LEADR Site Collaboration Survey

Thank you for your interest in the Lifestyle Empowerment Approach to Diabetes Remission (LEADR) Program, and for all your work in the field of lifestyle medicine.

This survey will collect your site's information for the purpose of tracking which sites are interested in running a 2025-2026 LEADR pilot, and who the key contacts are at each site. Please note that there is an option to save and continue this survey at a later time.

Submitting this survey does NOT obligate you to participate in this pilot. Additionally, ACLM is NOT able to work with you unless your site is able to provide a formal letter of support (see template further down) and we have added you to the IRB protocol for the study.

This interest survey will remain open until January 31st, 2026. All sites that would like to participate must have a survey submission completed by January 31st, 2026, and must provide the letter of support by March 25th, 2026.

ACLM staff will NOT be contacting anyone at your site without first having a conversation with you (the submitter of this form). However, we are asking questions about key contacts upfront because it significantly aids in the communications process to have this information stored in a central place.

This survey will provide:

The study protocol, which has been approved by the IRB at the University of New England. You are free to download this document and share it with leaders or others at your health system as part of understanding the project and/or seeking permission to participate. Please do not share it outside of that purpose.
A template for a letter of support that your organization can draft stating your intention to participate. This is something we would like to collect as soon as possible so we can submit them to our IRB. Your site will need to be added to the IRB protocol before we can work together.

After you complete the survey, you will be able to download the LEADR materials, which includes the Participant Workbook, the Facilitator Script, slide decks for all sessions, and a draft version of the Planning Guide. The Planning Guide includes one template for group visit progress notes using 99213.

This survey will ask about:

Your name and contact information
Your target timeline for running a LEADR program
Format of meetings
Team members who would be leading the session(s)
Description of your target participants for LEADR (your participation criteria)
How you plan to recruit participants
How many participants you would plan to recruit and hope to keep, on average
Overall demographics and SDOH factors for your patient population
Contact name and email of the decision-maker at your institution to confirm permission to participate in a research study. This may be you or someone else.
Contact name and email for the IRB and/or research/evaluation department at your institution, if applicable.
What you know about process involved in exporting EHR data (EHR export is not required to run a LEADR pilot)
Contact name and email for IT support or whoever would be assisting with EHR data export, if applicable.

For any specific questions, you can email ACLM Senior Director of Research, Dr. Micaela Karlsen, at research@lifestylemedicine.org.

Thank you very much for your time and support.

Please start the survey now by clicking on the START button below.

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