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Goal: A broad statement that captures the overarching purpose of the intervention – not
measurable. The workplan can have more than one goal.

Measurable Objectives: Realistic and tangible targets for the intervention – objectives
should relate to the activities column of your workplan and set specific numbers/types of
activities to be completed by a certain date. The objectives should be for the first and
second year of the intervention.

Activities: Events or actions that take place as part of an intervention. Activities are what
is actually done to bring about the desired effects or changes of the intervention and are
supportive of the objectives. The activities should be for the first and second year of the

Impact: The intended effects or changes that directly result from the intervention. The
impact should represent the results of the first year of the intervention.

Evaluation: How the activities and impact are measured. Includes both process and
outcome evaluation for activities and impacts in the first and second year of the
intervention. Each objective does not need both process and outcome evaluation;
however, the entire workplan should include both process and outcome evaluation.
Goal: Introduce systems changes to improve diabetes prevention among individuals at risk for diabetes by applying
the Chronic care model to diabetes prevention in a primary care setting.
Description of Intervention in Year 1: Develop and implement systems changes under the following headings 1)
The health care organization; 2) Community resources and policies; 3) Self-management support ; 4) Decision
support ; 5) Delivery system design; 6) Clinical information systems to improve diabetes prevention in the practice
Measureable Activities for Year 1 Impact for Year 1 Evaluation for Year 1
Objectives for
Year 1
By March ‘07 Contact appropriate Developing a plan for # of healthcare providers on panel
create a work healthcare providers application of CCM to # of meetings scheduled
group with at Schedule meetings diabetes prevention
least 10 Research interventions
healthcare using the CCM for
provider diabetes prevention
to provide
input on
changes for
By May ’07 Determine providers Enhanced quality of # of pre diabetics identified
pilot test the participating in diabetes diabetes prevention and #of pre diabetics enrolled in prevention
intervention prevention efforts increased identification and services
for systems Obtain approval of referral of pre-diabetics to # of providers participating in pilot test
change in one recommended systems appropriate services. feedback of participating providers
primary care change
By May ’08 Healthcare providers % of providers screening for pre
using data modify office practice diabetes
collection to incorporate pre diabetes # of individuals screened
systems to screening and care into # of individuals identified w/ pre
monitor and routine office visits. diabetes
track patients Individuals are more % of individuals identified w/ pre
with pre aware of their risk for diabetes who follow
diabetes report diabetes. recommendations
on no. of Individuals have Results from needs assessment
individuals improved access to survey completed by community
screened and services at the community health center
enrolled in health center. patients (including demographics)
diabetes The community health % increase in patients at the center
prevention center has during Year 1
programs increased capacity Results from patient satisfaction
and ability to provide survey of center diabetes prevention
quality care. services