K76 Administrative Supplement Application Project Summary/Abstract This is an administrative supplement to the parent award (K76AG064434) of Kei Ouchi, MD, MPH, MS, which will ensure continued productivity during his family medical emergency and will not change the scope of the parent award. Dr. Ouchi is committed to lead the field of emergency medicine to integrate the principles of geriatrics and palliative medicine. Dr. Ouchi is an emergency physician and home hospital physician (provides inpatient-level care at patient's home1) in the Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School. Dr. Ouchi's research focuses on the development of ED GOAL, a 6-minute motivational interview conducted in the emergency department (ED), which engages patients to address advance care planning (ACP) conversations with their outpatient clinicians and avoids a time-consuming, sensitive conversation in the time-pressured ED environment. With funding from the NIA GEMSSTAR R03 and Emergency Medicine Foundation, Dr. Ouchi developed ED GOAL and demonstrated its acceptability and feasibility in seriously ill older adults in the ED. ED GOAL may also increase patients' self-reported ACP engagement and ACP documentation after leaving the ED. The GEMSSTAR project identified that, in this setting where resources are limited, ED GOAL requires refinements to maximize its potential efficacy. This study will refine ED GOAL to maximize its potential efficacy and scalability, and determine the preliminary efficacy of the refined ED GOAL to increase ACP engagement one month after leaving the ED. The proposed 5-year training plan accelerates Dr. Ouchi's career development as an independent physician-scientist through training in: 1) cognitive impairment assessment and engagement of caregivers in ACP research (ED GOALCG); 2) adaptation of ED GOAL/ ED GOALCG by specially-trained nurses; 3) conducting a clinical trial of ED GOAL/ ED GOALCG administered by specially-trained nurses; and 4) implementation science in preparation for a future pragmatic clinical trial of ED GOAL/ ED GOALCG. James Tulsky, MD, an internationally recognized leader in palliative medicine, will serve as the primary mentor. Dr. Ouchi is co-mentored by: 1) Mara Schonberg, MD, MPH, a leader in health services research among older adults; and 2) Edward Boyer, MD, PhD, a K24-funded emergency medicine researcher with expertise in behavioral interventions. The ultimate goal is to establish ED GOAL as a national standard of care to help all seriously ill older adults to receive ACP conversations at the most critical times of their lives. Dr. Ouchi aims to expand the scope of ED-based care from acute, disease-oriented care (e.g., gunshot wounds) to include patient- centered care (e.g., value-based, end-of-life care) for seriously ill older adults by integrating geriatrics and palliative medicine principles.