabetes range within the past year: Hemoglobin A1C: 5.7%–6.4% or
Fasting plasma glucose: 100–125 mg/dL or
Two‐hour plasma glucose (after a 75 gm glucose load): 140–199 mg/dL or
Standard 3 – Evaluation of Population Served The provider(s) of DSMES will evaluate the communities they serve to determine resources, design, and delivery methods that will align with the population’s need for DSMES services.
Community Needs Assessment Individuals, their families and communities require education and support options that align with their needs
Understand: self‐management and support needs
special attention to those who do not usually attend clinic appointments
Access issues and barriers to care
Socioeconomic, cultural, insurance shortfalls, lack of encouragement from HCP to seek DSME
Standard 4 – Quality Coordinator A quality coordinator will be designated to ensure
implementation of the Standards and oversee DSMES services. The quality coordinator is responsible for all components of DSMES, including evidence‐based practice, service design, evaluation and continuous quality improvement
Program Coordinator – Pivotal role
Ensure quality DSMES is person centered and delivers high quality outcomes
Most importantly, collects and evaluate data to identify gaps in DSMES
Job Skills include informatics, marketing, health care administration and business management
Manages overall service and may also provide DSMES
At least one of the team members responsible for facilitating DSMES Services will be a RN, RD or Pharmacist with training and experience pertinent to DSME, or be another health care professional holding certification as a diabetes educator, CDE or BC‐ADM.
Standard 5 – DSMES Team Other health care workers or diabetes paraprofessionals can contribute with appropriate training and oversight by one of the team members listed.
Lay health, community workers and peer counselorsCan instruct, reinforce self‐management skills, support behavior change, facilitate group discussion and provide social support. They need training in diabetes management, teaching self‐management skills, group facilitation, and support System must be in place that ensures a
diabetes educator or other health care professional supervises the services provided by lay health, community workers, peer counselors and educators
A curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, will serve as the framework for the provision of DSMES.
The needs of the individual participant will determine which parts of the curriculum will be provided to that individual.
Focus on Patient Centered NeedsGo beyond the mere acquisition of knowledge
• Use creative, patient centered, experience based delivery methods
• These are effective for supporting informed decision‐making & meaningful behavior change and addressing psychosocial concerns
Standard 7 ‐ Individualization The DSMES needs will be identified and led by the participant with assessment and support by one or more DSMES Team Members.
Together, the participant and DSMES Team member(s) will develop an individualized DSMES plan.
Philosophy Regardless of their stage, people with diabetes have their own priorities and needs.
DSMES practice must be designed using person centered care practices, in collaboration, focusing on participants priorities and values.
Most important, no participant is required to complete a DSMES structure.
Initial intervention is complete when they achieve their goal.
Meaningful Behavior Change : Considering the Process Use creative person centered experience based delivery methods
Text messaging improves outcomes
Apps and technology can enhance communications
Incorporate the persons data to discuss problem solving
Reassess during key times and transition periods
Document assessment, education plan, intervention and outcomes
Determine strategies to keep connected for the long run
Standard 8 – Ongoing Support
The participant will be made aware of options and resources available for ongoing support of their initial education, and will select the option(s) that will best maintain their self‐management needs.
Importance of Ongoing Support
While DSMES is necessary and effective, it does not guarantee a lifetime of effective diabetes care
Initial improvements diminish over 6 months
To sustain momentum, participants choose the resource or activity that best suits their self‐management needs.
Type of support includes: Behavioral, educational, psychosocial or clinical
Ongoing Support Ideas Case management Diabetes support group or community program (ieWeight Watchers, or YMCA)
Physical activity programs Smoking cessation Visiting health workers Apps and phone calling Agree to return for medical/education visits Subscribe to a diabetes magazine Diabetes chat rooms Ongoing education and MNT appts Peer support through networking and online Communities
Standard 9‐ Participant Progress
The provider(s) of DSMES will monitor whether participants are achieving their personal diabetes self‐management goals and other outcomes to evaluate the effectiveness of the educational intervention(s), using appropriate measurement techniques.
Standard 9 – Participant Progress
Measure at regular intervals Patient defined self management goals
SMART Behavioral Goal Identify program goals and set individual behavioral goals SMART
specific
measurable
attainable
realistic
timely
Tracking Participant Data
Develop system that works for your team
Assessment of outcomes at appropriate intervals
Administrative support critical
Summarize monthly – compile yearly
Report out to Advisory Committee
The DSMES services quality coordinator will measure the impact and effectiveness of the DSMES services and identify areas for improvement by conducting a systematic evaluation of process and outcome data.
Different Work Settings Hospital based – see only inpatient
Hospital based – see inpatient and outpatient
HMO/ Clinic based – see only outpatients
Private practice
Other
Medicare
Private Payor
Rural health care
Medicaid
Indian Health Services, VA
Cash pay
Billing Practices Insurance companies provide a variety of payment schedules and degrees of coverage Inform patient of out of pocket expenses for program Deductible (worse at beginning of year)
Co‐pay
Financial agreement with clients
Can’t charge less for program than Medicare rates
If bill Medicare for services, other participants not allowed to attend for free
Medicaid Insurance Coverage Medicaid – partially federally funded, but administered by states Establishes its own eligibility standards
Determines the type, amount, duration and scope of service