Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 January 2009, National Health Foundation 1 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. January 2009, National Health Foundation 2 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 January 2009, National Health Foundation 3 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. January 2009, National Health Foundation 4 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. January 2009, National Health Foundation 5 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 January 2009, National Health Foundation 6 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 January 2009, National Health Foundation 7 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 January 2009, National Health Foundation 8 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 January 2009, National Health Foundation 9 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 January 2009, National Health Foundation 10 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 January 2009, National Health Foundation 11 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 January 2009, National Health Foundation 12 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. - 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 13