The Northern New England Cardiovascular Disease Study Group (NNECDSG) was formed as a regional clinical database that would allow clinicians to track outcomes after cardiac interventions. The purpose of the NNECDSG would be to use its database and organizational structure to seek best practices and disseminate information aimed at improving results for patients undergoing cardiovascular interventions. Since 1987, this voluntary regional collaborative of clinicians, hospital administrators, and health care research personnel has tracked consecutive cardiovascular interventions performed throughout Northern New England and reported its findings to the clinicians. Collaboration between NNECDSG institutions has led to progressive refinements in the clinical database, institutional site visits, efforts to understand and standardize ideal processes of care, risk-stratification tools to aid in decision making, and most recently, tools to track and report on appropriateness of interventions based on national criteria. As a result of these efforts, mortality rates after coronary bypass graft surgery have steadily declined and the variation in mortality rates between institutions has disappeared.