PROJECT ABSTRACT: OVERALL We propose the Dartmouth Learning Health System (LHS) Embedded Scientist Training (E-STaR) Center, building on a long-standing partnership between Dartmouth College (DC) and Dartmouth Health (DH) and 30 years of excellence in patient-centered outcomes research (PCOR). The DH LHS, initiated in oncology and palliative care in 2019, explicitly recognizes that the collective expertise of patients, care partners, scientists, and clinical care teams is necessary to effectively implement and sustain evidence-based, goal-aligned care. Through the Center we seek to train the next generation of LHS embedded scientists to fully partner with patients and communities to meet the healthcare needs of northern New England. Three integrated Cores will work in concert to impart LHS scientists with essential knowledge for conducting rigorous and reproducible PCOR/CER and to effectively implement evidence-based practices within the LHS. This will begin with intentional recruitment and selection of a diverse group of scientists through a national call, coordinated by the Administrative Core (AC). The Research Education Core (REC) will guide the development of the scientists’ knowledge and skills related to LHS competencies and PCORI methodology standards through a tailored training plan to be carried out over 18 months with a primary mentor and mentoring team. Experiential learning will involve the design and conduct of a LHS research project with the resources of the Research and Data Analysis Core (RDAC), including the integration of resulting evidence-based practices into the LHS. An environment of inclusivity and belonging will be fostered by creating a community of practice through scientist’s participation in a Learning Collaborative designed to create a cycle of peer-to-peer learning. The Center’s specific aims are: Aim 1: To accelerate the DH LHS through the recruitment and development of a diverse group of embedded LHS scientists equipped with the knowledge and skills to transform rural healthcare with a focus on the challenge of timely access to high-quality, equitable, person-centered care in rural settings. Aim 2: To support embedded LHS scientists through tailored training, mentoring, and experiential learning and in the conduct of PCOR/CER projects designed to advance rural health equity. Aim 3: To disseminate knowledge gained within the Dartmouth LHS E-STaR Center throughout our broader communities and to evaluate the Center’s progress in advancing the DH LHS toward meeting the healthcare needs of northern New England. By growing the LHS scientist workforce, we plan to advance rural health and healthcare equity through the study and implementation of evidence-based practices designed to make timely, high quality, person-centered, goal-aligned care accessible to all.

PROJECT NARRATIVE The Dartmouth Learning Health System Embedded Scientist Training and Research (E-STaR) Center will provide scientists with the skills and needed support to complete research studies with patients, clinical teams, and community partners. Studies will focus on improving the availability and quality of healthcare in northern New England. What is learned will be put into clinical practice and shared widely to promote access to high- quality, equitable, person-centered care across the United States.