Bardsley, M.

Conroy, S.

Kennedy, S. M.

McCue, P.

Parker, S. G.

Roberts, H.

White Rose Research Online

 PROSPERO International prospective register of systematic reviews How best to deliver Comprehensive Geriatric Assessment (CGA) on a hospital widebasis: an umbrella reviewPatricia McCue, Stuart Parker, Simon Conroy, Martin Bardley, Helen Roberts, Sheila Kennedy  CitationPatricia McCue, Stuart Parker, Simon Conroy, Martin Bardley, Helen Roberts, Sheila Kennedy. How best to deliverComprehensive Geriatric Assessment (CGA) on a hospital wide basis: an umbrella review. PROSPERO2015:CRD42015019159 Available from  http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42015019159  Review question(s)To define the key elements of CGA, for example nurse-led models vs. geriatrician–led models and the timing of CGATo define the principal outcome measures that have been used in RCTsTo define the characteristics of the main beneficiaries of CGA included in the RCTsTo summarise the main findings about the cost-effectiveness of models of delivery of CGATo summarise the gaps and weaknesses in the evidence baseSearchesCochrane Database of Systematic ReviewsDARE via the Cochrane LibraryOVID MEDLINE(R) EMBASE Limited to English LanguageLimited to last 5 yearsTypes of study to be includedInclusion: For the purposes of inclusion, CGA will be defined using the authors’ definition.The types of studies to be included will focus on(i) existing literature reviews and where necessary, the high quality RCTs which contribute data to the reviews ofcomprehensive geriatric assessment for inpatients(ii) Randomised controlled trials, performed and reported more recently than those included in the included literaturereviews(iii) Recent observational studies which describe models of delivery of CGA on a hospital wide basis, with directrelevance to UK clinical practice(iv) Full economic evaluations which meet the population and intervention inclusion criteria.Exclusion: Due largely to the constraint of time in producing a rapid review to inform further development of the                               Page: 1 / 5research, papers selected for review will be restricted to those published English.Condition or domain being studiedHospital inpatient care for frail older peopleParticipants/ populationPatients over 65 years of age, who are in receipt of inpatient hospital careIntervention(s), exposure(s)Comprehensive Geriatric Assessment (CGA) is often defined as ‘a multidimensional, interdisciplinary diagnosticprocess to determine the medical, psychological, and functional capabilities of a frail older person in order to developa coordinated and integrated plan for treatment and long-term follow-up’. CGA improves outcomes for frail olderpeople, including survival, cognition, quality of life and reduced length of stay, readmission rates, long term care useand costs. CGA is the accepted gold standard method of caring for frail older people in hospital but it is unclear whichgroups patients benefit most.  Included if about CGA in hospital setting.Excluded if CGA not part of the intervention, if CGA is an element only (not full CGA) and not inpatient careComparator(s)/ controlWe will include reviews and other studies in which the delivery of comprehensive geriatric assessment is compared tousual inpatient care, or in which the comparator is CGA in an alternative setting, or usual care in another setting, and,if appropriate reviews are available, enhanced CGA vs CGA in the same setting.ContextHospital in-patientOutcome(s)Primary outcomesCan we identify a model of choice for hospital wide CGA using the evidence from literature reviews of CGA? If not:Can we identify a model of choice for hospital wide CGA in the UK using the evidence from high quality randomisedcontrolled trials performed more recently than the most recent reviews? If not:Can we develop a CGA model that incorporates evidence from different reviews above?Timing - At follow up - 1,3,6 or 12 months Effect Measures:-Living at homeDeathInstitutionalisationDependenceDeath or dependenceActivities of daily livingCognitive statusReadmissions                               Page: 2 / 5Length of stayResource useSecondary outcomesThe review will summarise the overall health economic impact of different models of delivery of CGA, it willsummarise the results with regard to:the scale, timing and study designthe range of costs included and methodology employed to calculate the coststhe outcome metrics employedthe approach to marginal and opportunity costs.At follow up - 1,3,6 or 12 months Effect Measures:-Living at homeDeathInstitutionalisationDependenceDeath or dependenceActivities of daily livingCognitive statusReadmissionsLength of stayResource useData extraction, (selection and coding)Studies will be assessed independently by two reviewers and discrepancies will be resolved by discussion.The data to be extracted will include:the key elements of CGA principal outcomes that have been studies in RCTsthe characteristics of the main beneficiaries of CGA included in the RCTsthe main findings about the cost and resources of models of delivery of CGA  gaps and weaknesses in the evidence baseRisk of bias (quality) assessmentRisk of bias assessments will be incorporated into the synthesis. To avoid risk of bias, we will use a standardized tool                               Page: 3 / 5based on the Joanna Briggs Institute data extraction tool to extract the data from the included reviews. These findingswill be used to identify which findings should be emphasised as most reliable, to inform the synthesis and ensure thatthe conclusions are based on the best available evidence. Whilst the less robust may not necessarily be included, theywill still be considered.Strategy for data synthesisThe planned general approach to be used will be aggregate. A quantitative synthesis is planned.Analysis of subgroups or subsetsIf feasible we will compare populations and outcomes betweena) services which select subjects by specific clinical characteristics versus selection on the basis of age and b) services which are led by medical versus non-medical (e.g. nurse, physiotherapist) professionals.Dissemination plansA rapid, interim report for the research team, which will inform the further development of the project including thedefinitions and key elements of CGA at multiple levels (personal, operational, systemic) to be used through all theworkstreams and identification of key outcomes. A full report detailing the review methodology and findings. Anexecutive summary summarising the key findings of the review.Contact details for further informationDr McCueCampus for Ageing and VitalityEdwardson BuildingNewcastle Upon Tyne NE4 5PLpatricia.mccue@ncl.ac.ukOrganisational affiliation of the reviewNewcastle UniversityReview teamDr Patricia McCue, Newcastle UniversityProfessor Stuart Parker, Newcastle UniversityDr Simon Conroy, University of LeicesterDr Martin Bardley, Nuffield TrustDr Helen Roberts, University of SouthamptonDr Sheila Kennedy, University of SheffieldCollaboratorsMs Kay Phelps, University of LeicesterMs Emma Regan, University of LeicesterMr Keith Nockels, University of LeicesterAnticipated or actual start date17 November 2014Anticipated completion date13 November 2015Funding sources/sponsorsFunding Source: NIHR-HSDR, reference 110598                               Page: 4 / 5Conflicts of interestNone knownLanguageEnglishCountryEnglandSubject index terms statusSubject indexing assigned by CRDSubject index termsAged; Geriatric Assessment; Hospitals; HumansStage of reviewOngoingDate of registration in PROSPERO29 April 2015Date of publication of this revision29 April 2015DOI10.15124/CRD42015019159Stage of review at time of this submission Started CompletedPreliminary searches No   Yes Piloting of the study selection process   Yes   No Formal screening of search results against eligibility criteria   No   No Data extraction   No   No Risk of bias (quality) assessment   No   No Data analysis   No   No  PROSPEROInternational prospective register of systematic reviewsThe information in this record has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record,any associated files or external websites. Powered by TCPDF (www.tcpdf.org)                               Page: 5 / 5

How best to deliver Comprehensive Geriatric Assessment (CGA) on a hospital wide basis: an umbrella review

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How best to deliver Comprehensive Geriatric Assessment (CGA) on a hospital wide basis: an umbrella review

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