Table 5.

Sample matrices of change objectives for the maintenance of the National Diabetes Prevention Program among participating clinics in Texas, United States.

Maintenance outcome: Clinic administration consistently monitors the National DPP referral system.
Performance objectives	Perception and awareness	Outcome expectations	Feedback and reinforcement	Interorganizational relationships
PO1. Clinic administration updates EHR as needed.	PA1a. Acknowledge that the program champion can successfully lead the clinic’s National DPP referral process.	OE1a. Believe that the program champion understands that the National DPP referral process fits the clinic’s diabetes management goals.	FR1a. Express that the program champion will acknowledge the benefits of the adoption of National DPP.	IR1a. Recognize that the program champion will support the National DPP referral efforts.
PO2. Clinic administration continues to review patient outcomes on a regular basis.	PA4b. Describes referring patients with prediabetes to National DPP as a good fit for the clinic to decrease prediabetic patients’ risk of developing diabetes.	OE3a. Expects that incorporating the National DPP referral process into the clinic’s workflow will contribute to the successful implementation of the National DPP referral.	FR3a. Recognize that incorporation of the National DPP into the clinic’s workflow will result in increased referrals to National DPP.	IR3. Recognize that incorporating the National DPP workflow can help healthcare providers and other clinic staff complete the necessary steps to identify new and existing patients with prediabetes.
PO3. Clinic administration collects referral data and reports to providers.	PA4a. Perceive the success of the National DPP program in preventing diabetes. PA4b. Acknowledge the ability to discuss the National DPP referral with patients.	OE4a. Expect that the patient may not trust the National DPP program without a conversation with their provider.	FR4a. Express positive attitude about discussing the National DPP referral with the patient.	IR4a. Recognize that provider-patient communication increases trust in the patient for the National DPP. IR4b. Recognize that the discussion with the patient may increase their likelihood of attending and fully adhering to the National DPP.
PO4. Clinic administration provides continues guidance and training for current and new staff on completing referrals.	PA4. Describes resources and the importance for continuing provider about the DPP.	OE4. Expects that prioritizing continuing education will help current and new providers stay up to date with referral protocols for identifying and refer patients to the National DPP.	FR4. Expresses that continuing training is important to keep up with guidelines and help new staff gain the knowledge needed to make referrals.	IR4. Recognizes the importance of continuing education to maintain the referral numbers/process when new staff are hired.