 Evidence clearly shows that many people do not receive guideline-concordant health care; this is true even for low cost treatments such as Aspirin prescribing, Blood pressure and Cholesterol control and Smoking cessation the ABCS known to prevent cardiovascular disease CVD. In hospitals and integrated care systems with substantial resources, large quality improvement campaigns have been shown to increase adherence to guidelines by creating communities of learning that change behavior on a large scale. Agency for Healthcare Research and Quality AHRQ and the Patient Centered Outcomes Research Institute PCORI are partnering to launch a campaign to promote the improvement of guideline-based CVD preventive care in small primary care practices with limited resources and experience with quality improvement Implementation RFA-HS-14-008. The practices for each of these R18 grants will be in a contiguous geographic region. This study will evaluate each of these R18 implementation grants. 