1. STANDARD 2: STAKEHOLDER INPUT
ABC DSMES Services
STANDARD 2: STAKEHOLDER INPUT

2. Program updates

3. List of Stakeholders
Internal or External stakeholder?
Name
Role/Title

4. Responsibilities of Stakeholders
Provide input on DSMES services and outcomes
Ideas to promote value
Ideas to promote access
Ideas to increase utilization of the services
Ideas to help sustain the services
Review CQI project results from previous year and make recommendations
Recommend CQI plan for coming year

5. Target population Reference for published demographics
Published demographic data for ABC county
Population
Prevalence of diabetes
% Caucasian and other ethnic groups
Gender
Income/% poverty level
Schooling/literacy
other

6. Current allocation of resources
Equipment
Staffing
Interpreters/translated materials
Patient education materials
Space/classroom
Charting/EMR/goal tracking database
Accommodations for visual or hearing impaired

7. Current referral sources, marketing efforts

8. Participant stats Total number unique participants seen in past year=
Demographics (examples: race/ethnicity, gender, age, health literacy, insurance, income, education)
How does that compare to population wish to serve?
Attendance stats (examples: % referred who attended at least one session, % who completed as defined, % no shows and cancellations, average # class participants, # classes offered/ month

9. Behavioral Goal Data

10. Clinical Outcomes data

11. Curriculum Using  AADE 7 2nd edition  Michigan’s Life with Diabetes
 ADA’s Living Well with Type 2 Diabetes
 Conversation Maps
 Creative Pharmacist Sweet Spot Evolution
 Other ________________________
Updated curriculum with new handouts for new classes of medications, information on immunizations, diabetes supply management in a crisis

12. Community resource list
Healthy Eating Resources
Cooking classes at ABC community center
Grocery store tours at Xgrocery store
XX Food shelf
nutrition related books in the ADA online bookstore
Reducing Risk Resources
sliding scale fee dentist at X
free exams at X dental school
local podiatrist, eye dr
list of places to get vaccinations
Being Active Resources
Silver Sneakers at X YMCA
Tai Chi classes at X senior center
Walking trails map…
Mall walking group meets at X

13. Financials
Operating: break even, in the red, in the black
Denials?

14. CQI project and results from the past year

15. CQI plan for the coming year