title: 'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions.
abstract: BACKGROUND
  Comprehensive geriatric assessment has been shown to improve patient outcomes, but the geriatricians who deliver it are in short-supply. A web-based method of comprehensive geriatric assessment has been developed with the potential to improve access to specialist geriatric expertise. The current study aims to test the reliability and safety of comprehensive geriatric assessment performed "online" in making geriatric triage decisions. It will also explore the accuracy of the procedure in identifying common geriatric syndromes, and its cost relative to conventional "live" consultations.
  
  
  METHODS
  The study population will consist of 270 acutely hospitalized patients referred for geriatric consultation at three sites. Paired assessments (live and online) will be conducted by independent, blinded geriatricians and the level of agreement examined. This will be compared with the level of agreement between two independent, blinded geriatricians each consulting with the patient in person (i.e. "live"). Agreement between the triage decision from live-live assessments and between the triage decision from live-online assessments will be calculated using kappa statistics. Agreement between the online and live detection of common geriatric syndromes will also be assessed using kappa statistics. Resource use data will be collected for online and live-live assessments to allow comparison between the two procedures.
  
  
  CONCLUSIONS
  If the online approach is found to be less precise than live assessment, further analysis will seek to identify patient subgroups where disagreement is more likely. This may enable a protocol to be developed that avoids unsafe clinical decisions at a distance.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ACTRN12611000936921.
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
authors.forename: Len
authors.initials: L
authors.lastname: Gray
authors.forename: Lucy
authors.initials: L
authors.lastname: Dakin
authors.forename: Steven
authors.initials: S
authors.lastname: Counsell
authors.forename: Helen
authors.initials: H
authors.lastname: Edwards
authors.forename: Richard
authors.initials: R
authors.lastname: Wootton
authors.forename: Melinda
authors.initials: M
authors.lastname: Martin-Khan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017050:Episode of Care; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D020407:Internet / Q000592:standards*; D008297:Male; D012017:Referral and Consultation / Q000592:standards*; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods / Q000592:standards*