PROJECT SUMMARY Dr. Tessa Novick, an Assistant Professor of Internal Medicine in the Division of Nephrology at the University of Texas at Austin Dell Medical School, is a nephrologist, trained social worker and health services researcher whose career goal is to become an independent investigator in patient-oriented research focused on improving care for marginalized populations with kidney disease. This K23 award will provide Dr. Novick with training and mentored research experience in the following areas: (1) using complementary advanced epidemiological and qualitative methods to understand the scope and nature of a problem to inform interventions; (2) health disparities and community based participatory research; (3) intervention and clinical trial development, execution and interpretation. To achieve these goals, Dr. Novick has assembled a mentoring team comprised of primary co-mentors: Dr. Deidra Crews, Associate Professor of Medicine in the Division of Nephrology at Johns Hopkins University, who is an internationally recognized leader in kidney disease disparities and interventions to address them; Dr. Elizabeth Jacobs, Professor of Internal Medicine at the University of Texas at Austin Dell Medical School, who is internationally regarded for her work investigating health-care disparities, interventions to address social determinants of health, and advancing culturally competent care for diverse populations. The focus of the proposed mentored research is on understanding how health-related social needs of patients with end-stage kidney disease (ESKD) impact their care and how they might be addressed. ESKD affects over 700,000 Americans, and requires substantial patient engagement in order to achieve optimal outcomes. Health-related social needs are individual-level social determinants of health, such as unstable housing, food insecurity, transportation and utility needs. Dr. Novick hypothesizes that health-related social needs impair patient engagement, and are associated with higher acute care utilization and mortality. Dr. Novick further hypothesizes that dialysis patients will identify acceptable interventions to address health-related social needs, and interventions being tested in the general population using community health workers and organizations that bridge patients to community resources are feasible in the dialysis population. Dr. Novick will test these hypotheses using a series of complementary studies that (1) leverage data from the Veterans Health Administration and United States Renal Data System; (2) gain an in-depth understanding of the problem using qualitative research methods; and (3) refine an intervention that uses community health workers to connect dialysis patients with community resources.