Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and early detection and treatment of the illness and precursor lesions can prevent many of these deaths. Yet a majority of American adults have not received CRC screening, and improved CRC screening is one component of the nation's Healthy People 2010 goals. The Practice Partner Research Network (PPRNet), a practice-based research network among primary health care providers practicing in 33 States who use a common electronic medical record (EMR), has developed a quality improvement model for successfully translating cardiovascular research into primary care practice termed PPRNet-TRIP. PPRNet-TRIP incorporates prioritization of evidence-based quality philosophies, involving all staff (teamwork), delivery system redesign, patient activation, and EMR tools for individualized and population-based medicine. PPRNet-TRIP is implemented in practice settings through a combination of practice performance reports, practice site visits, network meetings, and web-based tools. The purpose of the activities proposed in the application is to assess, through a randomized controlled clinical trial in 30 primary care practices whether PPRNet-TRIP can also improve provider recommendation and patient receipt of CRC screening. The project will be 4 years in duration, with a two-year intervention. Fifteen practices will be randomly allocated to a control group and 15 to an intervention group. Control group practices will receive CRC screening guidelines. Intervention group practices will receive CRC screening performance reports and participate in twice-yearly practice site visits and annual research meetings to help them adopt the PPRNet-TRIP improvement model for CRC screening. After two years the impact of the intervention on CRC screening recommendation and completion will be assessed. A mixed-method process evaluation will also be conducted to assess the adoption of PPRNet-TRIP within participating practices.