The Northern States Ambulatory Research Network (NORTHSTAR) is a practice based research network composed of primary care providers in North Dakota and adjacent areas. The network represents a diverse group of practitioners from family physicians and general internists to physician assistants and nurse practitioners. The activities of NORTHSTAR focus on quality improvement in rural practice, conducting best practices research, and identifying and testing new methods of health care delivery in rural settings. The overall goal that we hope to achieve with this program is to improve the quality of care in the rural primary care setting for both patients and practitioners.