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.
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.



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).



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.



PROSPERO CRD42014014008.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, Ontario, M5T 3M6, Canada.
Charlene
C
Soobiah
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Caitlin
C
Daly
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, Ontario, M5T 3M6, Canada.
Erik
E
Blondal
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Joycelyne
J
Ewusie
Schlegel Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada.
Joanne
J
Ho
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, Ontario, M5T 3M6, Canada.
Meghan J
MJ
Elliott
Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, Ontario, M5T 3M6, Canada.
Rossini
R
Yue
Department of Medicine, University of Calgary, Foothills Hospital, 11th Floor South Tower, Room 1103, 1403-29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
Jayna
J
Holroyd-Leduc
Regional Geriatrics Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, L-wing, 1st floor, room L1-01D, Toronto, Ontario, M4N 3M5, Canada.
Barbara
B
Liu
Regional Geriatrics Program Central, McMaster University, 88 Maplewood, Hamilton, Ontario, L8M 1W9, Canada.
Sharon
S
Marr
Department of Medicine, University of Saskatchewan, 701 Queen St, Saskatoon, Saskatchewan, S7K 0M7, Canada.
Jenny
J
Basran
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada.|Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, Toronto, Ontario, M5T 3M6, Canada.
Andrea C
AC
Tricco
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada.|Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Jemila
J
Hamid
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1T8, Canada. sharon.straus@utoronto.ca.|Department of Medicine, University of Toronto, 200 Elizabeth Street, Suite R. Fraser Elliott 3-805, Toronto, Ontario, M5G 2C4, Canada. sharon.straus@utoronto.ca.
Sharon E
SE
Straus
D000368:Aged; D057186:Comparative Effectiveness Research / Q000379:methods*; D015577:Geriatric Assessment / Q000379:methods*; D000072219:Geriatricians; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement; D011787:Quality of Health Care; D012107:Research Design; D012196:Review Literature as Topic; D000078202:Systematic Reviews as Topic; D000071076:Network Meta-Analysis as Topic
Comprehensive geriatric assessment; Geriatric assessment; Geriatric care; Integrated knowledge translation; Network meta-analysis; Systematic review