Project Summary Dr. Hiba Dhanani will gain valuable research experience through the support of a diversity supplement to the parent grant, “A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults” (“LEAPS”). The LEAPS study uses complementary data sources to assess patient-centered outcomes in older seriously ill surgical patients, uses novel methods to evaluate the impact of palliative care processes on outcomes, and deeply examines barriers to implementation of perioperative palliative care in clinical practice. Aim 1 determines the association between direct targets of palliative care (pain, depression, and caregiving needs) and less proximal benefits (reduced healthcare utilization) to demonstrate the important role of palliative care in surgery. We will use data from the Health and Retirement Study (2004-2018) to identify a cohort of seriously ill older surgical patients (≥66y) admitted for a major surgery or trauma, and then link these data to examine downstream healthcare use. Aim 2 is a retrospective cohort of older seriously ill surgical patients (≥66y) admitted for (colectomy, hip replacement, coronary artery bypass (CABG), or lower extremity revascularization) in a large regional health system between 2016-2019 and uses Natural Language Processing in electronic health data to identify palliative care processes (goals of care discussions, healthcare proxy documentation, pain, and caregiver assessments) delivered during the surgical episode. These data will then be linked to Medicare claims to test independent associations between palliative care received during the surgical admission and healthcare utilization in the year after surgical discharge. Aim 3 uses ethnographic analysis of qualitative interviews and direct observations to obtain an in-depth understanding of contextual factors influencing implementation of palliative care processes in the clinical care of seriously ill older patients (≥65 years) throughout the surgical episode. Results from these studies will directly inform bedside clinical decisions and the implementation of targeted palliative care interventions to improve care for seriously ill older surgical patients. Dr. Dhanani will play a major role in study aims 1 and 2 and conduct analyses specific to trauma patients. She will conduct important early work in aim 3 to become familiar with ethnographic observations and qualitative research methods.