Fig. 1.

Figure 1 Conceptual Model of the Health Risk Appraisal (HRA) Driven, Goal-Directed Care Approach (*) A comprehensive, web-based HRA is completed by the patient before each annual wellness visit as a “homework assignment” (from home, work, or via a wireless tablet in the practice) and a personalized -prioritized health report is generated to aid strategic care planning based on patient goals, needs, preferences, and constraints. (**) In this model, existing chronic health conditions and disease processes are considered risk factors for future adverse outcomes (e.g., myocardial infarction or stroke) that can result in decreased life expectancy and diminished quality of life. This holistic, patient goal-directed care approach encompasses the majority of primary care and integrates biomedical, behavioral, and psychosocial determinants of health into a unified health improvement strategy.