1. the National Diabetes Prevention Program in the Community
Process and Impact Evaluation of Los Angeles County Department of Public Health’s Effort to Promote and Scale
the National Diabetes Prevention Program in the Community
Jennifer Torres, MSSW, MPH, PhD(c)1,2; Noel Barragan, MPH1,3; Lauren Gase, MPH1, 3; Amelia DeFosset, MPH1; Tony Kuo, MD, MSHS1,5,6
1Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health; 2 Columbia University; 3 University of California Los Angeles; 4 American Diabetes Association of Los Angeles; 5Department of Epidemiology, UCLA Fielding School of Public Health;6Department of Family Medicine, David Geffen School of Medicine at UCLA
Introduction
Key Informant Interview Results
Facilitators and Barriers to Implementation
The National Diabetes Prevention Program (DPP) encourages collaboration among agencies to prevent or delay the onset of type 2 diabetes. Partnerships with health departments can help safety-net providers and community- based organizations (CBO) scale up national efforts to increase enrollment, participation, and provider knowledge of the DPP.
In 2014, the Los Angeles County Department of Public Health partnered with safety-net health systems and CBOs in Los Angeles County to implement a program dissemination plan and mix-methods evaluation of DPP efforts. Methods included: onsite observations of DPP classes and provider visits, survey and interviews with key informants, and administrative data review of electronic health records to examine program reach, follow up and attrition.
This presentation will describe the process used to conduct the evaluation, including: (a) stakeholder engagement, (b) DPP program design and implementation methods, (b) facilitators and barriers to implementation of DPP, and (c) data collection methodologies (e.g. survey design, observational tools, decision support resources).
Facilitators to Implementation:
Interested partners;
National interest in program expansion;
Electronic health record expansion;
ACA implementation.
Barriers to Implementation:
Financial (lack of coverage);
Fatalism;
Limited access to educational resources;
Transportation;
Limited long-term evaluation studies;
Assessing motivation to take part in program.
Results
Early evaluation findings suggest that most, but not all, providers screened patients for pre-diabetes. At those health centers that offered DPP, most reported limited access to provider tools, low patient turn-out rates and very few had adopted systematic referral process for DPP. 
Methods
Discussion
The Los Angeles Department of Public Health has partnered with core groups involved in the implementation of the DPP in Los Angeles County, including the YMCA, and area safety-net healthcare systems. The goals of the evaluation are to understand: a) how the DPP program was being implemented (e.g. intervention fidelity), (b)provider knowledge of program (e.g. education provided to clinic staff on program, facilitation of assessment for program, protocols and decision support tools in electronic health record (EHR)), and (c) provider uptake of program (e.g. knowledge of program, challenges with referrals to program, challenges to implementation of program).
Initial evaluation results suggest the need for:
health centers to implement quality improvement training and technical assistance to enhance screening and referrals of prediabetic patients to programs like DPP.
Mass media campaigns;
Provider education and technical assistance;
Development of systems to close the feedback loop for referrals between clinics and program provider organizations.
*Los Angeles County Diabetes Prevention Community Advisory Board (CAB)
Contact Information: Jennifer Torres, MSSW, MPH, PhD(c) Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention 
The project was supported in part by a cooperative agreement from the Centers for Disease Control and Prevention, #1U58DP