Grant: Operating Grant: SPOR PIHCI Network - Knowledge Synthesis Grants

Caring for older adults with complex health needs remains a challenge in primary care. Approximately, 67% of older adults have 2 or more chronic conditions and account for 25% of all primary care visits. They see several clinicians, take multiple medications, and are exposed to drug-disease interactions and uncoordinated care, leading to reduced function and quality of life. Integrated care models like comprehensive geriatric assessments (CGAs) can manage complex health needs of older adults. CGAs focus on diagnosing and managing multiple conditions, and involve collaboration with a geriatrician and a care team. Research indicates that those who receive CGAs are more likely to remain in their homes, have lower mortality risk and improved cognition compared to usual care. However, the different models have not been compared to each other and it is unclear which is most effective. We propose to conduct a systematic review and network meta-analysis (NMA) to identify the most effective model of CGA (geriatrician-led care models) in primary care for improving patient (e.g., quality of life) and system outcomes (e.g., admission to long term care). We will use an approach where knowledge users (KUs) such as patients, caregivers, clinicians, and policymakers are involved throughout. Outcomes will be selected by KUs to ensure results are relevant to their decision making. We will use NMA, a statistical method, to compare and rank the different care models. Results will be discussed with KUs and key findings created to inform dissemination strategies. Involving KUs in selecting outcomes and developing key messages will promote uptake of results and inform healthcare decision making. Our KUs include those in Ontario, Alberta and Saskatchewan, who are making decisions about how to target clinical activities to optimize care of older adults. Ultimately, the results will lead to improved care for older patients through identification of optimal care models.