PROJECT SUMMARY – PROJECT 3 Primary care clinicians serve as the predominant source of care for patients with Alzheimer’s disease and related dementias (ADRD). High-quality primary care plays an important role in the prevention, diagnosis and treatment of ADRD itself and in the management of the many chronic conditions that are prevalent among those with ADRD. Little is known, however, about how access to high-quality primary care has changed in recent years – including changes in access associated with the COVID-19 pandemic -- or about the policy-, system- or practice-level factors that are associated with better quality of primary care for older adults with ADRD. Drawing on a unique national dataset that includes annual information on the ownership and staffing of all U.S. primary care practices from 2015-2024, linked Medicare claims data, and surveys of nationally representative samples of these practices conducted in 2017 and 2022, we propose 3 aims. Aim 1: Examine U.S. trends in access to primary care for older adults with ADRD using repeated cross-sectional studies of primary and relevant subspecialty care for Medicare beneficiaries with and without ADRD diagnoses, and how these trends varied for less advantaged populations. Aim 2: Use variations across states, delivery systems, and physician practices in the implementation of initiatives intended to improve the quality of primary care in order to identify policy-, system- or practice-level factors associated with better quality care for ADRD patients. Aim 3: Develop practical recommendations on how to improve primary care for less-advantaged patients with ADRD by purposively sampling respondents from Wave 2 of the practice survey that serve economically less advantaged and minoritized populations and conduct in-depth qualitative interviews with their leaders and staff. Findings across our three aims will be triangulated to develop recommendations that can assist practice leaders, health system leaders, and policymakers in improving primary care for patients with ADRD. Collaborating closely with Core B and C in this program project grant, this work will also contribute to Project 1 and 2 by providing local measures of primary care quality and draw from these projects by including measures of beneficiary access to Home and Community Based Services and Resident Services Coordinators. The findings will identify opportunities to reduce the magnitude of the disparities in access to high-quality primary care for older adults with ADRD.