OBJECTIVE: To describe the types of practice system tools that medical groups use for depression care, and to compare these with the tools used for care of other chronic conditions. STUDY DESIGN: Cross-sectional survey. METHODS: We surveyed the medical directors of 41 medical groups in Minnesota with sufficient numbers of patients with depression to be included in public reporting of performance measures for depression. The survey asked about the presence of practice systems used for depression and other chronic conditions. RESULTS: The response rate to the survey was 100%. Group sizes ranged from 7 to 2000 physicians and were evenly divided between metropolitan and nonmetropolitan areas. About 60% of the groups were multispecialty. Medical groups were most likely to have information support, decision support, and performance tools (such as a registry, flow sheets or check lists, written standards of care, reminder systems, and performance feedback to physicians) to support management of diabetes (ranging from 65% with a registry to 95% with written standards of care). In general, the fewest of these system tools were in place for management of depression (ranging from 12% with a registry to 58% with written standards of care). One exception was the use of patient self-assessment tools, which was most common for depression (51%). CONCLUSIONS: Our findings suggest that a lack of practice system tools may be one element that is hampering improvement in depression care. Further study is needed to demonstrate that implementing and maintaining these changes will improve depression care in diverse medical practices.