Download Type 2 Diabetes Final Program Report-Qualitative

Type 2 Diabetes
Qualitative Report for Good Hope Medical Foundation
Introduction
The Type 2 diabetes project implemented by the Chronic Disease Management
Consortium (CDMC), including California Hospital, Good Samaritan Hospital,
Huntington Hospital and National Health Foundation completed its three year funding
cycle with the Good Hope Medical Foundation on December 31, 2008. During the
program, the partnering hospitals worked to help individuals prevent and or manage
diabetes by conducting community outreach and screenings and providing educational
workshops for individuals at risk of developing diabetes (prevention) or who already
have the disease (intervention). The purpose of this qualitative report is to assess the
program’s structure, operations, outcomes, and overall effectiveness from the
perspective of program administrators and staff, including health educators and
promatoras responsible for program implementation. Data in this report was gathered
through semi-structured key informant interviews conducted in October and
November 2008 with 11 program administrators and staff. (Please see questionnaires
attached.)
This report is organized under the following major headings: 1) Patient Stories; 2)
Program Administration; 3) Program Outreach, Screening and Marketing; 4) Program
Workshops/Classes; 5) Data Collection & Evaluation; 6) Program Sustainability &
Replication, and; 7) End Results. Each section includes relevant information and key
themes summarized from the interviews conducted for this report as well as
appropriate background information.
Patient Stories
Program staff and administrators were asked to recollect stories they experienced
administering the program which they felt demonstrated success of the Type 2
program. These stories can be used to augment the quantitative evaluation outcomes
and results of this program and provide insight into the impact of the program on
individuals by highlighting patients’ experiences with the program as recalled by
program staff.
Newly Diagnosed Patient learns about Diabetes
A newly diagnosed patient who was very poor and did not have health insurance was
recruited to participate in the intervention class. She came to the first class crying and
expressed her intense fear of having the disease to the promatora running the class.
Overcome with emotion, she told the promatora that she thought her life was over and
felt lost and alone. After looking at her intake form the promatora explained to the
patient what her A1 c results indicated and began educating her and the class
participants about diabetes and the important ways this disease can be managed.
When the promatora began teaching about healthy lifestyle changes such as healthy
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eating, this patient became very active in the class, asking many questions and showed
a great interest in learning about cooking healthier. After completing the class this
patient was able to successfully control her A1 c level and continues to stay in touch
with the promatora. When she sees the promatora, she always thanks her for the help
and is proud to tell her how well she is doing and how much healthier she is now. After
reporting this story the promatora expressed how stories like this inspire her to do what
she does and point to the critical importance of education, especially for patients with
no real access for getting this knowledge elsewhere.
Too Many Tortillas
One promatora reported that her favorite story occurred during a workshop series
which consisted of all male participants. She stated that this was a very rare occurrence
but that it also provided a good support group feeling. Her favorite memory of this class
was from the day participants learned about counting calories and the importance of
monitoring their carbohydrate intake. During the class, one of the participants blurted
out, “Look at this, I am eating too many tortillas!!” His face was bright red--he was
excited to have caught the problem. The promatora stated that this story was
indicative of the many small and large revelations program participants experience
when they become educated about the disease and the impact of diet and lifestyle on
their health. The participant stated to the class, “No wonder I have been feeling so
poorly, I have been eating like this for 20 years.” While the promatora acknowledges
that changes in diet don’t happen overnight, she states that often just the recognition
of the problem is a first step in living a healthier life.
Patience and Understanding
One memorable participant, who started the intervention class, began the classes with
a very poor attitude. At the first class she quickly told the health educator that she had
already attended two paid diabetes education classes and that the teachers she had
were very negative and made her feel negatively about her diabetes. She went on to
tell the health educator that the education she had received in these classes was very
typical of what a doctor would tell a patient---eat better and exercise more--and that
she was not expecting to learn anything new at this workshop. Yet, soon after the
classes began, the health educator noticed a drastic change in this participant’s attitude
and demeanor. She began really opening up during the classes and was frequently
talking about her experiences with diabetes. After one of the classes she approached
the health educator and thanked her for being so understanding and motivating. She
was excited that the health educator was not at all condescending and that she could
relate to her, which helped her to open up about the disease as she was in an
environment where she felt respected. At the end of the class the participant talked
about how she had begun applying what she learned in the classes and that now when
she talks with others about the disease she teaches them what she has learned.
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Program Administration
This section includes data relative to program administrators and staffs perspectives on
the A) Staffing, B) Budget, and C) Timeline allocated for the Type 2 program. Aside
from the initial delay in starting the program which resulted from time spent choosing
appropriate workshop curricula, overall, respondents felt that all three of these
program components were planned and developed adequately and contributed to the
successful implementation of the program.
A) Staffing
The staffing structure for each hospital varied, but at a minimum each hospital had at
least one staff member who filled the responsibilities of the following roles: 1) Executive
Committee Member/Medical Expert 2) Program Manager/Dietician 3) Health
Educator/Promatora. Hospitals reported that throughout the duration of the program
all hospitals maintained their original staffing structure. Two hospitals reported
experiencing staff turnover in the health educator position which necessitated the
hiring and training of new staff members. All program managers felt that the staffing
structure at their hospital was adequate throughout the duration of program
implementation. Only one of the hospitals that experienced staff turnover reported
difficulty in having enough program staff during the period of time when looking to fill
the open position of a health educator. Otherwise, the program staffing structure was
reported as well suited for successful implementation of the Type 2 program.
While the staffing structure remained consistent, roles and responsibilities for program
managers and or Executive Committee Members changed and evolved during the 3year program. Most program administrators noted that their involvement in the
beginning of the program was much more intense and time consuming compared to
later in the program when program activities become more routine. One administrator
commented, “At the beginning of the program, I was much more involved in day to day
activities-- I helped with outreach, scheduling, talking to physicians and was doing data
entry. Now, much of that is performed by our staff and I am more involved in the
oversight of the program.” Program managers commented that they felt comfortable
giving their program staff (health educators/promatoras) more program related duties
such as data entry and maintenance of program rosters, etc., once staff became more
comfortable and familiar with program operations. Program managers noted that
continual monitoring of program activities and holding frequent supervisory meetings
was a key component to program coordination and to maintaining the quality of the
program. One Registered Dietician stated, “I still sit in on classes and also periodically
teach classes with the promatoras to ensure the quality and content of the classes are
maintained.”
B) Budget
Program Managers were asked whether they felt that the amount allocated in the
budget for operations and program staffing was adequate for successful program
implementation. Most respondents reported that the budget provided sufficient funds
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to implement the program for the three year period. One physician expert stated that
“the budget and timeline was appropriate because the initial program planning was so
well done.” Furthermore, because initial program implementation was delayed as a
result of difficulties in choosing the program curriculum (detailed in the interim
program report) all hospitals are able to continue program activities with Good Hope
funding for a minimum of four months after the funding period officially ends.
The only additional line item that was requested by a program manager that was not
included in the budget was for glucose testing materials. According to this program
manager, having the capability to test individuals’ glucose levels would have enhanced
outreach/screening activities. Not having a test to clinically prove a patient was “prediabetic” made it slightly more difficult to convince individuals of the importance of
attending the prevention classes. “It was hard to sell people on “risk” by using the ADA
screening test alone. According to this respondent, about 50% of the people screened
wanted to see a more accurate number or test.”
Another budgetary related issue that was mentioned during the interview was related
to program sustainability and the difficulty in finding additional funding for programs
once the initial grant ends. One Executive Committee Member stated that
“maintaining trained staff is difficult after funding runs out…most funders only want to
provide start-up costs and not programs already running.” This can result in time and
resources spent for programming that will not be continued after the pilot is
completed. This issue was also brought up many times during collaborative meetings
and is recognized by members as a barrier to sustaining successful programs at
hospitals.
C) Timeline
The start date of the program was delayed as a result of difficulties in finding an
intervention curriculum that would fit the diverse needs of each of the hospitals.
Because of this delay, a no-cost extension was granted by Good Hope Medical
Foundation through December 31, 2008. According to a program dietitian “the
program start-up at the hospital was also delayed because it took longer than
anticipated to start getting referrals for the program. Getting people to start coming to
the program was a challenge.” Other respondents echoed this sentiment stating that
informing providers and community partners about the program for referrals was a
time consuming task, especially when the program first began. Continuous reminders
were the key to spreading the word about the availability of classes. Other than these
two factors, which resulted in a delay in getting the program started, staff and program
administrators felt the timeline was feasible. After initial start-up issues, program
administrators reported that their hospitals were able to stay on track with the timeline
for implementation of the program through the three year period.
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Program Outreach, Screening & Marketing
All hospitals conducted various community outreach and screening activities with the
goal of marketing the program to communities to recruit appropriate individuals to
both the intervention and prevention workshops. Screening and outreach activities had
an educational focus, and informed community members with or at risk of diabetes
about the disease, its contributing risk factors and the importance of seeing a physician
if individuals were identified as “high risk”. Hospitals reported that much of the success
in conducting outreach resulted in establishing new relationships with local community
based organizations. With regard to barriers encountered, many respondents found it
difficult to recruit individuals to the prevention classes and mentioned strategies to
overcome these barriers, which are detailed below. This section is organized according
to the following sections: A) Outreach: Strategy, and, B) Outreach: Successes and
Barriers.
A) Outreach: Strategy
As described above each hospital had the same goal for outreach, yet each hospital
developed an outreach strategy unique to their targeted communities and population.
Hospitals reported performing outreach activities at local health fairs, clinics, schools,
senior centers/facilities, and other community based organizations. Within their own
hospitals, program staff also performed outreach to providers and hospital staff to
make them aware of the disease and its co-morbidities; the Type 2 program and its
services for patients; and to inform them of the program referral process. During the
three year program, hospitals performed a total of 25 in-services/lectures on diabetes
and the Type 2 program with 574 providers and hospital staff attending.
Respondents reported that after initially attending a variety of events at different
locations, they learned where they were most successful and effective in reaching and
recruiting patients and focused their outreach efforts at these select places. One
hospital reported that by establishing relationships with certain organizations and their
clientele, the outreach and the recruitment process became easier and more effective.
Additionally, one respondent stated that conducting personal outreach versus posting
flyers and sending out mailings to patients was a much more effective approach for
their hospital.
B) Outreach: Successes and Barriers
As alluded to in the preceding section, most of outreach success was realized through
hospitals establishing and building relationships with organizations in the community.
Respondents stated that organizations that provided a captive audience of individuals
with or at-risk of diabetes were those with which they focused on building partnerships.
Such organizations included local schools, health department sites, senior centers, and
the Mexican Consulate. These organizations eventually became a major source of
referrals for the program. One hospital reported that it had most success performing
outreach at senior centers during lunch times as they knew that individuals would be
there and would be willing to listen to their talk about diabetes and the program.
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Another hospital found that performing outreach at elementary schools right after
school or before or after PTA meetings was a good way to reach parents without their
children so parents could be more attentive. Through the development of these new
partnerships, future programs will be able to benefit from the efforts of the outreach
conducted from this program.
Barriers encountered during outreach were mostly related to the recruitment and
obtaining of referrals for the Prevention workshops. One program manager stated that
getting individuals to attend classes to “prevent” a disease is a hard thing to sell. “If you
tell an individual they are just at risk of diabetes they often exude an attitude of ‘if I
don’t have it, I don’t need it’. Very few people want to change before it’s too late.”
Respondents stated that a lack of motivation is the largest barrier to getting individuals
to come to prevention classes. To attempt to overcome this barrier hospital staff
reported offering small incentives/goodies to participants to attend the 4-class
prevention program. But even with these incentives it was difficult to get people in the
door. One medical expert commented that “until the public is better educated on the
importance of prevention” a lack of motivation to attend these classes will continue to
be a problem. In addition, one respondent also noted that providers were much more
likely to refer patients with diabetes into the intervention classes than at-risk
individuals.
Workshops: Prevention & Intervention
The prevention and intervention classes were the main focus of this program. Interview
questions regarding the workshop classes focused on assessing the impact and overall
effectiveness of the workshops based on the experiences of the program staff and
administrators. For many program staff indicators of program success came from
witnessing transformations in the behaviors and knowledge displayed by participants
over the course of the workshops. Respondents were also asked to discuss some of the
barriers and obstacles hospitals faced in implementing the workshops and ways their
hospital attempted to overcome such obstacles. Similar to what was mentioned
regarding barriers in conducting outreach; respondents noted difficulty related to
program recruitment and retention for the prevention classes.
A) Indicators of Workshop Success
In addition to patient stories provided in the first section of this report, program
respondents were asked to discuss how they evaluate the success of a workshop series,
specific class or that of an individual participant. Many respondents stated that when
participants expressed confidence in their ability to make changes to improve their
health and stated that they felt they could control and manage their disease--this was a
sign of success. Respondents also stated that retention rates were a major sign of
success for them. When they saw that the participants were coming back to classes and
very few were dropping out, they felt that they were engaging participants and that the
participants must be getting something out of coming to the classes. One health
educator mentioned that when she saw participants’ attitudes change during the
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course of the workshops series this was a sign for her that the education was getting
through to the participants. She stated that when at the end of the workshops
participants seemed happier, she felt she had succeeded in alleviating some of the
feelings of hopelessness several of the participants felt at the beginning of the classes.
Additionally, respondents noted various other indicators of success. One respondent
noted that she received positive feedback from providers who referred patients to the
classes. She stated, “providers are pleased with the content of the program.”
Furthermore, this respondent stated that the implementation of the Type 2 diabetes
program at her hospital was a huge success as it was the first diabetes program offered
by the hospital. She stated, “Type 2 has been neglected until this program started. It
has brought awareness of the need…we had no [diabetes] resources before this
program started.” Another administrator similarly noted that she felt that one success
of the program was that it gave patients access to diabetes education that the hospital
did not provide before the Type 2 program started. As these responses indicate the
Type 2 program was successful on many different levels. Beyond the impact on
individual patients, the program expanded services in hospitals, connected providers to
new resources and created awareness of the need for diabetes focused programming at
the hospitals.
Hospitals also noted that implementing the Type 2 programs provided an opportunity
for building relationships with new community based organizations. As noted in the
outreach section above, hospitals reported collaborating with several different types of
local organizations to perform outreach and screening activities. Two respondents
noted this relationship-building as a success of the program. By providing the
opportunity to establish new relationships with outside organizations, the Type 2
program enabled hospitals to expand their presence within communities and to utilize
these new partnerships for future programming and outreach purposes.
B) Workshops: Barriers and Obstacles
Respondents were asked to discuss some of the barriers and obstacles encountered
during the implementation of the program as well strategies developed in an effort to
overcome identified barriers. From the perspective of some of the medical experts and
staff interviewed, the program was very successful in increasing the knowledge of
participants and in educating both program participants and community members
about diabetes and its risk factors. Yet, some respondents noted that the clinical
outcomes for the interventions classes were much more difficult to achieve in the short
time frame of the four-week program. One medical expert stated that “chronic
conditions need to [be addressed for] anywhere from two-five years to see a change in
clinical outcomes.” Another respondent stated that some of the clinical outcomes set
for the program seemed to be beyond the ability of a four-week program to achieve,
but that this was not discovered until after the program was well into the
implementation phase. Several of the respondents suggested that the program be
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sustained for a period longer than two years and that this would allow patients to retake classes and stay in contact with program staff over a longer period of time.
Another issue mentioned by several respondents was in relation to recruiting patients
for the prevention classes. This was also mentioned as a response to questions
regarding barriers encountered during outreach and screening as detailed in the
outreach section. Several respondents reiterated this as a major obstacle encountered
for hospitals. Similarly, all hospitals noted that getting patients back to the hospital for
the three to six month follow-up visit was extremely challenging. Respondents noted
some reasons for this including the fact that often participants move or change phone
numbers so staying in contact with patients after the program ends can be difficult.
One program director stated that a benefit of recruiting patients from local schools was
that it is often easier to follow-up with parents as they knew where to find them and
could do follow-up at the school site. Another hospital provided incentives to patients
to attend follow-up visits. This helped increase numbers slightly, but follow-up still
remained an issue for this hospital.
Issues related to participants’ personal lives and competing responsibilities were also
reported as barriers impacting program recruitment and follow-up visits for hospitals.
Two respondents noted that transportation was mentioned by some participants as a
barrier to attending workshops (both intervention and prevention). Patients often have
to take public transportation and are traveling long distances to attend classes at the
hospital site. In an effort to overcome this obstacle, all hospitals reported implementing
both types of workshops at community-based organizations including community
clinics, school sites and senior centers. While implementing workshops off-site brought
along its own set of challenges,(mostly related to finding adequate space to run the
classes) by implementing the program directly in the community where patients live,
the hospital was able to increase program participation and retention rates at these
workshops. This also was referred to by many as a lesson learned from implementation
of the Type 2 program, in that taking classes directly to the community is very
beneficial when targeting low-income and underserved populations.
Program promatoras and health educators responsible for implementing the classes
noted that differences between teaching English and Spanish classes created initial
challenges in regard to tailoring the class curricula to the needs of the patients. One
promatora noted that Spanish speaking participants lacked the more basic and general
knowledge about diabetes and living a healthy lifestyle, therefore modules and class
content had to be formatted to fit the need for this level of information. The English
speaking participants often entered the classes already having some basic knowledge
about the disease and its risk factors and wanted to know more specific and detailed
information about diabetes and nutrition. This required promators/health educators to
educate themselves more about specific components of the curricula and to
communicate with their program’s registered dieticians and/or medical expert. The
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promatoras/health educators also had the option to refer participants directly to these
individuals when they felt appropriate.
It should be noted that most of the above barriers and obstacles identified were
discussed during the monthly and bi-monthly consortium meetings. At this time, staff
and committee members were able to discuss ideas on how to overcome and address
issues facing hospitals and staff. As such, many of the strategies used to address these
barriers were developed in a collaborative process and were shared between hospitals.
Data Collection/Evaluation
Through the database developed and maintained by NHF, hospitals were able to enter
and track self-reported participant demographic and clinical data collected via the
workshop questionnaires as well as run real time reports to show participant progress
and individual hospital and aggregate program progress in reaching select outcomes
and goals. All respondents felt that the database was well put together, easy to use and
beneficial for program management. A few respondents noted some initial kinks in the
program at the very beginning of the program, but stated that once resolved the
database ran very smoothly.
Respondents were asked to rate on a scale from 1 – 10 (1 being least satisfied and 10
being most satisfied) their overall satisfaction with the online database. Out of a total
of 8 respondents (3 respondents did not provide a rating), 50% (n=4) rated the database
as a 10, 25% (n=2) rated it a 9 and 25% (n=2) rated it an 8. Three respondents stated
that because of their role within the program they did not have enough interaction with
the database to provide an answer to this question.
Respondents were also asked to provide overall feedback about the database and to
describe how they used the database to manage the Type 2 program at their hospital.
Many respondents stated that a very positive aspect of the database was that it was
extremely user friendly. Specifically, respondents stated that they liked the color
coding system that indicated which participants had completed the program and had
all their data entered and which were still incomplete as well as the fact that participant
data could be found in one central location. Additionally, two hospitals noted that the
database was well tailored for use by the health educators and promatoras. One
program manager stated that while the database is very easy to use, it also provides the
right detail of information needed for program management and monitoring.
In regards to the reporting component of the system, several respondents noted that
the real time reports available to hospitals were easy to run and provided very useful
information for program management. One program manager noted that she
frequently used the reports to “coordinate and evaluate the program”. Another
respondent noted that she used the data from the reports to develop departmental
reports for hospital administrators about the status of the program. One program
director stated that the database system “keeps us on track with numbers and
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outcomes, and helps us see where we needed to modify the curriculum for more
success in achieving the set outcomes.” While another program director stated, “the
data collection system helps us to demonstrate the benefit of the program as the data
can support the qualitative claims of program success.”
Respondents also noted some of the problems/issues they encountered with the
database system. One respondent noted that “it took some time to work out some
initial kinks” in the program, but that working these issues out in a collaborative process
made it a more effective system. Similarly a program director stated that at the onset
of the program some of the necessary queries were not available through the system,
but once identified, it was easy to work with NHF to incorporate them into the system.
Other problems identified by respondents that frequently used the system included the
fact that the system times out if it takes too long to enter in data, that the system
freezes up at times and that the dates automatically convert into number format. Yet,
despite these issues, overall, respondents noted that the database has been an
effective way to capture and report on the outcomes achieved by this program.
Program Sustainability and Replication
In the following section, respondents were asked to comment on the sustainability of
the Type 2 program after initial funding from Good Hope Medical Foundation expires
and the potential for replication of the program by other hospitals. When discussing
program sustainability, it was noted by all respondents that they wanted to see the
program continue as they felt it is a very beneficial and needed program for their
hospital and the community. Respondents also felt confident that this program could
be replicated in other hospitals and communities with much success and benefit.
A) Program Sustainability
As noted in the budget section of the report, several hospitals have enough funding in
their budgets to sustain the program for at least four months after December 2008.
Only one hospital stated that they felt confident that their hospital would provide the
needed funding to continue the program and noted that they felt the program was
definitely a priority for the hospital. Another hospital stated that they plan to sustain
the program by applying for additional outside funding, but that the hospital has
several competing priorities, especially in the current economic environment, and that
there is no firm commitment that the program will receive any funding from the
hospital. Other respondents echoed this sentiment about current economic conditions
when responding to this question. One hospital stated that it did not have a definite
plan for program sustainability but that the program staff will do anything and
everything they can to continue the program. The medical expert from this hospital
noted, “it would be sad to see the program end as all the work done to get the program
up and running smoothly would be wasted…the need [for the program] continues
despite the cost to hospitals.”
B) Program Replication
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Respondents were also asked to discuss their opinions about the potential for
replication of the Type 2 program in other hospitals and communities. Respondents felt
confident that this program could successfully be replicated in other hospitals and that
it would be beneficial to turn the Type 2 program into a replication package (as was
previously done with the consortium’s HELP program) to move replication forward.
One respondent noted that staff from other hospitals have already contacted her to
communicate their interest in using the program in their hospital. Many respondents
felt that because the program was developed in a collaborative process to fit the needs
of the three different hospitals and diverse patient populations, it is customized to be
adapted in various hospital and community settings. One respondent noted that the
program is “easy for staff to be trained to implement,” and that by using promatoras it
can help take pressure off bedside nurses to sufficiently educate patients about
diabetes care and management.
End Results & Lessons Learned
At the end of the interview respondents were asked questions related to their
experience working with the Chronic Disease Management Consortium and whether
they felt that the Type 2 program reached its original goal and intention. Respondents’
comments regarding working with the consortium were overwhelmingly positive; many
mentioned looking forward to continuing to work with the CDMC. In regard to the
program’ success in reaching its original goals and intention, many felt that the
program was most successful in educating individuals and communities about diabetes
and less successful in realizing some of the clinical outcomes. Responses from the
entire survey were summarized in the last section of this report as lessons learned.
A) The Role of the Chronic Disease Management Consortium
Respondents felt that working with the consortium added great value to the Type 2
program and enhanced every aspect of the program development process. One
respondent noted “[hospitals] get more and better ideas when you have several
different perspectives working on a program.” Additional benefits mentioned included
sharing resources, drawing upon the diverse expertise and skill sets of members,
exchanging ideas and sharing experiences and feeling supported throughout the
development and implementation of the program. One respondent noted that being a
member of the consortium can be “painful” in terms of the time commitment and the
processes involved, but that the end result is a more effective program that has a
broader impact on patients and communities. One program manager specifically
stated, “[I] learned how to deliver the message of diabetes from the California Hospital
ladies.”
All hospitals started that they plan to continue to work with the consortium on future
projects. It should be noted that all hospitals were involved in the development of the
consortium’s Heart HELP cardiovascular disease program. The curriculum and planning
process for the program has been completed and hospitals are ready to start
implementation as soon as additional funding is received. Furthermore, one respondent
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noted that her hospital would like to continue to implement the Type 2 program and
work with the consortium to sustain the program. Another respondent stated that she
would like to expand the consortium’s childhood obesity program and activities as the
need for obesity prevention and intervention services remains relevant in the
community.
B) Progress toward the Program Goal & Intention
Reflections made by respondents in regard to whether they felt that the program
reached its original goal and intention were positive regarding the goal of educating
patients and communities about diabetes prevention and management. All three
hospitals felt that were successful in providing access to important diabetes education
for those in need. One hospital stated that “the intent to educate came to fruition….
[our hospital] went from having nothing [for patients] to having something, which has
been very positive for the hospital.” Another respondent stated that the goal of
reaching patients in need of education was successful and that that she felt that
numerous individuals who did not know about this disease now have at least an
awareness and/or basic understanding of the disease.
In regard to the clinical goals and outcomes of the program, one respondent felt that
some of these goals were not reached by the program. This respondent stated that
some of the clinical goals seemed to be a little unrealistic as end points, but that
educating individuals is an important first step and that this was realized by the
program, which is significant. Another respondent felt that there was not enough time
to reach the goals set for the number of patients that would attend the workshops
(both intervention and prevention). Another stated that they felt that the program
needed more time to reach some of its goals and outcomes and that beyond the set
goals of the program, the program should continue as it fills a critical need for diabetes
education in communities that continues to exist. One respondent stated, “some goals
were not reached, as we needed to see more patients…but three years is not a lot of
time, although, the program has already made a difference for a lot of people.”
The last question of the interview invited respondents to share any additional
information about the program. One respondent stated that being part of the program
was a great experience and that they are very appreciative of the funder for the
opportunity to develop and implement the program. She stated, “it helped a lot of
people and made a big difference, the grant was very well spent…I hope the foundation
continues to fund programs like this.” Another respondent stated that he saw great
societal value in the program and that he felt that being involved in the program was
“good for the soul.”
One respondent stated that they felt the NHF was a good repository for all the data
collected for the consortium’s programs and that NHF was an excellent facilitator of the
consortium and provided services hospitals did not have the capacity to provide for the
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program. Several of the respondents stated that they looked forward to continuing to
work with the consortium.
C) Lessons Learned
The Type 2 program provided the Chronic Disease Management Consortium with an
opportunity to continue its work to provide chronic disease prevention, intervention
and management programs to communities in need. The experience of developing and
implementing the Type 2 program also provided the CDMC with new experiences to
learn from and build upon when developing future programs. Highlighted below are
some of the key lessons learned from the Type 2 program as noted by program staff
and administrators.
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Time to Establish the Referral Process: Respondents noted that spreading
the word about the referral process for this new program was more time
consuming than anticipated. For program staff it required continuous
follow-up and making numerous calls before referrals for the program
started coming into hospitals. Future CDMC programs may take this into
account when developing a program timeline.
-
Prevention is Hard to Sell: Many respondents’ noted significant barriers in
recruiting patients for the workshop focused on prevention. Some stated
that using incentives to get participants to attend classes helped to some
degree. Others stated that until societal norms about the importance of
prevention change, getting participants to commit to attending prevention
classes will remain very difficult. Future programs may strategize about
different ways to approach marketing prevention classes to increase
participation and retention rates.
-
Implementing Programs in Communities Works: Several hospitals noted
success in implementing classes at community-based organizations located
in communities where the target population lives. Often, these classes
showed increased participation and retention rates compared to classes
implemented at the hospital site.
-
Developing Practical Clinical Goals: Some respondents noted that the
original clinical goals/outcomes set for the intervention program were
slightly ambitious especially when considering the poor health status of the
population that attended these workshops. Future programs may take note
of the goals and outcomes the Type 2 program was successful in attaining
and which they found difficulty with and use these results to help develop
appropriate program goals and outcomes.
January 2009, National Health Foundation
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