Determining the association of nursing on patients with intellectual or developmental disabilities in the acute care setting The NIH recently designated persons with disabilities as a health disparities population. The disparities experienced by those with intellectual and developmental disabilities (IDD) include a greater incidence of physical and mental ailments, increased morbidity and mortality, barriers to high quality care, stigma, biases, social disadvantage, and marginalization. However, there is a gap in the literature about approaches to reducing health disparities in the IDD population. Most research focuses on parents of IDD children, parents who have IDD, care for those who have dual diagnoses of IDD and another health problem, challenging behavior, and IDD caregiver burnout. To close the gap, we are proposing a supplement to R01NR014855 to utilize data collected in the parent grant to undertake novel methods to create individual risk profiles, using comorbidities, social determinants of health (SDOH) and IDD diagnoses, and to quantify the association of nursing resource factors on the risk adjusted outcomes of adult patients with IDD. Intersecting comorbidities, SDOH, and IDD diagnoses are expected to contribute to meaningful variation in clinical risk in the hospitalized IDD population. Quantifying the variable risk arising at the intersection of IDD, comorbidities, and SDOH is important because a particular challenge for this population is diagnostic overshadowing—when symptoms are misattributed to IDD rather than comorbidities and social determinant factors. Diagnostic overshadowing reduces quality of care and has been shown to lead to poor outcomes including increased mortality. Diagnostic overshadowing occurs more frequently when providers face time pressures, have poor teamwork, and lack resources. There is promising evidence that outcome disparities are reduced for other vulnerable populations, such as patients with serious mental illness and those with opioid use disorder, when they receive care in hospitals with better nursing resources, including increased nursing education, improved staffing, and more supportive work environments. The extent to which nursing resources are associated with IDD hospital patient outcomes is not known. The proposed study expands upon previous studies by: (1) quantitative research methods to specify pathways by which nursing resources might decrease adult IDD length of stay or readmission rates; (2) utilizing the secondary nursing data in the process of exploring adult IDD outcomes; and (3) ultimately using comorbidities, SDOH and IDD risk profiles to estimate which adult IDD patients may significantly benefit from greater nursing resources. Results will greatly improve our ability to target which nursing resources may benefit adult IDD patients. The central hypothesis is that an investment in nursing resources for the highest risk IDD inpatients will improve patient outcomes.