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Foundational Articles

Locke EA and Latham GP. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist 2002; 57(9): 705-717.

Steffen GE. Quality medical care: A   definition. Journal of the American Medical Association 1988; 260: 56-61.

Mold JW, Blake GH, and Becker LA. Goal-Oriented Medical Care. Family Medicine 1991; 23: 46-51.

Mold JW. An alternative conceptualization of health and health care: Its implications for Geriatrics and Gerontology. Educational Gerontology 1995; 21: 85-101.

Mold JW, Hamm R, Scheid D.  Evidence-based medicine meets goal-directed health care.  Family Medicine 2003; 35(5):360-364.

Waters D and Sierpina VS. Goal-directed care and the chronic pain patient: A new vision of the healing encounter. Pain Physician 2006; 9(4): 353-360.

Reuben DB and Tinetti ME. Goal-oriented medical care – An alternative health outcomes paradigm. New England Journal of Medicine 2012; 366(9): 777-779.

Tinetti ME, Esterson J, Ferris R, Posner P, and Blaum CS. Patient priority-directed decision making and care for older adults with multiple chronic conditions. Clin Geriatr Med 2016; 32: 261-275.

Tinetti ME, Nail AD, and Dodson JA. Moving from disease-centered to patient goals-directed care for patients with multiple chronic conditions: Patient value-based care. JAMA Cardiology 2016; 1(1): 9-10.

Reach G. Simplistic and complex thought in medicine: The rationale for a person-centered care model as a medical revolution. Patient Preference and Adherence, 2016; 10: 449-457.

Mold JW. Goal-directed health care: Redefining health and health care in the era of value-based care. Cureus 2017;

Nagykaldi ZJ, Tange H, and De Maeseneer J. Moving from problem-oriented to goal-directed health records. Ann Fam Med 2018; 16(2): 155-159.

Mold JW. Failure of the problem-oriented medical paradigm and a person-centered alternative. Ann Fam Med 2022; 20:145-148.

Mold JW and Duffy FD. How patient-centered medical homes can bring meaning to health care: A call for person-centered care. Annals of Family Medicine, 2022; 20(4): 353-357.

Prevention of Premature Death and Disability


Kohn M and Menon G. Life prolongation: Views of elderly outpatients and health care professionals. Journal of the American Geriatrics Society 1988; 36: 840-844.

Alexy B. Goal setting and health risk reduction. Nursing Research 1985; 34: 283-288.

Kiresuk TJ and Sherman RE. Goal-attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal 1968; 4(6): 443-453.

Maloney PF and Mirrett P. Use of the goal attainment scale in the treatment and ongoing evaluation of neurologically handicapped children. American Journal of Occupational Therapy 1978; 32(8): 505-510.

Weinstein MS and Ricks FA. Goal attainment scaling: Planning and outcome. Canadian Journal of Behavioral Science 1977; 9(1): 1-11.

Guyatt GH, et al. The n-of-1 randomized controlled trial: Clinical usefulness. Our three-year experience. Annals of Internal Medicine 1990; 112(4): 293-299.

Johnston BC and Mills E. N-of-1 randomized controlled trials: An opportunity for complementary and alternative medicine evaluation. Journal of Complementary and Alternative Medicine 2004; 10(6): 979-984.

Avins AL, et al. An n-of-1 trial to improve adherence and increase information from a clinical study. Contemporary Clinical Trials 2005; 26(3): 397-401.

Stiefel MC, Perla RJ, and Zell BI. A healthy bottom line: Healthy life expectancy as an outcome measure for health improvement efforts. Milbank Quart 2010; 88(1): 30-52.

Chou AF, Nagykaldi Z, Aspy CB, and Mold JW. Promoting patient-centered preventive care using a wellness portal: Preliminary findings. Journal of Primary Care and Community Health 2010; 1(2): 88-92.

Nagykaldi Z, Aspy CB, Chou A, and Mold JW. Impact of a wellness portal on the delivery of patient-centered preventive care. Journal of the American Board of Family Medicine 2012; 25(2): 158-167.

Nagykaldi Z, Voncken-Brewster V, Aspy CB, and Mold JW. Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care. Applied Clinical Informatics 2013; 4: 75-87.

Stuck AE, Moser A, Morf U, et al. Effect of health risk assessment and counseling on health behavior and survival in older people: A pragmatic randomized trial. PLoS Med 2015; 12(1): e1001889  doi:10.1371/journal.pmed.1001889

Applegate M, Scott E, Taksler GB, Sanchez M, Duong N, Mark L, Caniglia, E, Wallach A, and

Braithwaite RS. Project ACTIVE: A Randomized Controlled Trial of Personalized and Patient-Centered Preventive Care in an Urban Safety-Net Setting. J Gen Intern Med, 2021; 36(3): 606–613.

Maintaining and Enhancing Current Quality of Life


Hefferin EA. Health goal setting:Patient-nurse collaboration at the Veterans Administration facilities. Military Medicine 1979; 144: 814-822.

McGee H, O’Boyle CH, Hickey A, et al. Assessing the quality of life of the individual: The SEIQoL with a healthy and a gastroenterology unit population. Psychol Med 1991; 21: 749-759.

Ruta DA, Garrat AM, Leng M, Russell IT, and MacDonald LM. A new approach to the measurement of quality of life: The Patient-Generated Index. Medical Care 1994; 32(11): 1109-1126.

Paterson C. Measuring outcomes in primary care: A patient generated measure, MYMOP, compared with the SF-36 health survey. Br Med J 1996; 312: 1016-1020.

Clark F, Azen SP, Zemke R, Jackson J, Carlson M, et al. Occupational therapy for independent-living older adults. Journal of the American Medical Association 1997; 278(16): 1321-1326.

Hay J, LaBree L, Luo R, Clark F, Carlson M, Mandel D, Zemke R, Jackson J, and Azen S. Cost-effectiveness of preventive occupational therapy for independent-living older adults.  JAGS 2002; 50: 1381-1388.

Graff MJL, Vernooij-Dassen MJM, Thijssen M, Dekker J, Hoefnagels WHI, and Rikkert MGMO. Community based occupational therapy for patients with dementia and their caregivers: Randomized controlled trial. Brittish Medical Journal 2006; 333(7580): 1196-1201.

Waters D and Sierpina VS. Goal-directed care and the chronic pain patient: A new vision of the healing encounter. Pain Physician 2006; 9(4): 353-360.

Zubialdi JP, Mold JW, and Eubank D. Outcomes that matter in chronic illness: A taxonomy informed by self-determination and adult learning theory. Families, Systems, and Health 2009; 27(3): 193-200.

Nagykaldi Z, Jordan M, Quitoriano J, Ciro CA, and Mold JW. User-centered design and usability testing of an innovative health-related quality of life module. Applied Clinical Informatics 2014; 5(4): 958-970.

Purkaple BA, Mold JW, and Chen S. Encouraging patient-centered care by including quality-of-life questions on pre-encounter forms. Annals of Family Medicine 2016; 14(3): 221-226.

Purkaple BA, Nagykaldi ZJ, Allahyar A, Todd R, and Mold JW. Physicians' response to patients' quality of life goals. JABFM 2020; 33: 71-79.

Davenport C, Ouellet J, and Inetti M. Use of the patient-identified top health priority in care decision-making for older adults with multiple chronic conditions. JAMA Network Open, 2021; 4(10): e2131496

Optimizing Personal Growth and Development


Ryan RM and Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development,m and well-being. American Psychologist 2000; 55(1): 68-78.

Sheldon KM, Kasser T, Smith K, and Share T. Personal goals and psychological growth: Testing a intervention to enhance goal-attainment and personality integration. Journal of Personality 2002; 70(1): 5-31.

Ryan RM, Huta V, and Deci EL. Living well: A self determination theory perspective on eudaimonia. J Happiness Studies 2006; 9: 139-170.

Boeckxstaens P, Vaes B, De Sutter A, Aujoulat I, van Pottelbergh G, Mathei C, and Degryse J-M. A high sense of coherence as protection against adverse health outcomes in patients aged 880 years and older. Ann Fam Med 2016; 14: 337-343.

A Good Death


Wanzer SH, et al. The physician's responsibility toward hopelessly ill patients: A second look. New

England Journal of Medicine 1989. 320: 844-849.

Mold JW, Looney S, Viviani NJ, and Quiggins PA. Predicting the health-related values and preferences of geriatric patients. Journal of Family Practice 1994; 39: 461-467.

Stone MJ. Goals of care at the end of life. Proceedings of Baylor University Medical Center 2001; 14(2): 134-137.

Gawande A. Being Mortal: Medicine and What Matters in the End Metropolitan Books, Henry Holt and Company, 2014; New York, NY.

Health Systems Organization, Teamwork, Etc.

Steele Gray C, Grudniewicz A, Armas A, Mold J, Im J, Boeckxstaens P. Goal-Oriented Care: A Catalyst for Person-Centred System Integration. International Journal of Integrated Care, 2020; 20(4): 8, 1–10


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