OBJECTIVES Bipolar Disorder (BPD) and depression are associated with a broad burden of illness which may affect as much as 6% of the U.S. population. In the STAndards for BipoLar Excellence (STABLE) project we developed specific performance measures for BPD and, as part of this project we determined the knowledge, attitudes and beliefs about depression and BPD among primary care (PCP) and psychiatric specialty care (PSCP) providers. Additionally, we field-tested performance measures in a geographically diverse sampling of PCP and PSCP practices to assess actual practice. METHODS A questionnaire was administered to a random selection of PCPs and PSCPs to determine their knowledge, attitudes and beliefs about bipolar disorder. Selected clinical performance measures were subsequently evaluated through medical record review of 80 outpatient practice sites (the providers at these sites did not necessarily participate in the KABP survey). Partial results are shown here. RESULTS A total of 95.3% of the KABP survey respondents believed recognizing bipolar disorder was their responsibility (98.6% of PSCPs, 91.1% of PCPs). Additionally, 87.6% of the KABP respondents believed that they routinely assessed depression and BPD patients for substance abuse (98.2% of PSCPs and 73.7% of PCPs). In the field testing phase of the project, (through medical record review) we found that only 47.6% documented BPD screening prior to treatment of depression (62.8% of PSCPs and 38.4% of PCPs). Forty-one percent (78.1% PSCPs vs. 18.1% of PCPs) documented screening for substance abuse among depressed patients and 78.3% (87% PSCPs vs. 37.8% PCPs) document substance abuse screening in their BPD patients. CONCLUSIONS While providers demonstrated awareness of assessment and treatment guidelines for depression and BPD, appraisal of actual physician practices did not conform to KABP survey results. These observations provide an opportunity to improve care through professional organizations and health plans, and require different approaches than just guideline dissemination.