Several limitations of this study should be noted. Medication intensification rates are typically higher in Veterans Affairs than in non–Veterans Affairs settings, and in fact, the intensification rate that we saw was higher than that reported in both Veterans Affairs (5, 21) and non–Veterans Affairs populations (6, 12). This higher rate may stem from our definition of treatment change, secular trends, and the fact that providers knew that they were participating in a study about diabetes and hypertension (although they were not aware of study hypotheses or which patients were enrolled in the study until after the visit). However, a strength of our multisite design is that financial access to medications among Veterans Affairs patients is relatively homogeneous; thus, differences among patients in the ability to pay is unlikely to contribute to site variation in decision making about their blood pressure treatments. Our study was designed to examine cross-sectional treatment change: that is, change measured at the time of 1 visit. The 50% treatment change rate at any 1 visit may translate to high levels of intensification over time, but the focus on a single visit allowed us to better identify patient, provider, organizational, and visit predictors that may be diluted in longitudinal studies. In addition, our treatment change variable incorporated follow-up plans documented in the medical record. Providers may have asked patients to follow up without documenting the plan, and even when follow-up was planned, it may have not always been completed. Therefore, integrating our results with information about factors that serve as barriers to medication intensification over time, including completion of follow-up, is needed.