The objective of this study was to develop a comprehensive understanding of the driving forces that have contributed to difficulty in program delivery in today's constrained fiscal environment. In support of the overall study objective, the specific objectives were: 1) to define and describe the forces of change and associated impacts on program management and delivery; 2) to document the state of the practice among state DOTs, including gaps that may exist in tools, techniques, and management processes to support program delivery; and 3) to make recommendations regarding topic areas for further research.