This project's objective is to provide policy relevant evaluations to help assure that the Health Information Technology for Economic and Clinical Health (HITECH) Act electronic health records (EHR) meaningful use (MU) incentive program actually improves the quality of healthcare provided to the American public.  The focus will be on the planned 2014 clinical quality measure (CQM) set, based on the perspective that CQM are the most important aspect of MU.  PPRNet, an AHRQ-sponsored Center for Primary Care Practice-Based Research and Learning, will conduct the evaluations in a diverse cohort of primary care practices that have been working in this area for more than a decade.  PPRNet is a unique and experienced national EHR-based practice based research network among more than 200 primary care practices with more than 1200 providers in 41 States.  The project has three separate but related Aims that will each inform the development of Stage 3 MU CQM objectives and facilitate their adoption by primary care clinicians.  The three aims are to assess current and achievable benchmark performance across twenty-two 2014 CQMs relevant to primary care practice in PPRNet practices, assess the association between the adoption of strategies posited by implementation theories to be associated with high performance on quality and measured performance, and solicit recommendations from the highest performing practices to improve Stage 3 MU CQM objectives.  In the aggregate, the findings from these evaluations will help policy makers understand realistic benchmarks for CQM performance, the strategies required by primary care practices to achieve high performance, and how the MU objectives can be improved to yield the greatest impact on quality of healthcare provided to the American public.