Special Diabetes Program for Indians Competitive Grant Program

1. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Orientation for New Staff Day 1 Data Requirements – Recruitment/Screening Special Diabetes Program for Indians Competitive Grant Program

2. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Data RequirementsRecruitment/Screening Karen Wilde Rogers CC DP Data Coordinator

3. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Step 1Recruitment/Screening/Enrollment FormsOverview of Forms

4. FIGURE 2: OVERVIEW OF DATA COLLECTION ACTIVITY STEP RECRUITMENT: 1 SCREENING, REGISTRY, RECRUITMENT Ongoing until recruitment goals met BASELINE ASSESSMENTS 2 DP: Within month before beginning curriculum HH: Within month before beginning case management INTENSIVE ACTIVITIES 3 HH: Case management and HGHH Curriculum DP: DPP Curriculum and Lifestyle Coaching FOLLOW - UP ASSESSMENTS (DP ONLY) 4 Within a month of completion of DPP Curriculum AFTER - CORE ACTIVITIES (DP ONLY) Lifestyle Coaching and Reinforcement Activities 4a ANNUAL AFTER INTENSIVE ACTIVITY 5 Anniversary of Baseline Assessment ANNUAL (DECEMBER) Annual reports and Questionnaires 6 ONE TIME TELEPHONE INTERVIEW 7 Selected providers interviewed by CC

5. Recruitment Forms: Grantee Level Screening Forms: Participant Level Enrollment Forms: Participant Level SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Recruitment/Screening/Enrollment Forms

6. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Recruitment Forms: Grantee Level • Recruitment Team Meetings Form (R3.D, Submit in DEC) • Recruitment Activities Annual Report (AD1, Submit in DEC)

7. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Screening Forms: Participant Level • Community Screening Worksheet (R6.D, submit only 2nd pg) • Registry Input Form (R1.D, does not get submitted) • Registry Input Form Instructions (R1.D.03In) • Excel Registry (submit de-identified copy) • Excel Registry Instructions (R1.D.03InE)

8. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Screening FormsCommon Submission Issues • If Community Screening Worksheets are being used, please completely fill out and only submit the 2nd page, only if a participant ID has been issued for the participant. • Submitting Personal Health Information (PHI) in the Excel Registry.

9. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Screening Forms: Helpful Hints • Download the DPP Registry Guidelines document from the website. • Make a copy of your Excel Registry and run the Macro prior to sending it to the CC to avoid sending PHI.

10. Consent Form (R4.D, does not get submitted to the CC) HIPAA B Form (R5.D, does not get submitted to the CC) SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Enrollment Forms: Participant Level

11. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Resources • SDPI CGP website http://www.uchsc.edu/ai/sdpi/sdpi_index.htm • Username: dp • Password: dp ☞ username and password are case sensitive

12. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program

13. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Resources • Operations Manual http://www.uchsc.edu/ai/sdpi/dp/data/dp_manual.htm • Tip Of The Week (TOTW) • Frequently Asked Questions (FAQs) http://www.uchsc.edu/ai/sdpi/dp/resources/dp_resources.htm

14. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Data Contact Resource CC DP Data Coordinator Karen Wilde Rogers karen.rogers@uchsc.edu 303.724.1422

15. SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Data Requirements Recruitment/Screening Q & A