PROJECT SUMMARY Background: Approximately 300,000 Hispanic individuals experience respiratory failure each year in the U.S. Hispanic patients are twice as likely to die from respiratory failure as non-Hispanic patients. There is an urgent need to identify and remediate mechanisms for this disparity. The investigative team’s preliminary work identified two potential mechanisms: Hispanic patients with respiratory failure are more likely to be deeply sedated and less likely to receive physical therapy than non-Hispanic patients, which are both associated with mortality and poor long-term functional outcomes. The overall objective of this proposal is to promote equitable outcomes for Hispanic patients with respiratory failure through changes in intensive care unit (ICU) practice. Specific Aims and Project Methods: Aim 1: Evaluate trajectories of long-term functional outcomes for Hispanic and non-Hispanic survivors of respiratory failure. An analysis of a unique registry of patients with respiratory failure will examine risk-adjusted trajectories of six-month mortality and functional outcomes among 96 Hispanic and 96 matched non-Hispanic control patients. Aim 2: Characterize care delivery for respiratory failure by ethnicity. Detailed site visits at ten diverse U.S. hospitals will be integrated with interviews and surveys of ICU clinicians to understand delivery of deep sedation and other care processes that preliminary work demonstrate to be differentially applied by ethnicity. Aim 3: Refine and pilot an intervention targeting inequitable care delivery. The team’s preliminary intervention to promote equity in care delivery for respiratory failure will be iteratively refined through patient, family, and clinician engagement and piloted at two U.S. ICUs. Unique Aspects of this Proposal: This proposal tackles an enduring problem in critical care—detecting, understanding, and eliminating disparities—by uniting a sociologist with expertise in disparities research and intervention design with a critical care physician with expertise in health services research. With an experienced team of co-investigators, preeminent National Advisory Board, and rigorous mixed-methods design, the PIs are uniquely equipped to address this pressing challenge. Anticipated Impact: NHLBI’s Report on Addressing Respiratory Health Equity emphasizes the elimination of disparities in respiratory health will remain aspirational without robust evidence and innovations in intervention design. The outcome of this study will be a characterization of care delivery contributing to inequitable outcomes among Hispanic patients with respiratory failure and an intervention aimed at mitigating disparities.