老年科医生主导的综合老年评估对改善老年人患者及医疗保健系统结局的比较效果评估：一项系统评价和网状Meta分析方案
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.
作者信息
Soobiah Charlene, Daly Caitlin, Blondal Erik, Ewusie Joycelyne, Ho Joanne, Elliott Meghan J, Yue Rossini, Holroyd-Leduc Jayna, Liu Barbara, Marr Sharon, Basran Jenny, Tricco Andrea C, Hamid Jemila, Straus Sharon E
机构信息
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.
出版信息
Syst Rev. 2017 Mar 24;6(1):65. doi: 10.1186/s13643-017-0460-4.
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.
背景
综合老年医学评估（CGA）是一种由老年医学专家和跨学科团队参与的综合护理模式，可对患有多种疾病的老年人的复杂健康需求进行优先级排序和管理。CGA在不同的医疗环境中有所不同，从初级保健机构开展的共享护理到急性护理中的专科住院单元。涉及老年医学专家的护理模式在不同医疗环境中各不相同，目前尚不清楚哪种CGA模式最为有效。我们的目标是进行一项系统评价和网状Meta分析（NMA），以检验各种由老年医学专家主导的CGA的比较效果，并确定哪种模式能改善患者和医疗系统层面的结局。
方法
将采用综合知识转化方法，在整个评价过程中让包括患者、护理人员、老年医学专家和卫生保健政策制定者在内的知识使用者（KUs）参与进来。将检索包括MEDLINE、EMBASE、Cochrane图书馆和Ageline在内的电子数据库，检索时间从建库至2016年11月，以识别相关研究。纳入对≥65岁老年人进行的、比较由老年医学专家主导的CGA与任何干预措施的随机对照试验。主要和次要结局将由知识使用者选择，以确保结果与他们的决策相关。两名评价者将独立筛选检索结果、提取数据并评估偏倚风险。将使用NMA对数据进行综合分析，以便利用直接（头对头）证据以及间接证据进行多重比较。将根据累积排序曲线下面积（SUCRA）按干预措施的有效性进行排序。
讨论
随着全球老年人比例的增加，许多国家对有助于管理患有多种疾病的老年人复杂健康需求的专科老年医学服务的需求将会增加。这项系统评价和NMA的结果将加强决策制定和稀缺老年医学资源的有效分配。此外，知识使用者在整个评价过程中的积极参与将确保结果与不同层面的决策相关。
系统评价注册
PROSPERO CRD42014014008。
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