Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2017

Open Access 01-12-2017 | Protocol

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

Authors: 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

Published in: Systematic Reviews | Issue 1/2017

Login to get access

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
Appendix
Available only for authorised users
Literature
1.
Terner M, Reason B, McKeag AM, Tipper B, Webster G. Chronic conditions more than age drive health system use in Canadian seniors. Healthc Q. 2011;14(3):19–22.CrossRefPubMed
2.
Boyd CM, McNabney MK, Brandt N, et al. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):E1–E25.CrossRef
3.
4.
Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;(7):CD006211. doi:10.​1002/​14651858.​CD006211.​pub2.
5.
Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002;287(8):1022–8.CrossRefPubMed
6.
Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340:c1718.CrossRefPubMedPubMedCentral
7.
Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d6553.CrossRefPubMedPubMedCentral
8.
Van Craen K, Braes T, Wellens N, et al. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010;58(1):83–92.CrossRefPubMed
9.
Huss A, Stuck AE, Rubenstein LZ, Egger M, Clough-Gorr KM. Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci. 2008;63(3):298–307.CrossRefPubMed
10.
Conroy SP, Stevens T, Parker SG, Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing. 2011;40(4):436–43.CrossRefPubMed
11.
Heckman GA, Molnar FJ, Lee L. Geriatric medicine leadership of health care transformation: to be or not to be? Can Geriatr J. 2013;16(4):192–5.PubMedPubMedCentral
12.
13.
14.
Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane collaboration. 2011.
15.
Deverka PA, Lavallee DC, Desai PJ, et al. Facilitating comparative effectiveness research in cancer genomics: evaluating stakeholder perceptions of the engagement process. J Comp Eff Res. 2012;1(4):359–70.CrossRefPubMedPubMedCentral
16.
Deverka PA, Lavallee DC, Desai PJ, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Comp Eff Res. 2012;1(2):181–94.CrossRefPubMedPubMedCentral
17.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.CrossRefPubMedPubMedCentral
18.
19.
Laupacis A, Straus S. Systematic reviews: time to address clinical and policy relevance as well as methodological rigor. Ann Intern Med. 2007;147(4):273–4.CrossRefPubMed
20.
21.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol. 2016;75:40–6.CrossRefPubMed
22.
23.
Dalkey N, Helmer O. An experimental application of the Delphi method to the use of experts. Manag Sci. 1963;9(3):458–67.CrossRef
24.
25.
Soobiah C, Straus SE, Blondal E, Ghassemi M, Khan PA, Ho J, Berliner S, Tricco AC. Outcomes utilized to assess Alzheimer’s disease from a systematic review and survey of clinicians and decision-makers. Toronto: Paper presented at: Canadian Geriatric Society 33rd Annual Meeting; 2012.
26.
27.
Veroniki AAH-MTB, Fountoulakis KN. Appraising between-study homogeneity, small study effects, moderators, and confounders. In: Biondi-Zoccai G, editor. Umbrella reviews—evidence synthesis with overviews of reviews and meta-epidemiologic studies. Cham: Springer International Publishing; 2016.
28.
Sutton AJ, Abrams KR. Bayesian methods in meta-analysis and evidence synthesis. Stat Methods Med Res. 2001;10(4):277–303.CrossRefPubMed
29.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
30.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.CrossRefPubMed
31.
Carpenter J, Rucker G, Schwarzer G. Assessing the sensitivity of meta-analysis to selection bias: a multiple imputation approach. Biometrics. 2011;67(3):1066–72.CrossRefPubMed
32.
33.
Lambert PC, Sutton AJ, Burton PR, Abrams KR, Jones DR. How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS. Stat Med. 2005;24(15):2401–28.CrossRefPubMed
34.
Gelman A, Rubin DB. Inference from iterative simulation using multiple sequences. Stat Sci. 1992:457-472.
35.
36.
Jansen JP, Trikalinos T, Cappelleri JC, et al. Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report. Value Health. 2014;17(2):157–73.CrossRefPubMed
37.
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.CrossRefPubMed
38.
Salanti G, Kavvoura FK, Ioannidis JP. Exploring the geometry of treatment networks. Ann Int Med. 2008;148(7):544–53.CrossRefPubMed
39.
Veroniki AA, Vasiliadis HS, Higgins JP, Salanti G. Evaluation of inconsistency in networks of interventions. Int J Epidemiol. 2013;42(1):332–45.CrossRefPubMed
40.
Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29(7-8):932–44.CrossRefPubMed
41.
Andersen B, Fagerhaug T. The nominal group technique: generating possible causes and reaching consensus. Qual Prog. 2000;33(2):144.
42.
Moore A, Brouwers M, Straus SE, Tonelli M. Advancing patient and public involvement in guideline development. Toronto: Canadian Taskforce on Preventative Health Care; 2015.
43.
Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.CrossRefPubMed
Metadata
Title
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
Authors
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
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2017
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-017-0460-4

Other articles of this Issue 1/2017

Systematic Reviews 1/2017 Go to the issue

Research

Fit for purpose: perspectives on rapid reviews from end-user interviews

Methodology

Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review

Protocol

Perioperative adjuvant corticosteroids for post-operative analgesia in elective knee surgery – A systematic review

Protocol

The effect and safety of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in women: a protocol for systematic review and meta-analysis

Protocol

How can pharmacists develop patient-pharmacist communication skills? A realist review protocol

Protocol

Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol