TABLE 1.

Ecosystem Stakeholder Roles in Consumer Journey

Awareness and EducationRisk Assessment and DiagnosisEnrollment
HCP• Asks about family history• Assesses/screens for long-term risks for developing diabetes• Educates on prevention options and the importance of healthy lifestyle for preventing type 2 diabetes
• Asks about health behaviors• Discusses risk assessment results and consumer’s risk for diabetes• Gives consumer LCP referral
• Explains impact of healthy behaviors and health status• Orders and conducts blood glucose test• Informs LCP that consumer was referred
• Measures consumer’s BMI• Educates on implications of diagnosis• Refers to other resources
• Encourages consumer to share diagnosis/genetic predisposition with family• Assesses comorbidities and complications• Prescribes necessary medication
• Considers health literacy• Assesses potential barriers to and facilitators of action• Fills necessary prescription
• Collects current medical status and medical history• Refers to necessary LCP or HCPs• Follows up on referrals to LCP or other HCPs
• Assesses potential barriers to acting in a healthy way• Follows up with consumer
• Considers insurance
• Follows up with consumer
Health Care System• Ensures that intake forms include type 2 diabetes risk assessment• Coordinates and shares information across HCP groups• Acknowledges National DPP
• Offers information on prediabetes and diabetes across health clinics• Clarifies treatment guidelines• Offers electronic health record system that flags diabetes risk factors and prompts HCPs to offer blood glucose test
• Develops clinical quality measures for prediabetes and diabetes• Accepts new patients• Clarifies treatment guidelines
• Accepts health insurance• Develops guidance for staff to educate patients on diagnoses
• Uses patient-generated health data• Develops referrals and connections across clinics
• Refers to necessary LCP or HCPs• Informs consumer of referral
CDC• National DPP• National DPP• National DPP
 • Promotes DPP • Develops risk assessment • Develops partnerships with organizations and program providers
• Research and surveillance  Promotes risk assessment  Increases program referrals
  Clarifies processes and assumptions in patient care  Updates risk assessment  Provides program technical assistance
  Researches risk factors  Institutionalizes risk assessment  Expands reimbursement and cost coverage resources
  Provides care guidelines  Improves cost-effectiveness  Develops marketing mechanisms
  Conducts disease research  Provides navigation assistance for consumer referrals  Improves cost-effectiveness
 Develops health information tools•Research and surveillance Identifies and develops best practices for enrollment and retention
  Establishes health literacy guidelines  Clarifies patient care processes  Offers list of DPP classes, including locations and times
  Identifies best practices for prevention  Standardizes care guidelines• Research and surveillance
• Education  Develops reporting mechanisms and standards  Develops care and program quality measures
  Raises awareness of type 1 and type 2 diabetes and prediabetes  Expands outreach/screening  Clarify processes and assumptions in patient care
  Clarifies diagnosis standards
Payor• Covers/subsidizes prevention tools• Covers/subsidizes health care acquisition• Covers/subsidizes program costs
• Incentivizes preventive behaviors• Covers/subsidizes risk test/ screening
Family/Community• Shares personal stories/family history of diabetes• Encourages screening and blood glucose testing• Helps consumer understand/ process test results
• Creates informal support groups to encourage healthy behavior options• Shares information on where/how to get a type 2 diabetes risk assessment• Shares personal stories and support for the newly diagnosed consumer
• Shares health education/information materials• Supports community members in identifying risks and fears• Talks through information and questions for HCP
• Works with HCP organizations to develop health education materials• Encourages consumer to act• Encourages participation in DPP or other LCP
• Shares personal stories• Shares information on resources to support lifestyle change
• Encourages consumer to visit HCP with risk assessment results• Monitors/stays alert for any changes in diet, activity, or mental status of consumer
• Provides referral to HCPs• Encourages healthy lifestyle
Policymaker• Manages data collection, warehousing, analysis, and reporting• Standardizes guidelines and reporting requirements• Manages data collection, warehousing, analysis, and reporting
• Develops information-sharing guidelines• Monitors insurance provision• Develops, standardizes, and manages guidelines and reporting requirements
• Ensures that risk assessment has accurate content• Monitors insurance provision
Workplace• Supports health screenings• Offers incentives or health screenings• Offers insurance that covers DPP
• Provides health education materials• Holds information sessions on prevention options• Brings in health educators to discuss diagnoses/answer questions
• Offers healthy food and physical activity opportunities• Has HCPs available for consultation• Allows fitness breaks for employees
• Offers effective insurance provision• Hosts DPP in the workspace
• Offers formal or informal support groups or office hours
• Creates smoke-free environments
Community Partner• Supports health screenings• Offers incentives or health screenings• Helps consumer enroll and participate in the DPP
• Provides health education materials• Offers DPP classes
• Offers healthy food and physical activity opportunities• Provides case management/ navigation while consumer is enrolled in the DPP
• Creates smoke-free environments• Provides financial assistance for medications as needed