This regional guideline dissemination conference will demonstrate how local adaptation may be a necessary tool to reach health care providers. AHCPR's Diagnosis and Treatment of Congestive Heart Failure Secondary to Coronary Vascular Disease has been chosen a the demonstration guideline for this conference. The conference is built on three assumptions: 1> Guideline use and adoption is, like any other medical practice pattern, subject ot regional variation. 2.) Interactive learning among one's peers, especially when coupled with "academic detailing, " promises behavior change. 3.) Just s there is regional variation in medical practice, there is also institutional variation. The (conference) design and methods of the conference are built around these three assumptions. To measure the actual impact of the conference, conference participants will receive a pre- and post-conference survey focusing on attitudes, knowledge and use of guidelines. To fully explore the institutional dimension of guideline adaptation, internists, cardiologists, administrators, and nurses will be drawn from three broad groupings: hospitals, HMOs, and private practices from the greater Washington and Baltimore areas. The conference has a three tiered learning structure where knowledge becomes increasingly focused for the individual quideline user. Tier One presents the background and rationale of guidelines. Tier Two integrates the guideline into the specific practice environment of participants. Tier Three provides a workshop for application of the guideline to anonymous clinical cases. To enhance the interactive learning environment, the break-out groups from the three settings will be (between fifteen and twenty members) each. Sample size thus will be held around sixty individuals. A heart failure panel member and a local leader will channel and direct learning. The conference may serve as a model for other localities and other guidelines. The impact of the conference, therefore, reaches beyond the regional to the national level.