Data Collection Update SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2 Jenn Russell

Overview Assessment Forms and Questionnaires - Keep up the good work! Serious Adverse Event Form (SAE) Participant Attendance Form (I2) Individual Retention Form (I3) SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Are you submitting Serious Adverse Event (SAE) Forms? –42% (15/36) of grantees have submitted an SAE on one or more participants –Guidelines for SAE forms can be found in the Operations Manual (pp ) 03%20Operations%20Manual%20Version%203.dochttp://aianp.uchsc.edu/sdpi/common/manual_v3/OM. 03%20Operations%20Manual%20Version%203.doc SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Number of B1 Forms Number of Participants with SAE % Number of B1 Forms Number of Participants with SAE % Number of B1 Forms Number of Participants with SAE % DP SAE Report

Participant Attendance Form (I2) Page 1: –Make sure the Date of the First DPP Curriculum Class is recorded correctly – it should match the date recorded on the second page as the first date the participant attended a class. Page 2: –Record the date of the scheduled class – do not leave it blank. –Record YES or NO in the attendance box – do not leave it blank. –Record the correct date the class was made up if it was missed. –If class not made up or made up after a month’s time, write a retention record on the I3. SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Participant Attendance Form (I2) Page 3: –Record the date of the scheduled Lifestyle Coaching visit – do not leave it blank. –Record YES or NO in the Kept appt box – do not leave it blank. –If the Lifestyle Coaching visit was missed but made up in the same month, write the make-up date in the Provider Comments. –If the Lifestyle Coaching visit was not made up within the month, write a retention record on the I3. SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Participant Attendance Form (I2) Pages 4-6: –Indicate whether Lifestyle Coaching visit or Activity (or both on the same date) – do not leave it blank. –If Lifestyle Coaching visit, indicate Monthly (M) or Quarterly (Q) – do not leave it blank. –Record the date of the scheduled Lifestyle Coaching visit or Activity – do not leave it blank. –Record YES or NO in the Kept Appt box – do not leave blank. –If a Lifestyle Coaching visit was missed but made up in the same month, write the make-up date in the Provider Comments. (Does not apply to an Activity) –If a missed Lifestyle Coaching visit was not made up within the month, write a retention record on the I3. (Does not apply to an Activity) SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Individual Retention Form (I3) Page 2: If participant missed a class or Lifestyle Coaching visit listed on the I2, and the class or Lifestyle Coaching visit was not made up within the calendar month, there should be a matching record in the Retention Efforts table. Page 2: Use complete date (i.e., ) – Date should match missed class or visit on I2 Page 3: Always answer DROP-OUT question. If Yes, Proceed to REASONS. (Should be ‘Yes’ until next Annual December submission.) SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2

Questions? SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Year 4 Meeting 2