There are two failures we care about, and most research only addresses one. Care that works often takes years to reach the people who need it, and reaches some groups far later than others. At the same time, older adults routinely receive tests, medications, and procedures that offer little benefit and carry real risk — cascades of follow-up testing, medications that no longer serve them, screening that can no longer help. Both failures come from the same place: the gap between what evidence supports and what systems actually do.

We use implementation science to close that gap in both directions. We design and evaluate changes to how care is delivered, we study how entrenched low-value practices are reduced, and we ask throughout who the current system serves well and who it leaves behind.