An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study

Table 2 Clinical definitions of “at-goal” status for each intervention condition

Noncommunicable disease	Management metric	“At-goal” definition
Type II diabetes mellitus	Hemoglobin A1c OR fasting blood sugar	Hemoglobin A1c < 7.5 OR fasting blood sugar < 130 mg/dl^a
Hypertension	Blood pressure	Blood pressure < 130/80 mmHg or patient-tailored goal per risk stratification^b
Chronic obstructive pulmonary disease	Exacerbation status	≤ 1/3 Anthonisen criteria^c

^aThe 2018 American Diabetes Association guidelines [82] call for a goal A1c < 7% for most patients or A1c < 8% in “patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.” For our intervention, we established 7.5% as our goal to pragmatically accommodate both populations
^bBased on the 2017 American College of Cardiology and American Heart Association guidelines [83], we established < 130/80 mmHg as a default goal, with patient-tailored goals for select patients (≥ 65 years of age, multiple comorbidities, limited life expectancy, clinical judgment, patient preference)
^cThe 2017 update to the GOLD guidelines [84] define chronic obstructive pulmonary disease exacerbation as an “acute worsening of respiratory symptoms that results in additional therapy.” We used the Anthonisen criteria of worsening sputum volume, sputum purulence, and increased dyspnea to define the “worsening of respiratory symptoms” specified in the GOLD guidelines. We established a threshold of no more than one Anthonisen criterion as a pragmatic tool for determining clinical status

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