ABSTRACT. Half of the U.S. adult population has one or more preventable risk factors for cardiovascular disease (CVD) including hypertension (HTN) and hyperlipidemia, but only 10% are meeting all of their clinical goals due to suboptimal adoption of guideline recommended care. This is largely because primary care practices and health care systems are struggling to identify which combination of care structures and processes they need to implement to become high performing practices. The objective of this proposal is address this translational gap by developing a reliable, valid, and pragmatic assessment tool that will identify core features of primary care practices that are related to high performance on CVD-related outcomes. Despite a large body of research on practice transformation and improvement, we lack a systematic and scalable approach to identifying which features of primary care infrastructure and processes are associated with better patient outcomes. This lack of a reliable, validated, pragmatic assessment tool to define the practice changes that drive high performance in primary care continues to impede implementation of evidence-based care for chronic disease prevention and the translation of innovations in health care into routine practice. We therefore propose a mixed-methods study combining data analytics, survey techniques in the context of a two-stage Delphi process and qualitative in-depth interviews to delineate and prioritize elements of care structure and processes (e.g., decision support) that are hypothesized to be associated with improvements in CVD-related patient outcomes. We will then develop and validate a measurement tool for identifying gaps in care structures and processes that are amenable to change, and if implemented, will improve CVD-related patient outcomes. A strength of this proposal is collaboration across four Clinical and Translational Science Institutes: (1) New York University School of Medicine (NYUSoM)-Health and Hospitals CTSI (NYU-H+H CTSI), (2) Oregon Health & Science University (OHSU) Oregon Clinical Translational Research Institute (OCTRI), (3) Medical University of South Carolina's South Carolina Clinical Translational Institute (SCTR), and (4) the Institute for Clinical and Translational Research at Einstein and Montefiore (ICTR), and six geographically diverse partnering national practice networks that will form the research team for this proposal. The proposed research is significant because it will fill a methodological gap that impedes translation of innovations in health care into routine practice. Findings from use of the assessment tool will therefore provide a much-needed roadmap for building capacity and infrastructure for practice transformation, continuous quality improvement (i.e., adoption and sustainability of innovation) and improvements in population health.