Background: The Patient-Centered Medical Home (PCMH) has recently become one of the most pronounced care delivery models and aspirations of the health care community. However, few PCMH initiatives addressed one of the most pervasive underlying problems in our health care system: that it is difficult to avoid the prevailing disease-driven care approach and position care into a holistic, personalized, prioritized, and fundamentally goal-directed paradigm. Objective and Intervention: Our research group at the University of Oklahoma HSC Department of Family and Preventive Medicine has pioneered the development of an advanced model for goal-directed care delivery. This framework uses enhanced information technology to assist patients and clinicians to develop, personalize, prioritize, and systematically deliver a longitudinal health and wellness plan through patient activation and involvement, shared decision making, and concurrent patient - practice incentives, building upon a new-generation health risk appraisal (HRA) approach that leverages the existing patient-clinician relationship. Outcome Measures: The poster will summarize the design, preliminary validation, and pilot testing of the advanced HRA tool in primary care practices. Outcomes will include the correlation between predicted and measured mortality in a historic patient cohort, clinician and patient satisfaction with the HRA tool, and focus group feedback about the implementation of the HRA approach. Plans for next steps will also be highlighted. FMDRL_ID: 3113#Conferences #NAPCRGAnnualMeeting