1. Vidant July 21 st, 2015 Laura Edwards Joanne Rinker

2. VIDANT Diabetes Initiative  Locations: Winsor Tarboro Greenville Wallace Washington County (5 possible clinics-little Washington) Nags Head

3. Meeting Dates  July 21st: DSME Requirements  August 26th: Application process  September 23rd: Billing meeting with billing specialist  Sept 30th: Site audits and scheduling audit visits (6 visits scheduled the week of Oct 26-29th)  Dates TBD: Meeting 4 and 5: Present data and findings and present 3 sites per meeting. (Before Christmas 2015, basically November and December)  Date TBD: Meeting 6: Go live: Application by network or if they set up their own, application for the new network completed.  Date TBD: Meeting 7: Billing session on how to integrate

4. ADA/AADE: Agree on 5 Evidence Based principles  Diabetes education is effective for improving clinical outcomes and quality of life, at least in the short term.  DSME has evolved from primarily didactic presentations to more theoretically based empowerment models  There is no one “best” education or approach; however, programs incorporating behavioral and psychosocial strategies demonstrate improved outcomes.  Additional studies show that age- and culturally appropriate programs improve outcomes and that group education is effective.  Ongoing support is crucial to sustain progress made by participants during DSME programs.10,20,26,27 Behavioral goal setting is an effective strategy to support self management behaviors.28 Source: http://spectrum.diabetesjournals.org/content/23/1/65.full.pdf

5. ADA/AADE: AADE  TITLE: Diabetes Education Accreditation Program (DEAP)  Initial Application-3 steps  Online application with stop/ start option (does not have to be completed in one sitting), paper application also available  Submit supporting documents within 2 weeks  Complete a telephone interview or onsite audit with AADE DEAP staff or DEAP auditor(s) after fee, application, and supporting materials are received.  Initial and Renewal Application Fees:  $900.00 for all programs  Community Sites - free (maximum 10)  Branch Locations - $100.00 per location (maximum 30) ADA  TITLE: Education Recognition Program (ERP): 7th Edition  Online application-2 steps  Only available online, must be completed in one sitting  Submit supporting documentation within 2 weeks  Initial and Renewal Application Fees:  $1,100.00 for first program  Expansion and multi-sites - $100.00 per location  No max

6. ADA/AADE: AADE: Supporting Documentation  Program description, including mission, goals, and organization chart  Job descriptions for each of the positions within the entity’s organization  Resumes of coordinator and instructors  Proof of licenses and/or certification and acceptable continuing education (CE) credits related to diabetes for coordinator and all instructors  Performance measurement plan/continuous quality improvement (CQI) process  Copy of one de-identified chart  Copy of one complete section from the curriculum or the curriculum outline  Advisory group composition  Sample education materials (English and non-English as appropriate) ADA: Supporting Documentation  Documented evidence of Sponsoring Organizational support  Copies of or verification of program coordinator and professional instructor’s current credentials (CDR card or verification of CDR for RDs) to include verification of CDE or BC-ADM if applicable.  Copy of official certificate or verification of 15 continuing education credits if the coordinator or professional instructional staff do not hold a current CDE or BC-ADM.  Paper Audit Items: (Note all four required for new or original applicants; one randomly assigned for renewing/additional site applicants)  Documentation of Advisory Group activity including quality input obtain from group within 12 months prior to the application submission.  A full section of one assigned content area of the curriculum (please see above for required elements for each section or content area of the curriculum).  A description of a CQI project based on at least one of standard 9’s aggregated program outcomes (patient behavioral goal outcomes or other participant outcomes)using a formal plan/process.  A copy of one de-identified participant chart demonstrating the complete education process.  Payment

7. ADA/AADE: AADE: Renewal Process  Same three steps as initial application  Submit re- accreditation application  Submit support documentation  10% (of re- accreditation applications) randomly selected for onsite audit ADA: Renewal Process  Same two steps as initial application  Support documentation  Licenses and certificates of instructors  Proof of CE credits for noncertified staff  Only one of four possible audit items sent with initial application (randomly determined by computer)

8. ADA/AADE: AADE: Process timeline  No data collection period  No minimum number of patients in program  Copy of one de-identified chart representative of the target population and education process  Total application process: 4–6 weeks  Eligible to submit Medicare claims as of date of approval  Valid for 4 years  Must complete status updates and annual status reports ADA: Process Timeline  There can be no more than 3 months from the end of the reporting period to the date of the online application submission. A minimum of 1 patient must have been completed the education process in the specified reporting period at each site except at an expansion site.  Original Applications: (new programs) the reporting period can start up to 6 months prior to the online application submission date and be 1 month up to 6 months in length.  Renewal Applications: the reporting period can start up to 12 months prior to the online application submission date and can be 1 month to 12 months in length.  Application is processed by ADA staff within 30 days  Approval is retroactive to date of online application submission (for billing eligibility)  Valid for 4 years  Must complete annual status report

9. ADA/AADE: AADE: Support Services  Support by telephone, email  DEAP e-community  Free online podcast and Web cast  Online tools and sample documents  Accredited programs posted on AADE web site  Program coordinator complimentary one year AADE membership ADA: Support Services  Support by telephone, email  Monthly conference calls  Web casts (free)  Free online library of sample forms and other tools (e.g., CQI plan, curriculum format)  Recognized programs listed on ADA website  40% discount on publications  Chronicle on-line patient EMR  Living Well with Diabetes (50 English/Spanish/year)

10. ADA/AADE: AADE: Audits  5% of initial applications annually  10% of currently accredited programs annually  10% of programs seeking re- accreditation annually  2 weeks’ notice  Volunteer auditors (1–2 per audit site) ADA: Audits  5% annually (up to 70/year)  2 weeks’ notice  Volunteer auditors (2 per audit site)  Concerns poster must be posted

11. Comparison By Standard (2012)  Standard 1: The provider(s) of DSME will document an organizational structure, mission statement, and goals. For those providers working within a larger organization, that organization will recognize and support quality DSME as an integral component of diabetes care  Summary of differences: There are minor differences. AADE requires a written policy and procedure relating to the program and education process as well as a letter of support. ADA does not require written policies or procedures but does require a letter of support for the program.

12. Comparison By Standard  Standard 2: The provider(s) of DSME will seek ongoing input from external stakeholders and experts in order to promote program quality  Summary of differences: AADE requires a policy (document) to be in place to guide the advisory group. ADA requires membership documentation according to the standards and requires that for a program taught by a single discipline, at least a member of the other disciplines serve on the advisory group.

13. Comparison By Standard  Standard 3: The provider(s) of DSME will determine who to serve, how best to deliver diabetes education to that population, and what resources can provide ongoing support for that population  There are no differences. There shall be documentation of: 1. A needs assessment for the target population 2. The availability of resources to meet these educational needs

14. Comparison By Standard  Standard 4: A coordinator will be designated to oversee the DSME program. The coordinator will have oversight responsibility for the planning, implementation, and evaluation of education services.  Summary of differences: no differences. Both require a resume, documentation of 15 hours or CDE, BC-ADM cert and job description

15. Comparison By Standard  Standard 5: One or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be a registered nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM. Other health workers can contribute to DSME and provide DSMS with appropriate training in diabetes and with supervision and support.

16. Standard 5 Continued  Summary of differences: ADA has more specific criteria for programs that are taught by only one discipline; If so, there must be a policy in place that addresses how the education needs of a patient will be met if they are outside the scope of practice and/or expertise of the single discipline.  AADE states that mechanisms must be in place for ensuring that patient needs are met related to the scope of practice. It also requires documenting of reporting and supervisory relationship of CHWs and of which staff have nontechnical, nonclinical roles. AADE requires detail on CHW training, CE, and name of instructor.  ADA does not require additional documentation about training or CEs for CHWs.  AADE requires proof of continuing education credits for all instructors including those with CDE or BC-ADM. ADA requires written documentation and copies of continuing education credits for non-CDE staff. There is a difference between ADA and AADE with respect to the timing of continuing education credit acquisition. AADE requires 15 hours annually, which can be for a calendar year, and ADA requires all continuing education credits to be earned within 12 months prior to the online application date.

17. Comparison By Standard  Standard 6: A written curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, will serve as the framework for the provision of DSME. The needs of the individual participant will determine which parts of the curriculum will be provided to that individual.  Summary of differences: AADE supports a behavior-change focus curriculum package that includes assessment, implementation, evaluation of outcomes demonstrated in the AADE7, and self-care behaviors appropriate for patient and target population. AADE requires updates utilizing current evidence and practice guidelines. ADA specifies annual review of curriculum so that it is up to date with all 10 content areas covered.

18. Comparison By Standard  Standard 7: The diabetes self-management, education, and support needs of each participant will be assessed by one or more instructors. The participant and instructor(s) will then together develop an individualized education and support plan focused on behavior change  Summary of differences: There are no significant differences. AADE requests de-identified chart, review for collaborative goal setting, and an educational process policy to ensure that a consistent process is in place. Both require documentation. ADA emphasizes demonstration of the educational process.

19. Comparison By Standard  Standard 8: The participant and instructor(s) will together develop a personalized follow-up plan for ongoing self-management support. The participant’s outcomes and goals and the plan for ongoing self- management support will be communicated to other members of the health care team.  Summary of differences: There are no significant differences. AADE requires a written policy for personalized process and ongoing self-management support strategies to ensure that a consistent process is in place (part of the record/chart review). ADA emphasizes that documentation of actual planning for support services must be in place, not just a policy (DSMS Plan).

20. Comparison By Standard  Standard 9: The provider(s) of DSME and DSMS will monitor whether participants are achieving their personal diabetes self-management goals and other outcome(s) as a way to evaluate the effectiveness of the educational intervention(s), using appropriate measurement techniques.  Summary of differences: ADA’s indicators for this standard are concise; auditors would only look to see if there was a collection and summary of behavioral goals as well as one other outcome. AADE’s requirement is to have a policy in place to ensure consistent care regardless of staff providing care (part of record/chart review). ADA emphasizes the importance of acknowledging the distinction between tracking outcomes and conducting a continuous quality improvement (CQI) process.

21. Comparison By Standard  Standard 10: The provider(s) of DSME will measure the effectiveness of the education and support and look for ways to improve any identified gaps in services or service quality using a systematic review of process and outcome data.  Summary of differences: There are no significant differences. AADE specifically advises that CQI results be shared with the advisory group. ADA emphasizes the plan, process, and application

22. Checklists  ADA Checklist: http://professional.diabetes.org/admin/UserFiles/20 15%20ERP/initial-application-checklist.pdf http://professional.diabetes.org/admin/UserFiles/20 15%20ERP/initial-application-checklist.pdf  AADE Checklist: https://www.diabeteseducator.org/docs/default- source/legacy- docs/_resources/pdf/accred/Supporting_Documents _CheckList-2013.pdf

23. Where do we go from here? Questions?