| Begin with identified gap in the literature | Begin with identified local need |
| Structured by idealized conceptual framework | Structured by awareness of known local assets |
| Design based on infusion of unsustainable resources | Design is responsive to local constraints |
| Grant often adds responsibilities to existing jobs | Design often redistributes responsibilities based on new services offered |
| Develop grant-dependent roles outside the practices | Develop relationships between practices and community resources |
| Designed to minimize impact on physicians | Designed to redefine physician role |
| Grant avoids perturbing the system or adding new outside system | Design intends to create a learning system |
| Intervention is responsive to pathology | Intervention is responsive to patient experiences of health and illness |
| Funded interventions engage idealized patients as represented in the literature | Interventions engage real patients as represented in the practice |
| Based on incremental change | Based on punctuated change or whole-practice transformation |
| Funded interventions almost exclusively motivated by disease-specific aims | Innovations almost exclusively motivated by the health of patients and community |