Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘Program Sustainability’

FHCHC DPP/Chabaso Garden Greenhouse Is Up!

In Community Garden on November 9, 2011 at 10:08 AM

With the incredible generosity of Jose Luis, the husband of one of our program’s participants, Mike, owner of Growell in Cheshire, and a number of his employees, our greenhouse was mounted this past Saturday. They donated their time and expertise, in partnership with Oscar, maintenance manager from Chabaso Bakery. This means we can grow crops through the winter, continuing to provide nutrient-dense produce to our Diabetes Prevention Program participants and their families in a season when there is usually less.


Donations Make The Garden Go Round

In Community Garden on February 28, 2011 at 11:08 AM

High Mowing Seeds!

High Mowing Seeds!

High Mowing Seeds!

Rah Rah!

High Mowing Seeds!

The Diabetes Prevention Program just received a major donation from High Mowing Seeds, a small but extraordinarily generous organic seed production company in northern Vermont. Needless to say, we are overjoyed, and simply moved by the gift. Next week we will begin our tomatoes, eggplants, broccoli, cukes, and herbs in Fair Haven K-8 School’s rooftop glass greenhouse. Off to another miraculous growing season. Stay tuned!

Not Giving Up, Even After 4 No-Shows

In Intensive Lifestyle Intervention - General on February 22, 2011 at 2:46 PM

I couldn’t figure out why all the intake equipment was set up in the conference room. It was a typical day in the Diabetes Prevention Program; soup being served that raises funds for the garden, administrators talking to Yale about the joint child-obesity program, patients calling throughout. Intakes usually take place before the start of a new Intensive Lifestyle Intervention, when the program needs to be filled with those whose results from OGTT screenings placed them in the category called prediabetic. We were six weeks into our twelve-week program, however. Hardly the time to begin filling the next program.

Mari flies in the office door, her scrubs swishing against a busting notebook. She mumbles to herself, ‘She’s not here!’

I couldn’t help but ask.

‘It’s the intake I had scheduled. This patient isn’t here…again.’


‘She’s been scheduled four times.’

Mari picked up the phone with resolve. She plays with the patient, in a stern voice informing her of the missed appointment, and then laughing with compassion as the patient realizes her folly on the other end of the line. When they get off the phone, I ask how they decided to resolve the patient’s continued absence.

‘I’m going over to her house to do the intake.’ Mari exclaims proudly, like a woman who’s taken fate by the horns.

I couldn’t help wondering why – with 15,000 patients at FHCHC, how has this particular patient instigated a home visit? And what is Mari’s motivation for persisting?

‘It’s hard.’ She explained. ‘Weather, wrong numbers, messages left without call-backs. It’s difficult to generate participation. So when someone is interested and simply can’t get here, I’ll take an extra step.’

Tailoring Programs Is Essential

In About the Program on January 5, 2011 at 10:25 AM

Two recent videos, when combined, illustrate a driving force behind FHCHC’s Diabetes Prevention Program: tailoring. The National Institute of Health’s Diabetes Prevention Program is a brilliant and successful program. Central to its success, however, is that it is perfect for the population to whom it was originally delivered. Aligned with a long lineage of community health centers that focus on tailoring health care to fit their particular population’s character and constraints, so did FHCHC’s Diabetes Prevention Program adjust the original curriculum to fit the needs of Hispanic families in Fair Haven, Connecticut. Around the same time that FHCHC’s Diabetes Prevention Program was being translated and readied for execution, Malcolm Gladwell, author of The Tipping Point and many other noteworthy titles, delivered a Ted Talk in which he demonstrates the importance of tailoring products to fit the needs of those being served. Watch Gladwell’s Ted Talk here.



And like FHCHC’s Diabetes Prevention Program, state politicians and health officials on the smallest and most obese republic in the world are implementing a site-specific diabetes prevention strategy to try to reverse the effects of a homogenous western diet on the Pacific island. See ABC News’ video on Nauru here.


Although diabetes is a disease that is common to most developed and developing nations today, ensuring the success of diabetes-centered health interventions is contingent upon this tailoring principle.

FHCHC’s DPP Intensive Lifestyle Intervention – An Overview

In Intensive Lifestyle Intervention - General on December 8, 2010 at 4:01 PM

ILI Overview & Intake Procedure

If a Hispanic woman between the ages of 18-55 has had a blood test in the past three months that has rendered her pre-diabetic, and she is a patient at the Fair Haven Community Health Center, she is eligible to participate in the Diabetes Prevention Program’s Intensive Lifestyle Intervention (DPP’s ILI). There are two study tracks: delayed and immediate. Those randomized to participate in the delayed group see their provider every three months for a year, as well as a nutritionist once during that time. Those in the immediate track participate in a 12-week exercise and nutrition program, seeing a provider weekly and having the opportunity to continue participating after the initial 12-weeks. At the end of one year, all delayed and immediate-track ILI participants have an OGTT screening to distinguish any changes in their physical wellbeing. Those in the delayed group can then enter into the immediate track if they choose. Those randomized to participate in the immediate study group begin their weekly nutrition and exercise classes immediately.

Prior to the randomization process, pre-diabetic patients are invited to the clinic for an intake (click here to see the Intake Checklist). There, their labs are confirmed, vitals taken, and they are given the opportunity to join the ILI study (click here to see intake checklist). These intakes are free, and are scheduled by the DPP staff, rendering most of the process outside the clinic’s traditional admission and billing processes. Typically, the appointment takes around 30 minutes, and is conducted by a trained DPP administrator.

The intention of the intake is to determine whether a pre-diabetic patient is interested in participating in the ILI study, and if so, collect all the essential study data to get them started. The consent form solidifies their participation, after which vitals and other medical-related data is collected, and physical activity and nutrition-related questionnaires are filled out. As part of the initial data collection, patients are also given pedometers and a pedometer tracking form, the data from which will indicate the amount of walking each patient does on a typical weekday or weekend. The DPP awards $10 gift certificates to Walmart if they return the pedometers and the pedometer tracking form after a complete week, a strategy that has fueled participation.

FHCHC DPP OGTT Screening Follow-Up

In OGTT Screening on December 8, 2010 at 3:50 PM

The following checklist takes the reader through a step-by-step process of completing the group OGTT screening.


FHCHC DPP OGTT Screening Billing Flow

In OGTT Screening on December 8, 2010 at 1:06 PM

FHCHC’s Diabetes Prevention Program has strived to create a financially sustainable billing system. This is a month in the life of the OGTT billing process.

This document refers to several related documents:

Click here for a sample Encounter Form

Click here for sample coupons

Click here for a sample OGTT attendance, billing, and insulin data spreadsheet

DPP Financial Sustainability: No Special Treatment

In About the Program on December 8, 2010 at 1:03 PM

“The DPP gets no special treatment” declares FHCHC’s billing manager Marian Zayas. She is referring to the billing system used to ensure DPP financial sustainability. Knowing that neither the clinic nor grants could finance the program for more than several years, exploring and establishing an effective billing system has been a key objective from day 1.

Like other health clinics, FHCHC positions patients on a sliding fee scale based on their income and insurance status (see scales below). Those with no insurance combined with lowest income level are given the biggest discounts, while those with insurance and/or high income are given the lowest discount. The DPP has fully adopted this system so that each patient seen in an OGTT screening or participating in the Intensive Lifestyle Intervention is charged for their visit based on their position on the sliding fee scale. The DPP uses a coupon system to ensure that the DPP is charged for serves not covered by patients’ insurance (click here for a sample coupon sheet).

Click here to see the OGTT billing process which ensures insurance reimbursement and program sustainability.

FHCHC DPP OGTT Billing Coupon System

In OGTT Screening on December 8, 2010 at 1:02 PM

These are the coupons that the DPP staff pastes on Encounter Forms after OGTT Screenings. By using a coupon system, the Billing Department can charge the DPP the amount that isn’t covered by the OGTT screening patients’ insurance.

Click here to see the whole OGTT billing process.

DPP Research Flow: OGTT -> Preventative Interventions -> OGTT

In About the Program on December 8, 2010 at 1:02 PM
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