The overall goals of this project are to enhance the capacity and capability of a safety net focused distributed research network to conduct prospective comparative effectiveness research via a multi-setting, multi-state organization. The Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) will federate geographically dispersed safety net entities that collectively serve markedly diverse underserved populations. SAFTINet will both leverage and extend the established governance and technologic capabilities of the Distributed Ambulatory Research in Therapeutics Network (DARTNet) to allow more flexible options for participants and improved grid technology. This multi-state project will allow researchers, health policy experts, payers, and clinicians to better understand the impact of a wide variety of health care interventions on health outcomes for minority, underserved and socioeconomically disadvantage populations by supporting observational comparative effectiveness research. We will assemble a learning community dedicated to the aforementioned populations and build secure technology to allow authorized and authenticated stakeholders to answer important questions regarding issues ranging from treatment options to care delivery options. The Specific Aims of this proposal are to: " Establish a broad, safety-net focused, research partnership and learning community to govern relationships, establish priorities, provide data quality oversight, and evaluate the purpose and value of the community's effort that leverages the established governance structure of DARTNet " Extend the DARTNet framework to build, deploy and assess a safety-net focused distributed research network which combines ambulatory and inpatient clinical data and Medicaid claims and eligibility data for clinical and research purposes " Develop and enhance four sentinel cohort pairs of patients with asthma (pediatric and adult), hypertension, and hypercholesterolemia distinguished by their care delivery characteristics that can support comparative effectiveness research PUBLIC HEALTH RELEVANCE: This multi-state project will allow researchers, health policy experts, payers, and clinicians to better understand the impact of a wide variety of health care interventions on health outcomes for minority, underserved and socioeconomically disadvantage populations. We will assemble a learning community dedicated to the aforementioned populations and build a secure technology to allow authorized and authenticated stakeholders to answer important questions regarding issues ranging from treatment options to care delivery options.