Table 2.

Sample adoption, implementation, and maintenance outcomes and performance objectives.

Program: National DPP Setting: Clinic-based
Target: role	Adoption, implementation, and maintenance outcomes	Performance objectives
Adopters
Clinic leadership	Clinic leadership adopts National DPP to prevent diabetes among patients with prediabetes.	Partners with a CDC-recognized National DPP. Delineates the clinic’s National DPP referral goals. Approves legal agreement with National DPP. Designates a clinic program champion to spearhead the implementation of the National DPP referral process. Establishes reporting of participants who meet prediabetes criteria to National DPP.
Clinic administration	Clinic administration optimizes EHR to identify patients with prediabetes and refer them to the National DPP.	Optimizes EHR to facilitate the referral process. Joins the P2P network. Collaborates with EHR vendors to obtain the needed EHR updates and establish a patient identification process. Enables EHR identification of National DPP-eligible patients. Educates staff on EHR National DPP updates. Incorporates the National DPP referral process into the clinic’s workflow. Educates clinics staff about National DPP referral patient criteria. Establishes quality control to monitor the referral process.
Implementers
Clinic administration	Clinic administration monitors the referral system.	Educate clinic staff about the National DPP workflow and make changes to improve productivity. Encourages health care providers to make patient referrals. Identifies gaps in data reporting. Conducts monthly reports of patients who meet prediabetes criteria for National DPP referral. Submits referrals data report to National DPP quarterly.
Health care provider	Health care provider makes referrals of patients with prediabetes to National DPP.	Reviews patient’s medical records. Identifies patients with prediabetes. Discusses National DPP referral with patients with prediabetes. Connects patients to the National DPP providers. Encourages patients to enroll in National DPP. Submits patient referral to National DPP in the EHR. Shares appropriate patient information with National DPP providers.
Program champion	Program champion promotes and educates other clinic staff about the implementation of National DPP.	Advocates for the implementation of National DPP. Motivates clinic health care providers to make National DPP referrals. Ensures that the EHR referral process is operational. Communicates with the National DPP provider to ensure referral feedback. Receives confirmation about patients’ National DPP referral status.
National DPP provider	National DPP provider delivers the National DPP to referred patients with prediabetes.	Coordinates how to receive patients’ referrals with the clinic. Pulls and reviews the database of eligible National DPP patients from the clinic EHR continuously. Coordinates logistics for hosting introductory sessions and National DPP classes throughout the year-long program. Motivates patients to promote adherence to the National DPP program. Provides enrollment and outcome feedback to the clinic.
Maintainers
Clinic leadership	Clinic leadership maintains contractual /data agreements with National DPP providers.	Ensures that the contract is up to date and renews data agreement with National DPP as needed. Monitors fidelity of the referral system.
Clinic administration	Clinic administration consistently monitors the National DPP referral system.	Updates EHR as needed. Continues to review patient outcomes on a regular basis. Collects referral data and reports to providers. Providers continue guidance and training for current and new staff on completing referrals.
National DPP provider	National DPP provider maintains the delivery of the program to patients with prediabetes referred to from clinic.	Coordinates ongoing enrollment of new National DPP cohorts from patients’ referrals. Works with the clinic to continue providing patient status updates.

This table shows a sample of the adoption, implementation, and maintenance outcomes and performance objectives selected for the implementation of the National DPP.

CDC, Centers for Disease Control and Prevention; National DPP; National Diabetes Prevention Program; EHR, electronic health records.

Implementers: clinic administration, health care providers, program champions, and National DPP providers. Maintainers: identified included clinic leadership, clinic administration, and National DPP providers.

Healthcare providers: physicians making referrals, nurse practitioners, and physician assistants.

Program champion: health care providers or clinic administration.

Clinic leadership: chief executive officer, chief operations officer, chief medical officer, and chief nursing officer.

Clinic administration: technology/data analyst, practice administrator, and practice manager.

National DPP provider: lifestyle change coach and program administrator.