Health care organizations that strive toward continuous improvement in quality should be actively collecting and using performance information, implementing incentive systems to foster quality, investing in information technology, and implementing effective models of coordinated care. This project will develop case studies of four financially stable, integrated health systems or hospitals that have achieved a superior level of clinical performance while maintaining low costs. These 'high performers' will be compared with a group of average-performing institutions, both clinically and financially. Through site visits and in-depth interviews with CEOs, clinical leaders, and other key staff at these institutions, the case studies will clarify what the high performers have achieved and how they have achieved it. They will also highlight the barriers that average performers face in adopting some of the high performers' approaches. Project findings will help other hospitals and health care organizations scrutinize their own programs and practices to determine how they might adopt more successful quality improvement programs. http://www.esresearch.org