Project 24: Diabetes Prevention Program

What Is It?

Clay County is a recipent of a Diabetes Prevention Program (DPP) grant through North Carolina State University (NCSU) in conjunction with Blue Cross Blue Shield (BCBS). This is a 3 year grant that rewards Clay County based off of participants who complete a certain amount of classes and allows for the purchasing of incentives and social supports in the form of gas cards. DPP classes in Clay County started in January of 2016 and since then we have conducted 7 class sessions with an average of 14 participants per class. Classes have been held at different locations throughout the county such as: Clay County School System and at the Clay County Health Department. Future classes will be conducted mainly at the health department but will be moved if needed to best serve the community.

Because of the success of DPP classes conducted by CCHD we have been considered by the CDC to be a fully recognized site since 2019 with an annual renewal period. Clay County is the smallest county by land mass in NC and we are considered an underserved area because of the lack of access to care and other resources.  There are no hospitals within Clay County and patients must be referred out of county to receive necessary services.  The Curriculum is provided by the CDC and the facilitator of the program must be a trained and certified lifestyle coach. The name "Project 24" came out of the idea that 24 classes during the year really is only 24 hours of time. There are 24 lists for each lesson to allow participants to brainstorm 24 ideas that go along with that day's lesson. The DPP class is a year-long lifestyle change program towards wellness with 16 classes being the core portion of the class and the last 8 being the maintinence phase. 

Diabetes Prevention has been identified by Healthy Carolinians for multiple years an action that - when combined with other actions in our community - has a reasonable chance of making a difference in preventing diabetes in our community. This is an ongoing program in our community.

The priority population/customers for Project 24 are those who have been diagnosed as having prediabetes, and Project 24 aims to make a difference at the individual level. Implementation has been ongoing since 2016 at different locations around Clay County. 

Partners

The partners for this DPP: P24 include:

Agency

Person

Role

CCHD Alex Gilpin

Lead

NCSU/BCBS  

Support

MountainWise  

Support

 

 

Work Plan

Data is collected utilizing the CDC excel spreadsheet where all clients are given an identification number to remain HIPPA compliant. This information is only sent to the CDC through their secure database collection platform. The initial assessment and final assessment are uploaded into our electric health records CureMD, which allows the clients primary care provider to access the results in a secure way. When a prospective participant calls/e-mails, etc. about the program, we set up a one-on-one appointment with them before allowing them to enroll. We discuss their reason for wanting to participate, anticipated barriers, their support system, availability, and confidence. We go through the curriculum, discuss the program schedule, food journals, weigh-ins, goals, and all other aspects of the program in full detail. If blood work was not provided with a referral, we have them complete the CDC screening tool to determine eligibility. If the client is adamant on signing up right then, we will sign them up that day but we encourage them to go home, discuss it with their spouse/family and call back with a decision. We send them home with the enrollment form and have them drop it off at the front desk. Many of our participants are referred to us through their primary care provider because of an increase in A1C levels in conjunction with a high BMI. CCHD utilizes multiple avenues for marketing DPP classes to include: Ladies night out hosted by Erlanger-Murphy Medical, physician referrals from the area doctors and nurse practitioners, Facebook, Clay County Progress the local newspaper, the local radio station, and fliers that are distributed throughout the county. “MountainWise has developed marketing materials Clay County to increase participant enrollment and retention in the program through the production of a Storyteller video - highlighting both current and prior participants of the program to share their success stories. Through the development of a Diabetes Prevention Program Toolkit, MountainWise has provided the tools and resources to provide DPP sites in the region with ways to encourage participant engagement and retention throughout the duration of the program.”

2019-2020

  1. Create Marketing Materials March – mid April

Start marketing mid-April- May

Begin class in June on Thursdays

            Phase 1 will run June-December

Incentive schedule

            4 Classes in Phase 1: Exercise band – allows participants to workout from home without dumbbells.

            6 Classes in Phase 1: Calorie and Fat counter book- allows participants to really understand calories and fat.

            9 Classes in Phase 1: Bento Box Meal Prep- allows participants to understand that meal prepping is the key to success.

            13 Classes in Phase 1: T-shirt- allows participants to showcase their success.

            Phase 2 will run January-June

Incentives

            3 classes in Phase 2: Gym bag- allows participants to take workout clothes anywhere.

            4 Classes in Phase 2: Food Scale- allows participants to weigh their food to ensure they are getting the right portions.

            6 Classes in Phase 2 Body weight scale- allows participants to continue on their healthy lifestyle.

Classes will end June 2020

2020-2021

  1. Create Marketing Materials October- November

Advertise in December- beginning of January

Begin class in January towards the end of the month on Wednesdays

            Phase 1 will run January-July

Incentives

4 Classes in Phase 1: Exercise band – allows participants to work out from home without dumbbells.

            6 Classes in Phase 1: Calorie and Fat counter book- allows participants to really understand calories and fat.

            9 Classes in Phase 1: Bento Box Meal Prep- allows participants to understand that meal prepping is the key to success.

            13 Classes in Phase 1: T-shirt- allows participants to showcase their success.

            Phase 2 will run August- January

Incentives

            3 classes in Phase 2: Gym bag- allows participants to take workout clothes anywhere.

            4 Classes in Phase 2: Food Scale- allows participants to weigh their food to ensure they are getting the right portions.

            6 Classes in Phase 2 Body weight scale- allows participants to continue on their healthy lifestyle.

Classes will end January 2021

  1. Create Marketing Materials March – mid April

Start marketing mid April- May

Begin class in June on Thursdays

            Phase 1 will run June-December

Incentives

4 Classes in Phase 1: Exercise band – allows participants to work out from home without dumbbells.

            6 Classes in Phase 1: Calorie and Fat counter book- allows participants to really understand calories and fat.

            9 Classes in Phase 1: Bento Box Meal Prep- allows participants to understand that meal prepping is the key to success.

            13 Classes in Phase 1: T-shirt- allows participants to showcase their success.

            Phase 2 will run January-June

Incentives

            3 classes in Phase 2: Gym bag- allows participants to take workout clothes anywhere.

            4 Classes in Phase 2: Food Scale- allows participants to weigh their food to ensure they are getting the right portions.

            6 Classes in Phase 2 Body weight scale- allows participants to continue on their healthy lifestyle.

2021-2022

  1. Create Marketing Materials October- November

Advertise in December- beginning of January

Begin class in January towards the end of the month on Wednesdays

            Phase 1 will run January-July

Incentives

4 Classes in Phase 1: Exercise band – allows participants to work out from home without dumbbells.

            6 Classes in Phase 1: Calorie and Fat counter book- allows participants to really understand calories and fat.

            9 Classes in Phase 1: Bento Box Meal Prep- allows participants to understand that meal prepping is the key to success.

            13 Classes in Phase 1: T-shirt- allows participants to showcase their success.

Phase 2 will run August- January

Incentives

            3 classes in Phase 2: Gym bag- allows participants to take workout clothes anywhere.

            4 Classes in Phase 2: Food Scale- allows participants to weigh their food to ensure they are getting the right portions.

            6 Classes in Phase 2 Body weight scale- allows participants to continue on their healthy lifestyle.

Classes will end January 2022

  1. Create Marketing Materials March – mid April

Start marketing mid April- May

Begin class in June on Thursdays

            Phase 1 will run June-December

Incentives

4 Classes in Phase 1: Exercise band – allows participants to work out from home without dumbbells.

            6 Classes in Phase 1: Calorie and Fat counter book- allows participants to really understand calories and fat.

            9 Classes in Phase 1: Bento Box Meal Prep- allows participants to understand that meal prepping is the key to success.

            13 Classes in Phase 1: T-shirt- allows participants to showcase their success.

            Phase 2 will run January-June

Incentives

            3 classes in Phase 2: Gym bag- allows participants to take workout clothes anywhere.

            4 Classes in Phase 2: Food Scale- allows participants to weigh their food to ensure they are getting the right portions.

            6 Classes in Phase 2 Body weight scale- allows participants to continue on their healthy lifestyle.

 

Classes will end June 2022

Evaluation & Sustainability

Evaluation Plan:

Data is collected utilizing the CDC excel spreadsheet where all clients are given an identification number to remain HIPPA compliant. This information is only sent to the CDC through their secure database collection platform. The initial assessment and final assessment are uploaded into our electric health records CureMD, which allows the clients primary care provider to access the results in a secure way. Data is uploaded to through secure methods to CDC and NCSU to maintain both CDC recognition and grant reporting requirements. 

Sustainability Plan:

The following is our sustainability plan for DPP:

The past 2 years we averaged 14 participants per class but we know that there are more residents who are in need of what DPP has to offer. With the ability to supply incentives through the NCSU grant we are able to increase our numbers and have more participants complete the program. This is especially true with the ability to supply gas cards to those who are inhibited by transportation issues. Phase 2 is where the majority of participants drop out if they plan to discontinue the program most do not believe that it is not important to finish because they have completed the main portion of the class. The incentives  allow the clients to maintain interest till the end of the 24 classes. The NCSU DPP grant is a three year grant that is paid per participant that completesa certain number of classes during the 24 weeks of the program.  We are begininng the process of training another lifestyle coach that will be able to offer the Minority specific DPP thus reaching a wider array of participants. The funding will be provided by MountainWise. Although the grant period ends in 2022, Clay County Health Department will continue to offer DPP to Clay County residents and the surrounding counties. 

Measures
Time
Period
Current Actual Value
Current Target Value
Current
Trend
Baseline
% Change
DPP Weight
PM
2019
4%
5%
1
-33%
PM
2019
233#
150#
2
120%
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy