T2G Goal-Getter Submission Form

Have you exemplified leadership in improving diabetes care? Has your organization displayed a commitment to the Together 2 Goal^® campaign goal, driving measureable results among patients with Type 2 diabetes? If the answers are yes, your organization is what we call a Goal-Getter!

And in the Together 2 Goal^® campaign, we recognize our Goal-Getters. We share their successes—to not only celebrate them, but also to help spread best practices and lessons learned in diabetes management, empowering others across the country to tackle similar challenges and improve diabetes care through our campaign planks.

If your organization is a Goal-Getter, we want to hear from you. Whether you have motivated patients, changed a care process, or leveraged IT by implementing one of the campaign planks to improve diabetes care at your organization, tell us your story by completing the form available below. We’ve included a number of exploratory questions to help you along the way. You can also view a story from a fellow Goal-Getter, Geisinger Health System, here, about embedding point-of-care tools.

A representative from the campaign will contact you regarding the draft you submitted and work with you to finalize your Goal-Getter entry, providing limited writing support as needed. Note that copy may be edited for clarity and length. If you have any questions, please contact your Regional Liaison or together2goal@amga.org

Contact Information*

Organization *

City *

State *

Name *

Title *

Email *

Phone *

Campaign Plank*
Select which campaign plank your entry relates to. *

Entry Title*
Include a title that provides the reader with an idea of what this Goal-Getter entry is about. We encourage you to include your organization’s name within the title: *

Team Stats*
Provide an overview of your organization, including the following details:
• Type of organization (e.g., integrated system, IPA, etc.)
• Location
• Community/communities served
• Number of FTE physicians employed
• Number of sites of care
• Number of total patients served
• Number of patients with Type 2 diabetes served
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(Maximum characters: 2000)
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Challenge*
Describe what challenge related to diabetes care your team worked to address. Consider the following:
• How did your team identify this challenge as an area for improvement?
• What, if any, role did data play in identifying this challenge?
• What, if any, measureable goal for improvement did your team set?
• What barriers to improvement did your team identify?
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(Maximum characters: 2000)
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Game Plan*
Explain the intervention(s) your team implemented to address the aforementioned challenge. Your team’s intervention(s) may include a description of changes to or creation of new:

• Workflows and staffing		• IT
• Care Process		• Measurement or data reports
• Care coordination/outreach		• Provider and staff education
• Operations		• Patient education
• Financing and payment		• Technology

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(Maximum characters: 2000)
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Win(s)*
Summarize the outcome(s) of your team’s intervention(s) and the impact on diabetes care. Consider the following:
• How, if at all, were diabetes measures (campaign or other) impacted (e.g., changes from baseline)?
• What lessons learned or best practices did your team gain?
• What anecdotal improvements can you share (e.g., improved team dynamics, individual patient story)?
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(Maximum characters: 2000)
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"Head Coach"

Provide the following details for the individual on your team who led this effort. Please note, if that individual would not like to be contacted by peers interested in learning more about this effort, please do not include an email address.

Name *

Title *

Playbook
Share any supporting documents or resource(s) that your organization may have used to achieve this success that may be shared with a peer medical group or health system and would be useful in adopting and adapting this intervention for its organization. Please email documents or resources directly to together2goal@amga.org.

Resources may include public-facing documents or sample documents from your organization (e.g., org chart, treatment algorithm)
Do not share any patient identifiable information

Submission *

I submit this entry on behalf of my organization. I grant AMGA Foundation permission to include information shared here on the Together 2 Goal® website and other campaign communications and materials.

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