Our interprofessional team conducts multi-site effectiveness or implementation studies using designs with clusters testing evidence-based interventions to improve quality of care and patient centered outcomes in healthcare delivery systems. Our most recent interventions have focused on guideline based care for people with heart failure. In 2013 we completed the Improving Heart Failure Outcomes (IHO) study in partnership with 40 national community and academic hospitals recognized by the Magnet Recognition Program® to evaluate a toolkit of evidence-based resources based on national guidelines (http://circ.ahajournals.org/content/128/16/e240.short?rss=1&ssource=mfr). The toolkit included education resources, teach back questions, and assessments. Nurses used the resources in the toolkit to help people with heart failure care for themselves once discharged from the hospital. Patient knowledge improved and we were able to identify the characteristics of patients who could best care for themselves at home, but there was no effect on 30-day readmission. Next, in partnership with two rural hospitals in Virginia we completed a study to engage patients to inform the design and methods to be used in rural hospitals and tailor the intervention that worked in our IHO study to the context of the rural hospital (Phase 1). By engaging clinicians and patients, we learned that we needed to add some additional measures (e.g. quality of life). In Phase II we tested the tailored intervention successfully, and will be submitting our next grant with our partners focusing on increasing the adoption of guideline-based care processes in rural settings.