Table. Recommended Actions for Implementing the National Diabetes Prevention Program (NDPP): Results From Key Informant (N = 33) Interviews and Discussions With the Los Angeles County Diabetes Prevention Coalition^a .

Phase 1. Activities Identified from Key Informant Interviews (N = 33)a	Phase 2. Feedback from the LAC Diabetes Prevention Coalition
Area 1: Ways to Increase Demand for the NDPP Framework Domain: Expand Outreach and Education
Increase prediabetes awareness
•Promote the Ad Council American Diabetes Association (ADA)/American Medical Association (AMA)/Centers for Disease Control and Prevention (CDC) National Prediabetes Awareness Campaign to increase knowledge and awareness of the NDPP (n = 9). •Work with regional NDPP provider organizations to encourage the use of traditional and social media channels to distribute the campaign (n = 17). •Partner with regional media outlets reaching high-risk ethnic populations to promote the campaign (n = 10).	•Develop a strategy for the coalition to promote the campaign in the region. •Develop relationships with local media outlets to promote the campaign. •Work to tailor the campaign to have more of a local focus and message.
Engage trusted, culturally relevant organizations and individuals to promote prediabetes screening and the NDPP
•Adopt and disseminate non-invasive risk assessments screeners for prediabetes (eg, ADA and CDC prediabetes risk screeners) (n = 33). •Enlist organizations and individuals (eg, promotoras, diabetes educators, churches, community groups, health care systems) to conduct prediabetes screenings and concurrent NDPP promotion and referral (n = 25).	•Work with local health department to disseminate resources for identifying patient risk of prediabetes. •Host regional training on identifying prediabetes risk with community health workers, promotoras, and health navigators. •Partner with local community clinic organizations and community-based organizations (CBOs) to provide educational resources and training to increase screening and referrals. •Partner with Covered California to conduct screening of prediabetes risk with individuals applying for health insurance.
Outreach to employers to promote NDPP
•Identify and develop resources for how to work with local employers to implement the NDPP (n = 20). •Work with employers to identify opportunities to offer onsite classes for employees and/or refer employees to NDPP programs in the region (n = 20). •Develop materials and resources on return on investment (ROI) of the NDPP, including impacts on absenteeism and worker productivity (n = 21). •Partner with regional organizations that work directly with large employers (eg, Los Angeles Chamber of Commerce Health Committee chapters, unions) (n = 8). •Facilitate healthy competition, for example, invite employers to publicize NDPP success stories (n = 6).	•Work with local health department to identify organizations (ie, employers, nonprofits) to adopt the NDPP for employees. •Partner with third-party groups to identify organizations interested in scaling the NDPP. •Host a convening of regional employer human resource departments to educate them about the NDPP and identify opportunities to implement the program. •Partner with local health plans to identify employers with robust worksite wellness options to discuss providing NDPP services on site for employees. •Identify models for how NDPP providers can work with employers in the region.
Area 2: Ways to Engage Health Care Systems Framework Domain: Improve Health Care Referrals Systems and Protocols
Educate health care providers on prediabetes screening and the NDPP
•Survey clinics to understand local health system approaches to identifying, referring, and enrolling individuals into the NDPP (n = 18). •Identify key individuals/organizations to facilitate conversations with health care systems (eg, chief medical officers, Community Clinic Associations) to identify education needs (n = 20). •Develop (as needed) and disseminate materials and toolkits for educating providers on the NDPP (eg, AMA CDC Prevent Diabetes STAT Toolkit, US Preventive Services Taskforce prediabetes screening guidelines) (n = 30). •Develop continuing medical education resources around prediabetes risk and identification and referral to the NDPP (n = 30).	•Work with local health department to develop/adapt materials and provide training and technical assistance for educating providers on the NDPP. •Partner with local health department to develop continuing medical education for providers and lay practitioners on the NDPP. •Partner with local health department to develop and pilot test NDPPs within local health systems.
Promote use of electronic medical records (EMRs) to generate lists of patients with prediabetes and generate automatic referrals
•Develop mechanisms and protocol for local health care systems to: 1) query EMRs to generate lists of patients with prediabetes (n = 20); use EMRs to generate patient referrals to the NDPP and other programs (n = 13); 3) create feedback loops between NDPP providers and health care providers to track patient NDPP enrollment and progress (n = 25). •Partner with organizations implementing EMRs (eg, CBOs, NDPP providers) to develop infrastructure for identification, referral, and enrollment in NDPP (n = 14).	•Partner with local health departments to develop/adapt materials for health systems to use to educate providers on the NDPP. •Partner with local health care systems to develop infrastructure to screen, refer, and enroll patients into the NDPP. •Develop a comprehensive database for chronic disease prevention and management programs in the region for providers to use to refer patients. •Partner with meaningful use governing boards to create practice-based models for screening and referring into the NDPP. •Partner with local health care systems to evaluate and identify best practices for implementing NDPP in the region.
Create financial and quality measure incentives for addressing prediabetes (n = 33)
•Partner with health and medical groups (eg, CDC, Community Clinic Association of Los Angeles County) to promote: 1) including prediabetes screening in National Committee for Quality Assurance regulatory requirements for quality of care; 2) creating Health Care Effectiveness Data and Information Set measures for NDPP components; 4) incorporating NDPP in patient-centered medical home certification. •Partner with research institutions to conduct an economic analysis of the NDPP looking at ROI. •Engage health care systems and providers in quality improvement projects that focus on NDPP referral processes.	•Develop a white paper looking at the ROI for health care system implementing the NDPP. •Develop a white paper on facilitators and barriers to implementing the NDPP in health care settings.
Area 3: Ways to Increase the Supply and Capacity of NDPP Providers Framework Domain: Increase Access to and Insurance Coverage for the NDPP
Expand the network of CDC-recognized NDPP providers
•Develop resource inventory to include maps of current NDPPs in the region (n = 10). •Identify community organizations in high-need areas who may be interested in developing programs like the NDPP (n = 7). •Develop resources and training opportunities on the CDC NDPP recognition process to make it understandable and accessible to local community organizations (n = 20). •Identify funding sources to provide lifestyle coach training with no costs to participants (n = 23). •Work with small regional organizations serving low-income and ethnic populations to become recognized NDPP providers (n = 7). •Conduct training and technical assistance with regional organizations to obtain CDC recognition (n = 4). •Convene local CBOs and other potential provider organizations to discuss barriers and facilitators to implementing the NDPP (n = 17). •Work with existing recognized NDPP programs to: 1) expand their NDPPs to hard-to-reach areas; 2) develop a train-the-trainer model for NDPP program development and recognition; 3) partner with regional CBOs to host NDPPs for community members. •Identify funding opportunities to expand NDPP efforts (eg, ADA, AMA, regional hospital community benefits departments) (n = 33).	•Create resource inventory to identify and map NDPP providers in the region. •Facilitate resources and/or funding for CBOs to become recognized NDPP providers. •Provide trainings and technical assistance on how organizations can become CDC-recognized, especially with regard to data collection and reporting. •Identify and reach out to organizations working on chronic disease management to see if they are interested in providing NDPP. •Develop budget templates that organizations can use when establishing NDPPs. •Develop best practices resources of what has worked with providers regionally and locally in developing NDPP efforts. •Work with members of the coalition to identify funding opportunities (hospital benefits departments, etc.) for developing NDPPs.
Improve the cultural relevance of NDPP
•Tailor NDPP curricula/materials to meet the needs of a variety of cultural and linguistic groups (n = 27). •Identify top 5 languages/cultures in the region and translate NDPP materials into those priority languages (n = 27). •Train lifestyle coaches to provide curriculum in priority languages identified for the region (n = 10). •Identify culturally competent lifestyle coaches to provide NDPP in priority languages (n = 10).	•Facilitate resources for CBOs to adapt/create materials and toolkits for NDPP implementation. •Adapt NDPP lifestyle coach training opportunities to include training options in languages identified as priority in the region. •Provide training for NDPP providers to include other issues impacting participants (eg, mental health).
Evaluate local prediabetes data
•Identify methods for collecting prediabetes prevalence data (n = 8). •Monitor ongoing data collection and analysis of regional NDPP providers (n = 8). •Report and disseminate prediabetes data to help identify best practices (n = 3). •Publish papers on facilitators and barriers to implementing the NDPP (n = 10).	•Develop a survey for key stakeholders to understand the local impacts of prediabetes and the need for the NDPP.
Conduct NDPP implementation evaluation in existing and new pilot sites
•Develop an evaluation toolkit that can be implemented in across NDPP sites that includes information on what data to collect, data sources, how to analyze data, and how to report to CDC (n = 13). •Develop resources to measure: 1) enrollment and retention: Individuals’ decision-making processes; 2) program delivery (providers, cost, location, languages, frequency, use of personal scales); 3) impact (adoption of healthy behaviors, progression to diabetes). •Evaluate fidelity of NDPP implementation among local NDPP providers (n = 18).	•Convene key stakeholders to identify and prioritize data sources for evaluating implementation of the NDPP in the region. •Develop platform to facilitate sharing of NDPP program data. •Develop an evaluation plan for NDPP providers to use to measure success. •Conduct research of NDPP implementation efforts and disseminate reports on findings. •Disseminate finding of outcome data of existing pilot programs. •Develop and disseminate best practices from data collected through pilot projects in the region.

Abbreviations: LAC, Los Angeles County; NDPP, National Diabetes Prevention Program; STAT, Screen/Test/Act Today; CBOs, community-based organizations.

^a All themes and actions were generated from response rates from participants in key informant interviews and the in-person strategic planning session. Numbers in parentheses indicate how often the recommended action was recorded during the key informant interviews.