<qa>  What is the largest study to test this model?Our innovative approach addresses critical organizational barriers and challenges existing approaches to achieving better BP control. This study is novel because it will: 1 be the largest study to test this model, 2 use a cluster randomized design to include many more clinics than previously used, 3 use a diverse group of clinics with broad geographic distribution, 4 include large numbers of patients from minority groups to assess potential health disparities, 5 evaluate whether the effect can be sustained long-term, 6 include standardized BP measurements rather than error-prone office BPs, 7 minimize selection bias, and 8 evaluate a passive observation group to evaluate dissemination of PPCM throughout the practice. We expect that our study will find a 6-8 mm Hg difference in systolic BP which would lead to 20-30 fewer coronary deaths and 25-40 fewer stroke deaths if applied across broadly across similar settings. 