PROJECT SUMMARY/ABSTRACT Primary care is the first point of contact for most people experiencing cognitive concerns, and its providers are a critical workforce for dementia care. Timely and equitable diagnosis of Alzheimer’s disease and related dementias (ADRD) in primary care is a key national priority and enables primary care providers (PCPs) to identify treatment opportunities and to support patients and their caregivers in planning ahead and making decisions about safety, medications, management of comorbid conditions, and caregiving. Yet, missed and delayed diagnosis of ADRD in primary care is a persistent problem, occurring in over 60% of affected persons, impeding these key care functions, and is especially common among racial/ethnic minorities and socioeconomically disadvantaged populations. Early, equitable detection and diagnosis in primary care will be crucial as new disease-modifying therapies become available, but workforce studies indicate that there are insufficient specialists to make these diagnoses, especially in low-resource settings. Therefore, the overall goal of this project is to build on strengths and overcome barriers in the primary care workforce that contribute to missed and delayed diagnosis of ADRD, particularly among patients impacted by health disparities. To do so, this study will take place in 7 primary care practices (safety net, community, academic) that serve diverse populations in both urban and rural locations. We will use comparative ethnography to ascertain how the most efficacious PCPs do successfully and proactively identify and diagnose dementia in diverse primary care settings, and we will also identify drivers of disparities and barriers to timely diagnosis. Comparative ethnography, an innovative lens we will bring to this persistent health system challenge, is a qualitative approach used to holistically determine how social and cultural processes and individual and structural contexts impact healthcare. Our Specific Aims are: (1) Assess the diagnostic journeys of people with ADRD across diverse clinical settings and analyze their interactions with the primary care workforce to identify ways social, cultural, and structural contexts impact the ADRD diagnostic process; (2) Analyze how PCPs, their practice cultures, and available resources across these contexts strengthen or impede the ADRD diagnostic process; and (3) a) Identify systems and policy-level factors that impact the ADRD diagnostic process, b) Triangulate and compare findings across sites and domains, and c) Develop intervention targets, towards future translation. We will identify how patient/caregiver factors, clinician and practice culture, and policies and health systems strengthen or impede PCP engagement in the ADRD diagnostic process. A Stakeholder Advisory Board will partner with the research team to help identify intervention targets for future studies. The results will inform development of practice and policy intervention targets t...