Laying the Foundation for Success: SDPI Demonstration

Projects Overview

November19, 2010

SPECIAL DIABETES PROGRAM FOR INDIANS Healthy Heart Project Initiative: Year 1 Meeting 1

Overview–Background

–Planning Year

–Implementation

–Transition

Background

• Special Diabetes Program for Indians– Balanced Budget Act 1997

• Prevention/Treatment of Diabetes in AIANs• Administered by the IHS

– 2002 Reauthorization• Congressional direction – develop a competitive

grant program to demonstrate diabetes prevention and also address the most compelling complication of diabetes (cardiovascular disease)

• Evaluation required

• SDPI Competitive Grant Program– Tribal Consultation

– IHS Director decision

• $27.4 million/year x 5 years

– Grants to 60-70 programs ($23.3 million)

– Administration, Coordination, Evaluation ($4.1 million)

– “Competitive”- programs compete for funding

• Demonstration Projects

– Programs implement activities in 1 of 2 areas

» Diabetes Prevention; Cardiovascular Disease Risk Reduction

– Collaborative development of activities

– Comprehensive Evaluation, Coordinating Center

• Special Diabetes Program for Indians– 2007 Reauthorization

• Medicare, Medicaid, and SCHIP Extension Act

• Extended SDPI for an additional year at the same funding level

• Final Timeline– FY 2004 RFA, Selection of Programs

– FY 2005 Planning Year

– FY 2006-2009 Implementation of Activities Comprehensive

Evaluation

– FY 2009-2010 Transition to documentation of activities and

outcomes with a smaller dataset and fewer forms

Planning Year• 6 meetings November 2004 – October 2005

Collaborative process involving grantees, IHS, and Coordinating Center

Developed a common set of activities and an evaluation to be implemented in a diverse group of communities and cultures by program staff with varying levels of experience and expertise

• Operations Manual Core Elements Evaluation design and instruments

• IRB application template• Names and Logos

Collaborative Process

Collaborative Process

Collaborative Process – Reporting Out

• Healthy Heart Project– Recruit and screen to find people with diabetes– Goal: 50 people per year– Intensive case management– Treat CVD risk factors to target goals– Provide education on CVD risk reduction– Retention– Community activities– Outcomes – improvement in CVD risk factors,

CVD prevention

Core Elements

• Diverse set of 30 grant programs– One size doesn’t fit all!– Must implement and evaluate a common set of activities

• Grant programs encouraged to adapt to local setting, culture, circumstances– Technical Adaptations – flexibility with case management,

format of HGHH or other curriculum, adding content, adding pictures, local foods, interactive activities, local speakers

– Cultural Adaptations – translation, prayers/blessings, local traditions, talking circles, traditional games, culturally-specific examples, encourage cultural perspectives, communication styles, local images/designs

Adaptation of Program Activities

• Process – did programs successfully implement the activities, lessons learned?

• Outcomes – did participants improve on short-term, intermediate and long-term outcomes? What factors were associated with successful participants and programs?

Evaluation Design

Evaluation Design – Participant Level

Recruitment

Screening

Consent

Baseline Assessment

Annual Assessment

Annual Assessment

Time 0 ---------------------- Year 1 ----------------------Year 2 -----------------------Year3----------

Intensive Case Management, Community-Based Activities

Annual Assessment

Evaluation Design – Program Level• Measurements

Provider: demographic, professional background

- Program: recruitment, retention, team activities

- Organization: organization effectiveness- Community: community stakeholders’

perspective

Planning Year - Lessons Learned• Grantees

Start vs. plan- Wide range of programs, experience, and

expertise requiring diverse training needs- Communication/collaboration- Staff turnover- Stakeholder support- Common activities vs. local variation- Public health program evaluation vs.

research

Implementation - Continuing the Collaborative Process

• Seven additional meetings Technical assistance workshops, sharing challenges and

solutions, group discussions by staff position, Operations Manual revisions

Semi-annual progress reports to provide feedback• Ongoing technical assistance

Coordinating Center visits, website, quarterly technical assistance conference calls, one-on-one conference calls, support by e-mail and phone, Tips of the Week (TOTW)

Implementation - Challenges & Lessons Learned

• Organizational Availability of specialized space, hiring and purchasing

regulations, local stakeholder support (providers, management, and community leaders), communications, adequate computer hardware and software, internet access

• Grants Management Access to funds, allowable items/incentives, carryover

• Programmatic Recruitment, retention, access to patient records,

scheduling, staff turnover and re-training

Transition• Transition from program evaluation to program

documentation with a smaller dataset and fewer forms

– Program Evaluation• 8 types of participant-level forms• 7 types of program-level forms

– Program Documentation• 4 types of participant-level forms• 4 types of program-level forms

Summary– SDPI Demonstration Projects are a success– Many lessons learned– Beyond the Demonstration Projects – SDPI Initiatives

• 30 programs, including 7 new award recipients• Continue or newly implement Healthy Heart

Project• Document activities and outcomes• Disseminate information and best practices from

the SDPI Demonstration Projects to other IHS, Tribal, and Urban Indian health settings

Questions?