Table 1.

ACDC Core Components and Adaptation(s)

Domain	Relevant constructs	Core components	Adaptation(s)
Context	Patient population	Focus on rural patients with poorly controlled diabetes	HbA1c inclusion criteria based on site priorities and needs, variability in emphasis on rural patients*
	Format	HT nurse telephone encounters every 2 weeks for 6 months	Developed maintenance protocol in response to patient feedback for those who complete the initial 6-month project period
	Delivery setting	Delivery using only existing VHA HT infrastructure, staffing, and equipment (i.e., no new hiring or needed equipment)	n/a
	Personnel	ACDC core staff includes (1) a HT nurse who works directly with patients to deliver ACDC and (2) a medication manager who works in conjunction with the HT nurse to deliver the medication management component	1–5 HT nurses used at each site; Asheville, White River Junction, New Mexico, Montana, Columbus, and Boise used a clinical pharmacist (PharmD) medication manager, while Eastern Colorado used an endocrinologist (MD)
Content	Intervention procedures	ACDC intervention core components include (1) telemonitoring, (2) self-management support (12 intervention modules), and (3) medication management (Fig. 1)	In response to HT nurse feedback, refinements were made to self-management support modules, and one new module (sick day care) was added.
	Intervention materials	Patients perform self-monitoring of blood glucose data (SMBG) using standard HT-issued equipment	n/a
		HT nurse documents a summary note in CPRS for each encounter to facilitate communication with medication manager	Minor site-specific updates to project note templates were created in CPRS using each site’s OIT team to suit local HT nurse and medication manager preferences
	Intervention implementation and ongoing support	Standardized, mentored-implementation approach (Fig. 2)	Site feedback guided subsequent iterations (e.g., development of maintenance protocol)
		Identification of local site champion and continued engagement with mentoring team in Durham	Added monthly, all-site video conferences to foster mentorship collaboration across sites in 2020

Abbreviations: VHA Veterans Health Administration, HT Home Telehealth, ACDC Advanced Comprehensive Diabetes Care, CPRS Computerized Patient Record System

*See Appendix Table 1 for complete patient inclusion criteria and identification methods per study site