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01.12.2017 | Protocol | Ausgabe 1/2017 Open Access

Systematic Reviews 1/2017

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

Zeitschrift:
Systematic Reviews > Ausgabe 1/2017
Autoren:
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
Wichtige Hinweise

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.

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
Zusatzmaterial
Additional file 1: Stakeholder Engagement in Comparative Effectiveness Research (SECER) Framework. Conceptual framework which will guide conduct of knowledge user engagement in the systematic review. (DOCX 28 kb)
13643_2017_460_MOESM1_ESM.docx
Additional file 2: Eligibility criteria. List of criteria for selection of relevant studies. (DOCX 14 kb)
13643_2017_460_MOESM2_ESM.docx
Additional file 3: Preliminary MEDLINE Literature Search. Search strategy that will be used to identify citations and will be modified for the respective databases. (DOCX 14 kb)
13643_2017_460_MOESM3_ESM.docx
Additional file 4: Charting exercise. Description of variable that will be captured from relevant citations. (DOCX 19 kb)
13643_2017_460_MOESM4_ESM.docx
Additional file 5: Authorization for funding. Funding agreement with the Canadian Institutes of Health Research (CIHR) and the Strategy for Patient Oriented Research (SPOR). (PDF 45 kb)
13643_2017_460_MOESM5_ESM.pdf
Literatur
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