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Orange County Health Department's Grant Proposal <br />the disease, improve health outcomes, increase access through an improved treatment and <br />referral network, and reduce healthcare costs. Coordination of these services will qualify us to <br />become an ADA recognized DSME program under the `umbrella' of NCDERP. The OCHD in <br />collaboration with the Department on Aging currently provides diabetes education classes <br />throughout the county. The program has been well received by participants but limited staff and <br />resources have resulted in fewer classes offered with reduced attendance. There are no ADA <br />recognized DSME programs in the county nor a comprehensive referral and standard treatment <br />system in place. <br />Our program will include the following four elements: (1) DSME (2) Provider education and <br />training, (3) Improved DSME Marketing and Referral Plan (4) MNT and follow-up. The <br />program will be offered in various locations, times and settings within the county (in both the <br />northern and southern parts) to ensure access. <br />Our approach to these elements is: <br />1. DSME will be provided in accordance with the ADA and the NCDERP: All clients referred <br />will receive an initial assessment provided by a Registered Dietitian or Registered Nurse. <br />This will be followed by eight hours of DSME classes conducted by trained interdisciplinary <br />health professionals. Afollow-up assessment will be conducted at three months to measure <br />A1C and compliance with self-management behavior changes learned throughout the <br />program. Behavior change tools will be strategically awarded throughout the program to <br />promote program completion. With grant funding, we also aim to provide limited glucose <br />monitors, testing strips, A1C tests, and medication for the uninsured with the goal of <br />transitioning to pharmacy assistance programs. <br />2. The Diabetes Task Force will offer provider education and training in a seminar format at <br />least once annually. At these seminars, we plan to instruct providers on the standards of <br />medical care for diabetes including recommendations, referral systems, and multidisciplinary <br />disease management for medical providers. Our marketing plan includes the provision of <br />provider `toolkits' for program promotion and recruitment. <br />3. The DSME marketing and referral plan approach will be based on social marketing <br />principles and includes these key components: formative research with potential participants <br />and providers to improve program awareness and recruitment, behavior change messaging, <br />and targeted outreach efforts. <br />4. MNT will be offered as a complement to DSME to all participants enrolled. We will provide <br />referral information and education about MNT to participants and their medical providers <br />throughout the course of the program and during the follow-up period. Follow-up strategies <br />after completing the DSME program will include six and nine month contact by phone to <br />measure compliance with self-management behaviors. A one-year DSME follow-up group <br />class will also be provided. <br />8. Is your approach backed by evidence of success? If so, what is it? Examples of evidence <br />supporting our approach include the following: <br />Several studies have found that DSME is associated with improved diabetes knowledge and <br />improved self-care behavior, improved clinical outcomes such as lower A1C, lower self-reported <br />weight, and improved quality of life (Diabetes Care 1-2009) <br />1 <br />4 <br />