There have been few systematic evaluations of the effectiveness of state technical assistance programs, and the designs of the current technical assistance initiatives--even when they have been in operation long enough to permit evaluation--will make it difficult to estimate how well the programs work. Of particular concern from an evaluation perspective is the simultaneous statewide implementation of several quality improvement programs. This is understandable, given the perceived urgent need to improve nursing home quality. However, a strategy that concurrently implements multiple interventions makes it virtually impossible to measure the effectiveness of any particular type of technical assistance. States planning to implement quality improvement programs should consider the increasing importance of the need to evaluate these programs given the current fiscal environment.