Our study examines the Impact of Nursing Home Leadership, Care Environments and Health InformationTechnology on Outcomes of Residents with Dementia. Approximately 42% of 1.3 million nursing home (NH) residents have dementia. NH residents with dementia have frequent and longer length of stays than residents with other types of chronic illnesses. Nurse practitioners (NPs) are a predominant provider of NH care in the U.S. for residents with dementia with 11,222 clinicians providing care in 5000 facilities. A growing strategy for improving resident outcomes is to effectively integrate health information technology (HIT) into NH care delivery. The use and integration of HIT into resident care, clinical support and administrative activities (known as HIT maturity) enhances care coordination and communication between NPs and staff, enabling NPs to manage resident health conditions better and improve resident outcomes. Evidence supports that NPs deliver higher quality care to residents in more positive care environments with supportive collegial relationships, greater access to resources and information. Studies focusing on NH dementia care delivery confirm that technology, shared communication, and care environments with clearly defined NP roles, helpful relationships, and supportive care lead to improved quality. We will examine the impact of NH HIT maturity and care environments on outcomes of residents with dementia, including hospitalizations and emergency department visits. Our specific aims are to: 1) Provide comprehensive assessments of HIT maturity and NP care environments in NHs with dementia residents, 2) Examine the impact NH HIT maturity and NP care environments on a differences in outcomes for residents with dementia, and 3) Explore facilitators and barriers for achieving improved outcomes of NH residents with dementia in various HIT maturity and care environments from the perspectives of NH administrators and NPs, respectively. During Aim 1 we will survey adm