'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions

Abstract

Background
Comprehensive geriatric assessment has been shown to improve patient outcomes, but the
geriatricians who deliver it are in short-supply. A web-based method of comprehensive
geriatric assessment has been developed with the potential to improve access to specialist
geriatric expertise. The current study aims to test the reliability and safety of comprehensive
geriatric assessment performed “online” in making geriatric triage decisions. It will also
explore the accuracy of the procedure in identifying common geriatric syndromes, and its
cost relative to conventional “live” consultations.
Methods/Design
The study population will consist of 270 acutely hospitalized patients referred for geriatric
consultation at three sites. Paired assessments (live and online) will be conducted by
independent, blinded geriatricians and the level of agreement examined. This will be
compared with the level of agreement between two independent, blinded geriatricians each
consulting with the patient in person (i.e. “live”). Agreement between the triage decision
from live-live assessments and between the triage decision from live-online assessments will
be calculated using kappa statistics. Agreement between the online and live detection of
common geriatric syndromes will also be assessed using kappa statistics. Resource use data
will be collected for online and live-live assessments to allow comparison between the two
procedures.
Discussion
If the online approach is found to be less precise than live assessment, further analysis will
seek to identify patient subgroups where disagreement is more likely. This may enable a
protocol to be developed that avoids unsafe clinical decisions at a distance.
Trial registration
Trial registration number: ACTRN12611000936921