This chapter discusses the attempt to develop evidence-based systems for defining, guiding, and monitoring aspects of psychiatric care in the USA. It provides some of the limitations in these approaches and some recommendations about how to deal with the role of a practice-based research network. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) introduction is clear in defining mental disorders as a grouping of symptoms plus either clinically significant distress or impairment in major role functioning. The financial, organizational, and procedural elements affect the flow and characteristics of patients through the system, and ultimately the selection and utilization of treatments for those patients. This process determines the outcome for both the individual and for the population under care. The chapter also explores how to determine the proper mix of these elements to meet the appropriate needs of a population and to achieve better outcomes for individuals.