PROJECT SUMMARY/ABSTRACT This is a K01 Mentored Research Scientist Development Award submitted to the National Institute on Aging by Robert Tyler Braun, an Instructor in the Department of Population Health Sciences at Weill Cornell Medical College (WCMC). Dr. Braun's career goal is to become an independent researcher on improving end-of-life care for the elderly by assessing various policy interventions and delivery models of hospice care. This K01 application will provide Dr. Braun with the necessary training 1) to gain expertise in aging and hospice research; 2) to understand clinical care for hospice patients; and 3) to gain methodological skills to conduct qualitative studies related to hospice delivery and care. Dr. Braun has assembled a mentor team of accomplished researchers from WCMS and Vanderbilt University School of Medicine (VUSM): Dr. Lawrence Casalino (primary mentor) who is the Livingston Farrand Professor of Public Health at WCMC and an expert on health care organization and behavior, and qualitative methods; Dr. Holly Prigerson (co-mentor) who is the Irving Sherwood Wrights Professor of Geriatrics at WCMC and an expert on end-of-life care; Dr. David Stevenson (co-mentor) who is a professor and the holder of the Endowed Directorship in Health Policy Education at VUMC and an expert in the delivery of hospice care; and Dr. Mark Unruh (co-mentor) who is an Associate Professor in the Department of Population Health Sciences at WCMC with expertise in long-term care and Medicare claims data. Over the past couple of decades, the hospice industry has moved from largely a not-for-profit sector to predominately for-profit. Facilitated by relatively easy market entry and generous Medicare payments, PE firms and PTCs have been acquiring hospices (many of them non-profit), with the goal to deliver short-term, above market returns to their investors. Despite this emergence, little is known of its effect on hospice care. Building on his previous research and training on assessing this phenomenon in physician practices, Dr. Braun will identify the organizational, staffing, patient, and quality characteristics associated with PE and PTC acquisitions using publicly available hospice data from Center for Medicare and Medicaid Services (CMS) (Aim 1), use rigorous econometric methods to assess the effect PE and PTC acquisition on hospice care using patient-level Medicare claims (Aim 2), and use qualitative methods to assess organizational, cultural, and delivery aspects of hospices post-acquisition integration (Aim 3). This research will be a foundation for an R01 grant application and will incorporate the new skills acquired through his training, which inform opportunities for improvement in hospice delivery of care.