An evaluation of the comparative effectiveness of geriatrician-led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-03-24

AUTHORS

Charlene Soobiah, Caitlin Daly, Erik Blondal, Joycelyne Ewusie, Joanne Ho, Meghan J. Elliott, Rossini Yue, Jayna Holroyd-Leduc, Barbara Liu, Sharon Marr, Jenny Basran, Andrea C. Tricco, Jemila Hamid, Sharon E. Straus

ABSTRACT

BackgroundComprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective. Our objective is to conduct a systematic review and network meta-analysis (NMA) to examine the comparative effectiveness of various geriatrician-led CGAs and to identify which models improve patient and healthcare system level outcomes.MethodsAn integrated knowledge translation approach will be used and knowledge users (KUs) including patients, caregivers, geriatricians, and healthcare policymakers will be involved throughout the review. Electronic databases including MEDLINE, EMBASE, Cochrane library, and Ageline will be searched from inception to November 2016 to identify relevant studies. Randomized controlled trials of older adults (≥65 years of age) that examine geriatrician-led CGAs compared to any intervention will be included. Primary and secondary outcomes will be selected by KUs to ensure the results are relevant to their decision-making. Two reviewers will independently screen the search results, extract data, and assess risk of bias. Data will be synthesized using an NMA to allow for multiple comparisons using direct (head-to-head) as well as indirect evidence. Interventions will be ranked according to their effectiveness using surface under the cumulative ranking curve (SUCRA).DiscussionAs the proportion of older adults grows worldwide, the demand for specialized geriatric services that help manage complex health needs of older adults with multimorbidity will increase in many countries. Results from this systematic review and NMA will enhance decision-making and the efficient allocation of scarce geriatric resources. Moreover, active involvement of KUs throughout the review process will ensure the results are relevant to different levels of decision-making.Systematic review registrationPROSPERO CRD42014014008 More... »

PAGES

65

Journal

TITLE

Systematic Reviews

ISSUE

1

VOLUME

6

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13643-017-0460-4

DOI

http://dx.doi.org/10.1186/s13643-017-0460-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1084252626

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28340600


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20 schema:description BackgroundComprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective. Our objective is to conduct a systematic review and network meta-analysis (NMA) to examine the comparative effectiveness of various geriatrician-led CGAs and to identify which models improve patient and healthcare system level outcomes.MethodsAn integrated knowledge translation approach will be used and knowledge users (KUs) including patients, caregivers, geriatricians, and healthcare policymakers will be involved throughout the review. Electronic databases including MEDLINE, EMBASE, Cochrane library, and Ageline will be searched from inception to November 2016 to identify relevant studies. Randomized controlled trials of older adults (≥65 years of age) that examine geriatrician-led CGAs compared to any intervention will be included. Primary and secondary outcomes will be selected by KUs to ensure the results are relevant to their decision-making. Two reviewers will independently screen the search results, extract data, and assess risk of bias. Data will be synthesized using an NMA to allow for multiple comparisons using direct (head-to-head) as well as indirect evidence. Interventions will be ranked according to their effectiveness using surface under the cumulative ranking curve (SUCRA).DiscussionAs the proportion of older adults grows worldwide, the demand for specialized geriatric services that help manage complex health needs of older adults with multimorbidity will increase in many countries. Results from this systematic review and NMA will enhance decision-making and the efficient allocation of scarce geriatric resources. Moreover, active involvement of KUs throughout the review process will ensure the results are relevant to different levels of decision-making.Systematic review registrationPROSPERO CRD42014014008
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36 Secondary outcomes
37 active involvement
38 acute care
39 adults
40 allocation
41 approach
42 assessment
43 bias
44 care
45 care settings
46 caregivers
47 comparative effectiveness
48 comparison
49 complex health needs
50 comprehensive geriatric assessment
51 countries
52 cumulative ranking curve
53 curves
54 data
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56 demand
57 different levels
58 effectiveness
59 efficient allocation
60 electronic databases
61 evaluation
62 evidence
63 geriatric assessment
64 geriatric resources
65 geriatric services
66 geriatricians
67 health needs
68 healthcare policymakers
69 healthcare settings
70 healthcare system outcomes
71 inception
72 indirect evidence
73 inpatient unit
74 integrated model
75 interdisciplinary team
76 intervention
77 involvement
78 knowledge translation approach
79 knowledge users
80 level outcomes
81 levels
82 library
83 model
84 model of care
85 multimorbidity
86 multiple comparisons
87 need
88 network
89 objective
90 older adults
91 outcomes
92 patients
93 policymakers
94 primary care setting
95 process
96 proportion
97 protocol
98 relevant studies
99 resources
100 results
101 review
102 review process
103 reviewers
104 risk
105 risk of bias
106 search results
107 services
108 setting
109 shared care
110 specialized geriatric services
111 specialized inpatient unit
112 study
113 surface
114 system outcomes
115 system-level outcomes
116 systematic review
117 team
118 translation approach
119 trials
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