1. Data Collection – Beyond Baseline SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training March 9, 2011

2. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Overview ID Assignment Data Collection Forms Annual Assessments Participant Attendance & Retention Forms Helpful Appendices

3. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training ID Assignment A numbering system developed to help programs keep track of their participants, both potential and enrolled NDPID Awardee #: National Diabetes Program ID Awardee #: Unique identifier for each program Site #: For those programs with multiple data collection sites, an ID for each site has been assigned. Those with only 1 site will use a “1”. Participant ID #: Each individual entered into the Excel Registry is automatically assigned a personal ID number, starting with 0001. Program staff will label data collection forms with this number to indicate the person from which the data was collected. See Appendix C – ID Assignment

4. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training ID Assignment Continued ID Number Format The ID Number format will define individuals as follows: __ __ __ __ __ ____ __ __ __ NDPID # Site #Participant ID # For example, the first potential or enrolled participant listed in the registry for Albuquerque Service Unit would be referred to as follows: NDPID – 53203 Site ID – 1 First participant (0001) – 53203.1.0001

5. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Data Collection Forms C1 – Comprehensive Assessment Form C2 – Comprehensive Participant Questionnaire P1 – Participant Attendance Form P2 – Participant Retention Form

6. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training VisitForm(s) BaselineC1 C2 Ongoing (Attendance)P1.H AnnualC1 C2 As needed (Retention)P2.H

7. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Participant Timeline Recruitment Screening Consent Baseline Assessment Annual Assessment Time 0 ---------------------- Year 1 ----------------------Year 2 -----------------------Year3----------  Intensive Case Management, Community-Based Activities Annual Assessment

8. Annual Assessment (C1) +/- 30 days of the yearly anniversary of first attended Case Management Visit Make sure to check the ‘Annual’ box in the header and write in the appropriate year (i.e., 1, 2, 3, 4, etc.) All measurements and labs must be obtained Reference the Instructions column for timelines SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Participant completes C2

9. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Participant Questionnaire (C2) Participant completes C2 at baseline and each annual Participant may decline Make sure the header is complete and ‘Date Form Completed’ is not left blank

10. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Participant Attendance Form (P1) Record ONLY dates actually attended for: – Case Management Visits – HH Group Activities

11. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Participant Retention Form (P2) Submit only if: –Participant status changes to inactive Choose ONLY 1 reason for inactivity –Participant is returning to active status See Appendix K – Retention Policy

12. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Helpful Appendices for Data Collection C – ID Assignment I – Data Flow Discussion J – Forms Identification Scheme K – Retention Policy L – Document Access, Confidentiality, and Retention Policy N – Clinical Guidelines and Timelines 4. Timelines for Clinical Measurements and Lab Results 8. Medication List (Medications Recorded on the C1 Form)

13. SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: New Program Training Questions?