title: New horizons in the implementation and research of comprehensive geriatric assessment: knowing, doing and the 'know-do' gap.
abstract: In this paper, we outline the relationship between the need to put existing applied health research knowledge into practice (the 'know-do gap') and the need to improve the evidence base (the 'know gap') with respect to the healthcare process used for older people with frailty known as comprehensive geriatric assessment (CGA). We explore the reasons for the know-do gap and the principles of how these barriers to implementation might be overcome. We explore how these principles should affect the conduct of applied health research to close the know gap. We propose that impaired flow of knowledge is an important contributory factor in the failure to implement evidence-based practice in CGA; this could be addressed through specific knowledge mobilisation techniques. We describe that implementation failures are also produced by an inadequate evidence base that requires the co-production of research, addressing not only effectiveness but also the feasibility and acceptability of new services, the educational needs of practitioners, the organisational requirements of services, and the contribution made by policy. Only by tackling these issues in concert and appropriate proportion, will the know and know-do gaps for CGA be closed.
authors.affiliation: B111, Division of Rehabilitation and Ageing, B Floor Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.affiliation: University of Leicester School of Medicine, Leicester LE1 5WW, UK.
authors.forename: Simon Paul
authors.initials: SP
authors.lastname: Conroy
authors.affiliation: Kavli Research Centre for Ageing and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway Institute of Medicine, University of Bergen, Bergen, Norway.
authors.forename: Anette Hylen
authors.initials: AH
authors.lastname: Ranhoff
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby Royal Hospital, Derby, DE22 3NE, UK.
authors.forename: Adam Lee
authors.initials: AL
authors.lastname: Gordon
mesh_terms: D000368:Aged; D002983:Clinical Competence; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D019317:Evidence-Based Medicine; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics / Q000458:organization & administration* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D017146:Models, Organizational; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D000071836:Professional Practice Gaps / Q000458:organization & administration* / Q000592:standards; D057170:Translational Research, Biomedical / Q000458:organization & administration* / Q000592:standards
keywords: geriatric assessment; health services research; homes for the aged; older people; organisational models; translational medical research