PROJECT SUMMARY/ABSTRACT PwCD (PwCD) are challenged by the lack of high quality and readily available accommodations in healthcare settings. This may contribute to lower quality care though there is a paucity of rigorous epidemiologic data. This project will investigate the healthcare outcomes of PwCD and the healthcare system-level factors impacting their accommodation. Aim 1 will compare emergency department (ED) visits, admissions, and lengths of stay per year in PwCD to those without communication disabilities. We will conduct a retrospective (2019) cross-sectional analysis of the electronic health record (EHR) data of 47 healthcare organizations, composed of 58.7 million patients. Communication disability types will be broken down into hearing, speech/language/cognitive, voice, and pragmatic groups. The comparison group for each communication disability type will be adults in the total sample without any communication disabilities. Relationships between communication disability and the healthcare outcomes of ED visits and admissions will be assessed using negative binomial regression. Four admission diagnoses will be selected to compare lengths of stay in 2019 between groups. The relationship between communication disability and length of stay will be assessed using multiple linear regression. We hypothesize that PwCD will have higher rates of ED visits and admissions, and longer lengths of stay. The innovation and feasibility of this aim is supported by our use of the TriNetX platform, a federated network of cross-organizational EHR data. The second aim will determine the healthcare system factors impacting accommodations for PwCD. We will conduct a collective case study of early adopting healthcare systems through key stakeholder interviews and policy document reviews. A novel pathway adapted from the Americans with Disabilities Act and the Joint Commission will structure data collection and analysis. The innovation and feasibility of this aim is supported by our connections with a national learning collaborative of disability coordinators representing 30 U.S. healthcare systems. The knowledge gained from completion of these objectives will pave the way for multifaceted interventions which address systems level contributors. It will also establish baseline clinical outcomes on which to measure health impact and guide future policy. My fellowship training will take place at the Larner College of Medicine’s (LCOM) Clinical Translational Sciences (CTS) program at the University of Vermont which provides a robust and highly interdisciplinary education with ample opportunities for cross-disciplinary collaboration. My two-year, pre- doctoral fellowship training will capitalize on the LCOM CTS program’s strengths in health services research. Through my F31 fellowship training, I will advance my skills in both epidemiologic and qualitative methods. This training plan is uniquely tailored to my career aspiration of contributing critical health serv...