1. An evaluation of the comparative effectiveness of geriatrician-led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older adults: a protocol for a systematic review and network meta-analysis
- Author
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Sharon Marr, Meghan J. Elliott, Jayna Holroyd-Leduc, Barbara Liu, Rossini Ying Kwan Yue, Jenny Basran, Joanne Ho, Erik Blondal, Caitlin H. Daly, Jemila S. Hamid, Charlene Soobiah, Joycelyne E. Ewusie, Andrea C. Tricco, and Sharon E. Straus
- Subjects
Integrated knowledge translation ,medicine.medical_specialty ,Comparative Effectiveness Research ,Comparative effectiveness research ,Network Meta-Analysis ,MEDLINE ,Medicine (miscellaneous) ,030204 cardiovascular system & hematology ,Cochrane Library ,Comprehensive geriatric assessment ,Geriatric care ,03 medical and health sciences ,0302 clinical medicine ,Knowledge translation ,Acute care ,Health care ,Outcome Assessment, Health Care ,medicine ,Protocol ,Humans ,030212 general & internal medicine ,Aged ,Quality of Health Care ,Shared care ,business.industry ,Geriatricians ,Quality Improvement ,Geriatric assessment ,3. Good health ,Review Literature as Topic ,Research Design ,Family medicine ,Meta-analysis ,Systematic review ,business ,Systematic Reviews as Topic - Abstract
Background Comprehensive 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. Methods An 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). Discussion As 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 registration PROSPERO CRD42014014008 Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0460-4) contains supplementary material, which is available to authorized users.
- Published
- 2017