HomeMy WebLinkAboutAgenda - 08-18-2009 - 4fORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: August 18, 2009
Action Agenda
Item No. .~-
SUBJECT: Diabetes Self-Management Program Grant Funds
DEPARTMENT: Health PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Grant Award Letter
Grant Application
Budget
INFORMATION CONTACT:
Rosemary Summers, 245-2411
PURPOSE: To accept grant funds from Kate B. Reynolds Foundation to implement the
Diabetes Self-Management Program in the Health Department for Orange County residents.
BACKGROUND: The Health Department applied to the Kate B. Reynolds Foundation in the
Spring of 2009 for a grant to defray costs for a diabetes self-management program that is a part
of the Health Department strategic plan. A special NC Program allows local health departments
that meet certain qualifications to bill Medicaid and private insurance for diabetes education
services. This grant provides a bridge for services to be started while qualifications are obtained.
The goal of the program is to achieve better management of diabetes, increase access through
an active treatment and referral network, improve health outcomes, and reduce healthcare
costs. The burden of diabetes in Orange County, as identified in the 2007 Community Health
Assessment, indicates that approximately 5,123 adults have been diagnosed and are living with
diabetes. While the overall Orange County mortality rate for diabetes is well below the state
average, the minority death rate is much higher at 44.7 deaths per 100,000 people. In addition
to the burden of disease, many residents are not receiving or accessing adequate preventive
care for their illness. The 2006 Orange County Behavioral Risk Factor Surveillance Survey
estimated that only 55% of those diagnosed with diabetes had taken a course on diabetes
management. This equates to 2,305 County residents who have been diagnosed but not
received education on how to manage the disease. Currently, UNC Healthcare and Duke
University Medical Center provide American Diabetes Association-recognized Diabetes Self
Management Education (DSME) programs in Durham County. There are no known DSME
programs in Orange County,
The program consists of four elements:
(1) Diabetes self-management education (DSME),
(2) Medical provider education,
(3) Improved DSME Marketing and Referral Plan, and
(4) Medical Nutrition Therapy and follow-up services.
2
The educational program is planned for various locations, times and settings in both northern
and southern Orange to ensure access for low income patients. The attached grant application
details the need and proposed program details.
Kate B. Reynolds awarded $202,532 for atwo-year grant period (August 1, 2009 -July 30,
2011) for operating funds to defray costs for Orange County low income individuals who
participate in the diabetes self-management program. The grant funds will be used to hire
contract staff, support continuing education requirements, purchase laptops, software, and
docking stations, capital furnishings, and supplies as the program is developed. No staff
positions are added during the grant period. Contract staff will have specific project
responsibilities to minimize disruption of current service delivery by permanent Health
Department staff. The attached budget details line item costs for the program.
A team of Health Department staff will develop a business plan that achieves self-sufficiency for
the program. The team is attending the UNC Management Academy where it will obtain skills
for business planning over the nine-month course and utilize the development of this program
as the capstone for the Academy. Tuition for local health department participants in the UNC
Management Academy is paid by the NC Division of Public Health.
The Department will present a first year report of accomplishments and a business plan to the
Board of Commissioners in the summer of 2010.
The Department, in consultation with the Budget Office, requests the establishment of a grant
ordinance for this project. The grant is not a standard County fiscal year and requires careful
tracking and reporting to the grant agency. A grant ordinance facilitates tracking and reporting
of all grant-related expenditures.
FINANCIAL IMPACT: The grant amount is $202,532 over atwo-year period (August 1, 2009-
July 30, 2011) covering all direct costs associated with the program. The business plan created
by the staff program team, expected to be completed in May of 2010, will detail aself-sufficiency
plan for this program. Grant coverage of start-up costs and sustaining on-going costs by billing
for qualified services will minimize additional County costs. A report to Commissioners will be
made prior to the grant ending.
RECOMMENDATION(S): The Interim Manager recommends the Board accept funding from
Kate B. Reynolds Foundation in the amount of $202,532 for the Diabetes Self Management
Program, direct the staff to create a grant ordinance per the program budget, and authorize the
Chair to sign the grant acceptance statement.
June l0, 2009
Dr. Rosemary Summers, Health Director
Orange County health Department
300 West Tryon Street
Hillsborough, NC 2727E
Dear Dr. Stlmasas:
Congratuhuions. At its meeting oa May 29, 2009, the Corporate Trustee of the Kota B. Reynolds Charitable
Trust', upon rocommendation of the Heahh Care Division Advisory Board, spproved a two-year 5184,120 great
for operating funds W start a diabetes self alru~agcment edeu~Riore program serving low-income individuals ivn
Orange County as described in your application. Additionally, 518,412 was approved -for indirect expenses for a
total grarrt of 5202,532.
The full grant payment of 5202,532 will be made when you are ready to utilize the fue~is. Please budget these
funds for use over the two-year Brant period as specified in your applicxtioa. Aelnual based oo the
information preseee0ed in your application will be requaed. Appropriase report fot~ are available through our
website ~ http://www.kbrorg/grant-rcport-forms.
Your grant number is 2009-209. Please refer ~ this number in ap communicaiioa re$atdirrg this award.
To accent this trans your board chair mast siaa erred date tke attached acceotaace st:temest and retnra it
to me within 30 days.
As a grantee, the Trust is excited to offer you three years of membership in the North Carolina Ceuta for
Nonprofits. The Trust will pay your dues socording to the following schedule: Year 1-100•Y•, Year 2-75'/e, and
Year 3-25'X.. If you are not already a member, please complete the enclosed form ald mail it to the North
Carolina Cwta for Nonprofits.
We may wish to include your grant award in press releases prior to the publication of our Annual Report. If this
is not satisfactory with you, please let us know when you return the aocepcance fit. You may publicize
the grant in atry manner you feel appropriate. Please inoorporamethcenclosed-information about the Trust in
your publicity.
We are looking forward to participating in this important program and wish you and your associates much
success.
Sincerely,
A1R6 J. Sanart\\~
Senior Frogmen Officer
(336)397-5511
AJS:dbl
Enclosures
oc: Anissa 1. Vines, Vice Chair
1,28 REYNOLOA VILLAGi • WINLTON-SALEM, NG 27 1 06-3 1 2 3
93df723-1456 • FAX 956/723-7765 • WEB SITE: 11rWw.l~[.Of~Q • titOW48s-9080 (N.C
Orange County Health Department's Grant Proposal
ORGANIZATIONAL CAPACITY
1. What is your organization's mission? The Orange County Health Department is a team of
100 multidisciplinary professionals within five divisions that serve approximately 124,000
residents in Orange County. The Health Department's mission statement is: "To enhance the
quality of life, promote the health, and preserve the environment for all people in the Orange
County Community. The department's 2006-2011 strategic plan recognizes the need for
prevention and management of diabetes and chronic disease. Our proposed diabetes self-
management education program aligns with the department's mission and strategic plan. The
goal is to provide diabetes self-management education and counseling to people with diabetes to
promote better management of the disease, increase access through an active treatment and
referral network, improve health outcomes, and reduce healthcare costs.
2. What have you achieved in the past three years? Over the past three years, Orange
County Health Department has worked toward our mission to "prevent, promote, protect" with
the following major achievements related to chronic disease prevention and management:
• Accredited by the North Carolina Local Health Department Accreditation Board, June 2008.
• Maintained active relationships with over 50 community agencies and organizations.
• Formed a Diabetes Task Force in 2006 and developed a Diabetes Resource Guide for Orange
County which is available to residents on our website (www.co.orange.nc.us/health).
• Since 2005, partnered with Department on Aging to offer a 6-week diabetes class series.
Evaluations have shown an increase in participant knowledge, skill for prevention and
management, and overall satisfaction with the program.
• Doubled the number of Medical Nutrition Therapy (MNT) services provided by the
department's Registered Dietitian (RD). Approximately 90% of referrals have been due to
obesity and chronic disease and two thirds are at the 0-20% pay level on the sliding fee scale.
Client outcomes include improved AlC, weight loss, and greater blood pressure control.
Increased referrals are contributable to clinicians recognizing the importance of MNT in
chronic disease management.
• Became a medical home for underserved populations by expanding preventive clinical
services to include Primary Care. Men, women and children enrolled in our prevention
programs have been able to receive sick care and ongoing management of chronic diseases.
In 2007-08, 398 clients received 730 primary care services.
• In the past two years, a Chronic Disease Care Coordination Nurse provided 113 encounters
to 16 non-Medicaid Adults in Orange County. Of the eight adults diagnosed with diabetes, six
improved their blood sugars or A1C. Three adults were sight-impaired and were taught to
monitor their blood glucose using talking monitors. *This service was discontinued due to
budget cuts and the need to re-allocate staff to mandated services.
• Implemented an Eat Smart-Move More Churches program in which 13 African-American
churches, with the support of $500 mini-grants, developed health ministry teams to promote
policy and environmental change to improve nutrition and increase physical activity.
YOUR PARTICIPANTS
3. What issue are you addressing? How many individuals or groups within your focus
area are affected by it? The proposed project will address the issue of diabetes care and self-
management. The burden of diabetes in Orange County, as identified in the 2007 Community
Health Assessment (CHA) indicates that approximately 5,123 adults have been diagnosed and
Orange County Health Department's Grant Proposal
are living with diabetes. In addition, there are thousands more adults living with undiagnosed
diabetes as evidenced by the NC Diabetes Prevention and Control Branch estimation that
228,000 adults statewide are living with undiagnosed diabetes. The diabetes death rate in
Orange County for the 2002-2006 period was 17.1 per 100,000, somewhat lower than the state
rate of 27.1 per 100,000. However, the minority death rate in Orange County due to diabetes
was much higher at 44.9 per 100,000.
In addition to the burden of disease, many residents are not receiving or accessing adequate
preventive care for their illness. The 2006 Orange County Behavioral Risk Factor Surveillance
Survey (BRFSS) estimated that only 55% of those diagnosed with diabetes had taken a course on
diabetes management. This equates to 2,305 county residents who have been diagnosed but not
received education on how to manage their disease. Currently, UNC Healthcare and Duke
University Medical Center provide American Diabetes Association (ADA) recognized Diabetes
Self Management Education (DSME) programs in Durham County. There are no known DSME
programs in Orange County.
The BRFSS also estimated that in 2006, about 30% of people with diabetes had less than two
A1C tests (recommended twice annually) and 36% had no foot exam in the previous year
(recommended annually). Additionally, there is concern about the number of residents who self
monitor their blood glucose as recommended. The CHA community survey indicated that only
37.4% of respondents checked their blood glucose one or more times/day (recommendation is 4
times/day) and 22.5% checked their blood glucose one or more times/week (State Center for
Health Statistics, 2006 BRFSS).
People with diabetes are also at increased risk for co-morbidities that could result in
hospitalizations. In 2006, there were 152 diabetes-related hospitalization costing $14,525
average cost per case. (Impatient Hospitalizations and Charges by Diagnosis and County of
Residence, SCHS).
Many factors contribute to the onset and management of diabetes including family history,
unhealthy eating behaviors, inactivity, obesity, rural living conditions, limited access to health
care and medications, and lack of education about the disease. Only 48% of residents are
meeting recommendations for physical activity, only 23.5% are meeting recommendations for
fruit and vegetable intake and 56% of Orange County adults are overweight or obese,
contributing to the increasing prevalence of diabetes.
In addition to lifestyle factors, a large proportion of residents have trouble accessing the needed
healthcare services for preventive and management of chronic disease. There are 13.9%
uninsured county residents and 32% who live in rural areas, where there are few health care
resources and very limited public transportation (Economic Development Commission Report,
2007). We anticipate an increase in the prevalence of under/uninsured residents due to current
economic conditions, and vulnerable populations may face additional health and wellness
challenges impacting individuals, families, and the entire community.
J
2
Orange County Health Department's Grant Proposal
4. Describe the participants who will be included in your program. How many are
financially needy? Are the participants different in any way from the full population you
describe in question three? Our DSME program will be available to county adults who have
been diagnosed with diabetes. Our marketing plan is focused on targeted outreach to those who
have historically lacked access to such services including minority populations, the
under/uninsured, those living in rural areas, and those lacking transportation to classes offered
outside the county.
The actual participant profile is unknown at this time but will focus on the underserved noted
above. Our goal is to enro1160 residents in the first year of the grant, with up to 50% being
uninsured. In our second year when we are ADA certified, we seek to enroll 80 participants with
up to 50% being uninsured. (Current health departments in the NCDERP have reported enrolling
80 participants in the first year.)
In addition to our primary participants, our program will also include education, training and
outreach to community medical providers. The marketing plan includes training and education
on the standards of medical care for diabetes including recommendations, referral systems, and
multidisciplinary disease management.
YOUR IMPACT
5. What impact are you committed to achieving? How many of the participants will
achieve that impact? At least 50% of participants will have an improved Al C three months
after completing the program compared to baseline as evidenced by the data tracking system
(Tiara Software). At least 50% of participants will have an annual foot exam as evidenced by the
data tracking system.
In order to improve A1C levels, participants must make changes in self-management behaviors
including: healthful eating, being active, self-monitoring, taking medication, problem solving,
reducing risks, and healthful coping. These are American Association of Diabetes Educators
(AADE) standards of outcomes for DSME and a focus of our program.
In addition to individual behavior change, we are committed to achieving an improved systems-
level change in the following ways: Providing at least two community medical provider
trainings within the grant time period on the standards of medical care for diabetes including
definitions, recommendations, referral systems, and multidisciplinary disease management for
our medical providers; and becoming an ADA recognized DSME program under the umbrella of
the NCDEIZP.
6. How many of the participants would be likely to achieve the anticipated impact if your
program did not exist? No state or local data are available to estimate the number individuals
likely to achieve the anticipated impact. See county data presented in question three regarding
current behaviors and health status of people with diabetes in diabetes in Orange County.
YOUR PROGRAM
7. Describe the work for which you seek funds. What approach will you use to achieve the
anticipated impact? We are seeking grant funds to support our efforts to provide diabetes self-
management education and counseling to people with diabetes to promote better management of
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Orange County Health Department's Grant Proposal
the disease, improve health outcomes, increase access through an improved treatment and
referral network, and reduce healthcare costs. Coordination of these services will qualify us to
become an ADA recognized DSME program under the `umbrella' of NCDERP. The OCHD in
collaboration with the Department on Aging currently provides diabetes education classes
throughout the county. The program has been well received by participants but limited staff and
resources have resulted in fewer classes offered with reduced attendance. There are no ADA
recognized DSME programs in the county nor a comprehensive referral and standard treatment
system in place.
Our program will include the following four elements: (1) DSME (2) Provider education and
training, (3) Improved DSME Marketing and Referral Plan (4) MNT and follow-up. The
program will be offered in various locations, times and settings within the county (in both the
northern and southern parts) to ensure access.
Our approach to these elements is:
1. DSME will be provided in accordance with the ADA and the NCDERP: All clients referred
will receive an initial assessment provided by a Registered Dietitian or Registered Nurse.
This will be followed by eight hours of DSME classes conducted by trained interdisciplinary
health professionals. Afollow-up assessment will be conducted at three months to measure
A1C and compliance with self-management behavior changes learned throughout the
program. Behavior change tools will be strategically awarded throughout the program to
promote program completion. With grant funding, we also aim to provide limited glucose
monitors, testing strips, A1C tests, and medication for the uninsured with the goal of
transitioning to pharmacy assistance programs.
2. The Diabetes Task Force will offer provider education and training in a seminar format at
least once annually. At these seminars, we plan to instruct providers on the standards of
medical care for diabetes including recommendations, referral systems, and multidisciplinary
disease management for medical providers. Our marketing plan includes the provision of
provider `toolkits' for program promotion and recruitment.
3. The DSME marketing and referral plan approach will be based on social marketing
principles and includes these key components: formative research with potential participants
and providers to improve program awareness and recruitment, behavior change messaging,
and targeted outreach efforts.
4. MNT will be offered as a complement to DSME to all participants enrolled. We will provide
referral information and education about MNT to participants and their medical providers
throughout the course of the program and during the follow-up period. Follow-up strategies
after completing the DSME program will include six and nine month contact by phone to
measure compliance with self-management behaviors. A one-year DSME follow-up group
class will also be provided.
8. Is your approach backed by evidence of success? If so, what is it? Examples of evidence
supporting our approach include the following:
Several studies have found that DSME is associated with improved diabetes knowledge and
improved self-care behavior, improved clinical outcomes such as lower A1C, lower self-reported
weight, and improved quality of life (Diabetes Care 1-2009)
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4
Orange County Health Department's Grant Proposal
It is well documented that MNT is an integral component of diabetes prevention, management,
and self-management education (Journal of ADA 2008). Because DSME and MNT provide
different behavioral modification techniques, they are complementary and maybe more
medically effective for some beneficiaries than receipt of just one of the components. Research
indicates MNT combined with DSME improves outcomes (American Association of Diabetes
Educators, ADA 4-2005).
Social marketing is an innovative behavior change discipline developed in the 1970s and is most
effective for sustaining healthful or socially beneficial behavior change, increasing program use,
or building customer satisfaction with existing services (Weinreich 1999). Social Marketing
constructs are used by well-known organizations such as Centers for Disease Control and
Prevention, National Cancer Institute and National Heart Lung Blood Institute.
TRACKING TO SUCCESS
9. How will you know when your impact has been achieved? What information or
evidence will you use to verify success and/ or make course corrections in your program?
The program coordinator will be responsible for ensuring that our program is meeting the
NCDERP guidelines to become an ADA recognized DSME program and will also monitor
progress towards achievement of grant impacts. The coordinator's responsibilities will include
overall quality control for data collection, medical provider recruitment, training, and referral
system, monitoring participant attendance and follow-up, program auditing, marketing efforts
and instructor evaluations. Data including participant demographics and DSME outcome
measures including A1C levels will be tracked in Tiara Software purchased from NCDERP.
Additional program impact data points will be tracked in Microsoft Excel. The program
coordinator will convene a subcommittee of the Diabetes Task Force who will meet regularly to
monitor program progress and make adjustments as needed.
10. What do you most want to learn from this program? We hope to learn the most
effective strategies to engage practitioners in the referral and program promotion process and
which client marketing and recruitment techniques were the most successful. Did our methods
increase. the number of participants? Were medical providers satisfied with the provider training
and outcomes of referred participants who completed the program? We also want to track
program participants to learn if we were effective in reaching the under/uninsured and if not,
why? Did participants reach their self- management behavior change goals? How did
participants define `success'? Did A1Cs improve? Why did some participants fail to complete
the program? Do participants receiving MNT in addition to DSME have better health outcomes
than those who do not? Once ADA recognition is achieved, will the reimbursement of insured
off set the cost for the uninsured participants? Can we find Pharmaceutical Assistance Programs
for our un/under insured participants?
S
5
county
line item
53010C
53050C
54000C
55000C
59000C
591000
611000
620000
620050
629000
680007
800100
801000
Oran a Count Health De t DSME Pro ram: O eratin Bud et Year 1
Detail price per
UNIT # units
needed type of
units
Total Cost
CONTRACT SERVICES/PERSONNEL S Su ' otal 635.00
Pro'ectCoordinator RD avers er20hr/week $ 30.00 1,040 hrs $ 31,200.00
Admin Asst averse 10 hrs/week $ 15.00 520 hrs $ 7,800.00
DSMEintsructors DSMElnstructors $50 ersession $ 50.00 60 hrs $ 3,000.00
Inter reter $55 X 75hrs $ 55.00 75 hrs $ 4 125.00
Health Communications Intern $13 hrX 270 $ 13.00 270 hrs $ 3 510.00
TRAINING ro wired trainin s for 5 staff $ 1,000.00 5 staff 5 5,000.00
PERSONAL MILEAGE a rox 300 mi/es ermonth $ 0.55 3,636 miles $ 2,000.00
TELEPHONE s esker hone for tele-conferencin
$ 200.00
POSTAGE .44 erstandard iece $ 0.44 1,000 $ 440.00
DUPLICATING B&W, double-sided and color co in $ 0.03 varies co ies S 1,500.00
PRINTING notebooks & si na e
$ 4,000.00
SUBSCRIPTION/PARTICIPANT State Umbrella Partici ant Fee $4 er erson $ 4.00 60 clients $ 240.00
DEPARTMENTAL SUPPLIES DEPARTMENTAL SUPPLIES Sub Total $ 9,701.00
Behavior Chan a Tools edometers,lo s,etc 60 artici ants clients $ 6,000.00
Health sam le food for class 60 artici ants clients $ 3 000.00
Resource texts
$ 521.00
Medical Records su lies 60 artici ants clients $ 3.00 60 clients $ 180.00
EDUCATIONAL SUPPLIES Teachin tools: models, dis la s, ames, DVDs 5 6 400A0
OTHER SUPPLIES/CLINICAL SUPPLIES OTHER SUPPLIES Sub Total $ 8 121.00
Al C tests and controls
$ 1 198.00
GlucometerStri s $20 erbottle $ 20.00 250 bottles $ 5,000.00
Glucometers $9 er unit $ 9.00 30 meters $ 270.00
Lancin devices & Lancets Lancin = $7.84/ea~ Lancets $3.94 32 k 30 atients $ 1 653.00
COMMUNITY PROJECT SUPPORT/MARKETING COMMUNITY[PROJECT SUPPOR ! MKTG Sub Total. $ 16 Z00.00<
Focus Grou s 2-3 row s X 15-25 artici ants X $20
$ 2,000.00
PSAs, website, si na e; ra hics for exhibit board $ 1,500.00
Promotional fliers/ osters/ ostcards "In-house ra hic develo ment $ 4,000.00
Medical Provider Referral Kits
$ 1,000.00
Print Ads $ 2 500.00
Brandin items with to o & contact info $ 2 500.00
Diabetes Task Force Trainin /U date 2 meetin s er ear $ 2,700.00
IT CAPITAL TECHNOLOGY 1T PI L TECHNOLOGY Sub Total $ 4,22D.D0
Re ortin Software Tiara software re wired b State Umbrella $ 200.00
Two La to s, software, dockin station case
$ 4 020.00
CAPITAL FURNISHINGS Add-on to desk & office rollin chair $ 1,000.00
TOTAL
$ 108,657.00
y
county
line item
53010C
530500
550000
590000
591000
611000
620000
620050
629000
680007
Oran a Count Health De t DSME Pro ram: O eratin Bud et Year 2
Detail price per
UNIT # units
needed type of
units
Total Cost
CONTRACT SERVICES/PERSONNEL CONTRACT SVGS I PERSONNEL Sots Total `' $ 49635,001
Pro'ect Coordinator RD avers er 20 hr/week $ 30.00 1,040 hrs $ 31 200.00
Admin Asst averse 10 hrslweek $ 15.00 520 hrs $ 7,800.00
DSME Intsructors DSME Instructors $50 er session $ 50.00 60 hrs $ 3 000.00
Inter reter $55X 75hrs $ 55.00 75 hrs $ 4,125.00
Health Communications Intern $13 hrX 270 $ 13.00 270 hrs $ 3,510.00
.2 FTE Staff Re istered Dietitian OCHD STAFF count in kind
.1 FTE Staff Public Health Nurse OCHD STAFF count in kind
.2 FTE Staff Communication S ecialist* OCHD STAFF count in kind
TRAINING re uired trainin s for 5 staff $ 1,000.00 5 staff S 5 000.00
PERSONAL MILEAGE a rox 300 miles ermonth $ 0.55 3,636 miles S 2,000.00
POSTAGE Direct mail osta a 44 cents er iece $ 0.44 1,000 stam s 5 440.00
DUPLICATING B&W, double-sided and co/orco in $ 0.03 varies co ies $ 1,500.00
PRINTING notebooks & si na e
b a ooo.oo
SUBSCRIPTION/PARTICIPANT State Umbrella Partici ant Fee $4 er erson $ 4.00 60 clients 5 140.00
DEPARTMENTAL SUPPLIES bEPARTMENTAL SUPPLIES Sub Total S 8 701.00
Behavior Chan a Tools edometers to s etc 60 artici ants clients $ 5,000.00
Health sam le food for class 60 artici ants clients $ 3 000.00
Resource texts $ 521.00
Medical Records su lies 60 artici ants clients $ 3.00 60 clients $ 180.00
EDUCATIONAL SUPPLIES Teachin tools: models, dis la s, ames, DVDs $ 3,000.00
OTHER SUPPLIES/CLINICAL SUPPLIES OTHE R SUPPLIES Sub Total $ 7,121.00
A1C tests and controls
GlucometerStri s
$20 erbott/e
$ 20.00
250
bottles
$ 1,198.00
$ 4 000.00
Glucometers $9 er unit $ 9.00 30 meters $ 270.00
Lancin devices & Lancets Lancin = $7.84/ea; Lancets $3.94 32 k 30 atients $ 1,653.00
COMMUNITY PROJECT SUPPORT/MARKETING COMMUNITY PROJE CT SUPPORT Sub Total $ 12,238.00
Focus Grou s 2-3 rou s X 15-25 artici ants X $20 2,000.00
PSAs, website si na e; ra hits for exhibit board $ 1 500.00
Promotional fliers/ osters/ ostcards *In-house ra hit develo ment $ 2,000.00
Medical Provider Referral Kits
$ 1 000.00
Print Ads $ 1,500.00
Brandin items with to o & contact info $ 2,000.00
Diabetes Task Force Trainin /U date 2 meetin s er ear $ 2,238.00
.TOTAL
$ 93,875.00