Background: As a result of COVID-19, the VA has undergone a sizable transition to Care at a Distance in order to ensure the safe delivery of services. Components encompass expanded telehealth, distancing measures at routine face to face visits, and other practice changes. How Veterans with chronic conditions who regularly use VA healthcare experience these changes is unknown. This 18-month pilot study assesses a mixed methods approach to describe Care at a Distance for older, chronically ill Veterans, how service changes are experienced by Veterans, and how the experiences affect health management and outcomes. Significance/Impact: The unprecedented impact of COVID-19 provides an opportunity to advance novel Veteran-centered mixed methods to understand the pandemic’s effects on Veteran healthcare. Investigations can identify and test out Veteran-centered system improvements that support preparedness for future emergencies. This study aligns with VA’s strategic goals and objectives for FY2018-2024 to promote ‘customer service,’ and HSR&D’s scientific priorities to improve telehealth’s effectiveness, and to use primary care to optimize complex chronic disease management. It also aligns with ongoing activities in the Veterans Experience Office using journey mapping to understand Veteran experiences of VA care. Innovation: The proposed mixed methods pilot study is interdisciplinary, using novel methods in VA studies. By drawing upon theories and methods of medical anthropology and health services research, the pilot study is positioned to produce deep and actionable knowledge about COVID-19’s impact on Veterans and their care. Specific Aims: Aim 1: Describe components of Care at a Distance, to inform adapting an experience-based journey mapping template, which will describe how Care at a Distance affects the healthcare experiences of older Veterans with comorbidities, and their health outcomes. Aim 2: Test the feasibility and acceptability, and conduct an analysis, of embedding experienced-based journey mapping within in-depth qualitative interviews to describe Care at a Distance for older Veterans with comorbidities, and their routine care providers. Aim 3: Assess the utility of the mixed methods techniques to examine relationships among service changes, Veteran experiences, and health outcomes, incorporating chart review as a comparative and triangulating data source. Methods: The study uses a sequential design carried out at the James J. Peters VA in Bronx, NY and VA Hudson Valley Health Care in upstate, New York. In Aim 1, a documents analysis of VA Care at a Distance changes will be conducted to refine an inventory of components, key features, and their implementation. The inventory will inform an adapted experience-based journey map template and interview topic guide, and a medical chart analysis. In Aim 2, 40 Veterans will be recruited who are 65+ years old with two or more comorbidities (one being HIV or diabetes) and eligible for enrollment ...