DESCRIPTION (provided by applicant): The primary goal of this application is to nurture the development of Dr. Samantha Solimeo as an independent VA investigator dedicated to improving healthcare delivery to older Veterans with chronic conditions. The application focuses on improving the care of Veterans who are at risk of osteoporosis, in an effort to improve osteoporosis care and as a model for developing strategies to improve care coordination within VA primary care Patient Aligned Care Teams (PACTs), between PACTs and VA specialists, and between VA and non-VA providers. In examining osteoporosis, the application focuses on a condition that causes substantial morbidity and mortality among Veterans, that is frequently under-diagnosed, and for which a 2007 HSR&D sponsored evidence synthesis and a 2011 Office of the Inspector General report highlighted need for improvement efforts. The application presents integrated career development activities and research projects that build on Dr. Solimeo's expertise in qualitative methods, her prior research in geriatric chronic conditions, and her recent work through the VISN 23 PACT Demonstration Lab which evaluates the implementation of PACTs and identifies factors that lead to high functioning PACTs. The career development activities are designed to provide Dr. Solimeo with content knowledge and methodological skills in key areas of implementation science, notably: pragmatic intervention and dissemination design; quantitative methods and secondary analysis of administrative data; and organizational management. Activities include targeted readings; formal coursework through the University of Iowa, University of Indiana, and SAS Institute; and tutorials offered by other organizations. The Research Plan outlines three incremental projects designed to complement her career development and that will ultimately position Dr. Solimeo to lead a multi-site study to improve osteoporosis care in collaboration with VA program offices, facilities, and primary and specialty medicine leadership. Project 1 will involve the secondary analysis of VA and Medicare administrative data to identify variation in testing rates for osteoporosis using dual-energy X-ray absorptiometry (DXA) across individual VA facilities and PACTs for several groups of older veterans who are at risk for osteoporosis, including those with low-trauma fractures after age 50, receiving chronic corticosteroid or anticonvulsant therapy, or receiving androgen deprivation therapy for the treatment of prostate cancer. Project 2 will involve a mixed methods study to identify barriers to DXA testing within VISN 23, factors that underlie variations in DXA testing found in Project 1, and factors affecting primary care-based care coordination for older veterans. Quantitative data that will be collected include surveys to assess osteoporosis knowledge and to measure team function. Survey data will be triangulated with qualitative interviews of a pu...