DESCRIPTION (provided by applicant): Candidate: Gulshan Sharma, MD, is an assistant professor in the Department of Internal Medicine, Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep (APICS) Medicine who will serve as principal investigator on this project. His passion is to provide high quality end of life care to terminally ill older adults. Dr Sharma's long-term goal is to develop a career an an independent investigator in patient-oriented research. His immediate goals are 1) to study the impact of continuity of care on end of life ICU use in older adults with terminal illnesses, 2) to obtain additional training in conducting health services research with formal coursework, and 3) to particate in the care of critically ill patients. Environment: The mentorship and institutional resources available to Dr Sharma create an ideal environment for fostering his career in this underexamined but highly relevant field. Drs. Goodwin and Freeman brings considerable experience in both mentoring and health services research in older adults. Drs. Bruera and Brody complement the team with their expertise in end of life care and ethical issues when dealing with terminally ill hospitalized patients, respectively. The overarching aim of this study to examine the role of continuity of care on end of life ICU use. Research plan: The specific aims of the research are: Aim 1. To describe continuity of care in patients one year prior to the diagnosis of lung cancer. Aim 2. To describe patient and physician level characteristics associated with continuity of care in transition from outpatient to inpatient setting. Aim 3. To determine the relationship between continuity of care and end of life ICU use. Aim 4. To examine the effect of hospitalists on continuity of care and end of life ICU use. Methods: First, we will assess both the continuity score and usual care provider in the 12 months prior to diagnosis for advanced lung cancer patients. Second, we will assess transition care continuity by determining whether the outpatient physician provided care during hospitalization in the last 6 months of life. Third, we will examine the associations between continuity score/ usual care provider/ transition care continuity and end-of-life ICU use. Lastly, we will use the operational definition of hospitalist to examine the relationship between inpatient care by a hospitalist and end of life ICU use. Importance: Findings from the proposed study will provide important insight into how changing practices of medicine in last two decades have impacted ICU use in terminally ill patients. Interventions to improve continuity in terminally ill hospitalized patients can help reduce end of life ICU use.