Abstract
This perspective describes why and how Healthcare Delivery Science (HDS) is the stage of translational science research necessary to answer the vexing question of clinical research: "Why is it that what we know works is frustratingly difficult to translate or 'scale' to real-world clinical practice?" Our patients with late-life psychiatric and neurocognitive disorders (PNCDs) are managed in the specialty mental health, general health and long-term care service sectors, and over their lifetimes often require complex, multifaceted and coordinated evidence-based interventions that span all three healthcare sectors to optimize their quality of life and functioning. This perspective defines core principles of HDS and summarizes key implementation and dissemination research methods to further understanding of translational research challenges in real-world settings and to facilitate their widespread dissemination. The importance of Learning Health Systems, especially Age-Friendly Health Systems, as real-world research laboratories, is also reviewed. Importantly, translation of evidence-based interventions across service sectors and large diverse patient populations requires skilled interdisciplinary teams. We characterize existing and projected geriatric professional workforce trends necessary to meet the population health service demands and will offer strategies to ensure success in the growth of the workforce that is required. Selected examples of HDS research are presented that have shown dissemination and translational promise, including a review of the "naturalistic" observational study example associated with private equity investment in the specialty mental health and long-term care service sectors. Finally, HDS's "value proposition" is offered to support the proposition that discovery science priorities could also be shaped from HDS evidence.