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Open Access Study protocol

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

Len Gray1, Lucy Dakin1*, Steven Counsell2, Helen Edwards3, Richard Wootton4 and Melinda Martin-Khan1

Author Affiliations

1 Centre for Research in Geriatric Medicine, University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia

2 Indiana University School of Medicine, 1001 West 10th Street, OPW-M200, Indianapolis, Indiana 46202, USA

3 School of Nursing and Midwifery, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia

4 Centre for Online Health, University of Queensland, Level 3, Foundation Building, Royal Children's Hospital, Herston 4029, Australia

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BMC Geriatrics 2012, 12:10  doi:10.1186/1471-2318-12-10

Published: 20 March 2012

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