PROJECT SUMMARY/ABSTRACT Chronic pain, pain that persists longer than 3 months, is both a leading cause of disability and the primary reason for seeking out medical attention in the United States. The cost of this persistent healthcare burden ranges from $560 to $635 billion annually, and it disproportionately impacts older adults over the age of 65. In 2019, over 17 million (30.8%) Americans over the age of 65 reported experiencing chronic pain. Of increasing urgency is the need for non-pharmacological pain management options, given the ongoing opioid overdose epidemic in the US. Thus, a better understanding of integrating non-pharmacological pain management strategies, particularly acupuncture, which is already recognized as an efficacious first-line treatment, is urgently needed. Currently, there are gaps in our understanding of acupuncture as a non-pharmacological pain management strategy and whether it is feasible, acceptable, and appropriate for the older adult American population in the long term. Acupuncture for chronic pain is particularly under-researched in underserved and immigrant populations. Our overarching hypotheses are: 1) priorities differ between institutional and individual interests regarding acupuncture for chronic pain treatment; 2) the majority of older adult patients with chronic pain do not have an integrative pain management plan (and limited continuity of care); 3) study designs are structured inconsistently in randomized controlled trials (RCTs) evaluating acupuncture for chronic pain. For Aim 1, we will utilize ethnographic approaches to document stakeholder perspectives at the institutional, provider (acupuncturist and physician), and patient levels. We will document 60 stakeholder perspectives using semi-structured in-depth interviews. For Aim 2, we will utilize a retrospective case series study design to track older adult patients who received acupuncture for their chronic pain over a two-year period. We will use the electronic health record system to complete this aim. For Aim 3, we will conduct a scoping review of all RCTs with an acupuncture intervention for chronic pain. Data for aims 1 and 2 will be collected at the Chinese Hospital in San Francisco, California, an integrated nonprofit community hospital system that provides acupuncture alongside biomedical treatment. It is the only hospital in the US whose mission is to serve the Chinese diaspora. Identifying positives and negatives within this integrated healthcare system will help pinpoint best practices for improving chronic pain management within the older adult population. With this research proposal and detailed training plan, the applicant will gain a multidisciplinary skill set combining ethnographic methods, implementation science analysis, and health equity approaches while advancing knowledge of non- pharmacological pain management options for older adults. This project takes advantage of a critical inflection point of medical systems integration...