Introduction: Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited examples from which to model. This article offers case examples of educational design, results, and lessons learned from 4 tobacco cessation PI CME activities. Purpose: To share with the CME community different cases of PI CME educational design and results so that CME providers may have examples to draw from and develop more PI CME activities. Methods: This is a case report. Results: Four of 9 partners of the Cease Smoking Today (CS2day) initiative developed the 4 tobacco cessation PI CME activities. Each project was designed and implemented using a common planning framework and clinical performance measures but with varying operational and educational design components depending on the strengths and resources of the leading partner. Three projects that are completed show improvements in aggregated practitioner performance and smoking quit rates. One project is currently under way. Discussion: These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice. (Contains 6 tables, 4 figures and 3 footnotes.)