Evaluating the comparative effectiveness of geriatrician-led models of care for improving patient and healthcare system outcomes: A systematic review and network meta-analysis

Nominated Principal Applicant: Dr. Sharon E. Straus (University of Toronto)

Principal Applicants from Alberta: Dr. Jayna Holroyd-Leduc (University of Calgary)

Co-principal applicants from Alberta: Sylvia Teare (University of Calgary)
                                                         Dr. Heather Armson (University of Calgary)

Provinces involved: Ontario, Alberta, Saskatchewan

Project duration: 12 months


The Canadian population is experiencing a demographic shift with older adults (aged ≥65 years) accounting for an increasing proportion of the population. By 2036, it is estimated that older adults will represent 25% of the population and will consume 62% of healthcare spending. Caring for older adults in primary care is challenging as they receive care from several providers and take multiple medications. They are often exposed to drug-disease interactions and fragmented care, leading to reduced function and quality of life. Integrated models of care such as comprehensive geriatric assessment (CGA) can prioritize and manage complex health needs of older adults with multimorbidity. CGAs focus on diagnosing and managing multiple conditions, and involve collaboration with a geriatrician and an interdisciplinary team. CGAs differ considerably across healthcare settings, ranging from shared care to specialized inpatient units.

CGAs can improve health outcomes and are typically completed by a geriatrician (subspecialists within internal medicine who specialise in providing care for older adults with complex health needs). There are 261 geriatricians in Canada and they cannot assist primary care clinicians with all older patients. We propose to conduct a systematic review and network meta-analysis (NMA) to examine the comparative effectiveness of geriatrician-led CGAs for improving patient (e.g., quality of life) and healthcare system outcomes (e.g., admission to long term).

We will use an integrated knowledge translation approach where we will engage knowledge users (KUs) such as patients, caregivers, nurses, primary care physicians, geriatricians and healthcare policymakers throughout. Outcomes will be selected by KUs to ensure the results are relevant. We will engage with KUs to develop the key messages for the systematic review, which will inform our dissemination strategy.

Our research project is directly aligned with the healthcare priorities of Canada, and we have partnered with Ontario, Alberta and Saskatchewan, highlighting the importance of this issue.

Our research project is aligned with the priorities of Alberta, as we are interested in evaluating models of care such as comprehensive geriatric assessments, which prioritize and manage complex health needs of older adults. Comprehensive geriatric assessment involves collaboration among patients, caregivers, geriatricians, and an interdisciplinary team which includes primary care. Identifying which interventions are most the most effective across healthcare settings will help inform healthcare delivery and planning around integrated care in primary care settings.

The Alberta SPOR PIHCIN will provide support for this project in the following areas:

  • Access to networking support in Alberta and nationally through the SPOR PIHCIN network of networks;
  • Methodology development support through the Alberta SPOR PIHCIN Coordinator and Tripartite Leads; 
  • Networking connections to the Strategic Clinical Networks (SCNs) and relevant primary health care and public health networks in Alberta;
  • Provide patient feedback on the LOI that was submitted in development of the grant proposal;
  • Facilitate any requested expertise from the seven Alberta SPOR SUPPORT Unit Platforms to ensure that integration from research into care has a significant positive impact for patients and the health care system. 

Conference presentation: (to be updated)

Publication: (to be updated)

Contact information:

Dr. S. Straus
Division Director of Geriatric Medicine,
Department of Medicine,
University of Toronto

Dr. Jayna Holroyd-Leduc
Head and Associate Professor, Section of Geriatric Medicine, 
(403) 944-1771