The purpose of this Career Development Award is to provide Dr. Lee Ann Lindquist, a fellowship-trained geriatrician, with the means and structure to transition into an independent investigator in Geriatric Patient Safety and Health Literacy. She holds an appointment as Assistant Professor of Medicine at Northwestern University Feinberg School of Medicine and is supported by the strong research environment of the highly successful Divisions of General Internal and Geriatric Medicine as well as the commitment of her experienced mentors, Drs. David Baker, Linda Emmanuel, and Gary Noskin. Her long-term career goal is to conduct and disseminate patient-oriented research that improves the safety of the elderly as they transition between inpatient and outpatient settings. During the proposed award, the applicant plans to receive focused training in health literacy and patient safety through coursework in health literacy, theory based patient safety modalities, interventional implementation, and real world experiences of serving on the patient safety committee at a tertiary care hospital, Northwestern Memorial Hospital. The research project focuses on improving the safety of seniors as they transition home from an acute hospital stay. Preliminary studies consistently show that seniors experience a lack of preparation and make multiple errors as they move between home and hospital settings. Seniors also have high rates of inadequate health literacy and memory issues which can compound the confusion during the discharge process. No studies have previously evaluated health literacy as a potential risk factor for discharge safety nor incorporated it into any discharge interventions. This project will be three tiered: (1) A prospective cohort survey of 200 hospitalized seniors with home follow-up to determine the impact health literacy and other variables have on medication errors and missed follow-up appointments. (2) A systematic analysis of the discharge process from a senior viewpoint using current patient safety modalities (i.e. Failure Modes and Effects Analysis [FMEA] and Root Cause Analysis) and senior focus groups to formulate a discharge safety toolkit. (3) A pilot study using the developed discharge toolkit on high risk seniors. This application aims to develop means of better communicating with low health literate and high risk seniors so as to make the discharge system safer. Through the process, the investigator will obtain advanced knowledge in patient safety and develop methods to overcome the barriers of inadequate health literacy. By the completion of this award period, the candidate will have the skills, experience, and research track record necessary to become an independent investigator and leader in health literacy and geriatric patient safety.