Phelan et al senior center in western Washington state in the mid-1990s demonstrated the efficacy of this intervention: HEP participants had less functional decline and fewer hospitalizations than those in the control group (Leveille et al 1998). Local dissemination of HEP demonstrated its effectiveness at various other sites in western Washington with a larger number of staff. Older adults enrolled for one year reduced their risk of disability, improved their health status, had less functional decline, and avoided the increase in hospitalization predicted by baseline risk factors (Phelan, Williams, Leveille, et al 2002). Based on local success, the Robert Wood Johnson Foundation (RWJF) began funding a national dissemination of HEP in 2001. The primary goal of the national dissemination was to determine how well HEP could be implemented in settings that serve minority, low-income, and rural populations and to measure its impact in those settings (Glasgow et al 2003). With this goal, HEP sites were established in five other states using the same dissemination model that had been successful within Washington state. The overall enrollment target at the outset of the funding period was 700 participants. We also note an independent implementation of a very similar program, called Health Matters, that enrolled a lower-risk population at one site in California (Holland et al 2003; Leveille et al 2004; Tidwell et al 2004). Both the importance and the inherent difficulty of such translational research are increasingly recognized, as highly effective programs have faced substantial challenges and barriers to large-scale dissemination (Olds 2002; Gross et al 2004). We planned the present evaluation to determine whether the impact of one year of HEP participation at new, widely dispersed sites was comparable with benefits observed in the efficacy trial and effectiveness study of HEP. If the benefits in geographically widespread and newly developed venues were similar to those observed in previous trials, then policy discussions focused on making the program widely available might be warranted. Methods Setting The intervention was conducted at thirteen senior centers in western Washington that had been involved with the local dissemination of HEP (Phelan, Williams, Leveille, et al 2002) as well as twelve community or senior centers in five other states where HEP was newly established with the support of RWJF funding: Portland, Maine; Albany, New York; Portage, Vicksburg, Comstock, and Kalamazoo, Michigan; Chicago, Illinois, and Sacramento and Carmichael, California. All but one of these settings had expressed interest in implementing the program prior to the RWJF funding being secured by Senior Services of Seattle/King County (SSSKC); the funding made it possible for these sites to actually mount the program. Community settings were desired because they can offer, and encourage participants to become involved with, core elements of the intervention: chronic disease self- management (CDSM classes) (Lorig et al 1999), regular exercise (Lifetime Fitness Program [LFP] or other group program) (Wallace et al 1998), and social connections (eg, HEP health mentor, volunteer work, group meals and trips) (Davis et al 1998). Participants HEP targets ambulatory, community-dwelling adults with at least one chronic illness who therefore are at risk for functional decline. In keeping with the targeting criteria used in the efficacy trial (Leveille et al 1998), the five- state dissemination excluded participants with dementia or terminal disease. From 1 July 2002 through 31 December 2002, 224 adults enrolled in HEP. The present analyses include all participants due for one-year follow- up on or before 31 December 2003. Local staff recruited participants via letters, signed by and mailed from their primary care provider’s (PCP’s) office, recommending HEP and giving the name and phone number of the nearest HEP nurse. The letter encouraged potential enrollees to call the HEP nurse. If a call was not received, the nurse called the potential enrollee, explained the program, and invited him/her to come to the site. PCP practices were affiliated with healthcare systems that contributed financially to HEP, usually in the form of salary support for the HEP nurse. Patients whom PCPs indicated were inappropriate for the program (non-ambulatory, having dementia, or other terminal illness) did not receive a letter. Community case managers, social workers, or individuals in similar positions also referred potential participants whom they recognized as being at risk for functional decline and likely to benefit from the HEP program. Other participants self-referred in response to newspaper articles, flyers, advertisements in the senior center newsletter, and presentations to groups at the site and to health and social service providers. 268 Clinical Interventions in Aging 2006:1(3)