Evaluation of geriatrician-led models of care: A systematic review and network meta-analysis

Straus, S (NPI); Holroyd-Leduc, J; Basran, J; Liu, B; Tricco, A; Soobiah, C; Moore, A; Marr, S; Brathwaite, H; Watt, J; Manley, G; Ringer, L; Hamid, J; Colquhoun, H; Armson, H; Teare, S; Robertson, D; Goodridge, D; PausJenssen, E

Background

Comprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and interdisciplinary team, and can help prioritize and manage complex health needs of older adults. CGA models differ across healthcare settings, ranging from shared care conducted in primary care to specialized units in acute care, and it is unclear which geriatrician-led model is most effective. Our goal is to conduct a systematic review (SR) and network meta-analysis (NMA) to examine the comparative effectiveness of geriatrician-led CGAs and identify which models improve patient and healthcare system outcomes. An integrated knowledge translation approach will be used, whereby knowledge users (KU) such as patients, caregivers, clinicians and policymakers will be engaged in the SR process.

Methods

Electronic databases will be searched from inception to November 2016 to identify relevant studies. Randomized controlled trials of older adults (≥65 years old) that examine geriatrician-led CGA models compared to any intervention (including usual care) will be included. Outcomes will be selected by KUs using a modified Delphi approach and preferred outcomes will be included in the SR. Data will be synthesized using an NMA to allow for direct and indirect comparisons across interventions. Research findings will be presented in a one-day workshop and KUs will create key messages, which will inform dissemination strategies to relevant audiences.

Conclusion

Identifying optimal CGA models will enhance allocation of scarce geriatric resources. Active involvement of KUs throughout the review process will ensure results are relevant to different levels of decision-making.