Reliability of an 'online' geriatirc assessment procedure.

There is a severe shortage of geriatricians and gerontic nurses across Australia. These specialists play a pivotal role in hospital geriatric consultation services which, among other clinical functions, make important triage decisions around access to geriatric assessment units, rehabilitation, community post-acute care, and residential care. In the face of inexorable workload growth, improving the efficiency of geriatric consultation without compromising integrity of the process, is a major challenge. This study explores the reliability, safety and cost-effectiveness of an “online” method of conducting geriatric assessment. The model under scrutiny has been developed by the Academic Unit in Geriatric Medicine and the Centre for Online Health at the University of Queensland. It comprises: - Standardised assessment (based on the interRAI Acute Care system) performed on location by a specifically trained gerontic nurse - Data entry on web-based software - An inbuilt clinical decision support system - A capacity for geriatricians to review and report cases “online” (who can be anywhere in the world) immediately on completion of the nurse assessment - A training strategy for all participating and affiliated practitioners - Electronic messaging systems to facilitate distribution of findings among clinicians. Preliminary research suggests the method to be attractive to clinicians, reliable, safe and highly efficient, while improving the quality of assessment and promoting the skills of gerontic nurse assessors. The study will examine: - The level of agreement between online and live geriatrician clinical assessments and recommendations, taking into account inter-rater reliability of live consultations. The cost of the “online” approach compared to conventional geriatric consultation (including a formal economic evaluation) Paired assessments (online and live) of 115 patients referred for geriatric consultation will be performed by separate geriatricians. To evaluate “natural” variation between geriatrician assessment, inter-rater reliability of (115 paired) live assessments will also be determined. Three pairs of geriatricians across 3 hospital sites will participate. The paired assessments will be randomly configured to remove potential biases. Combinations relate to format (live-live or live-online) and order of patient contact (the order of geriatrician consultation will be randomly allocated for live-live pairings). The assessment outcomes of interest include recommendations for rehabilitation and permanent long term care, as well as diagnoses of common geriatric syndromes. Agreement will be characterised by kappa statistics calculated to appraise the level of agreement of triage recommendations. New diagnoses not present in the medical record at the time of assessment will be recorded, to identify the risk and potential impact of these being overlooked in the online approach. Each procedure will be subject to a detailed costing analysis to support an economic evaluation. If demonstrated to be valid, safe and cost effective, the online assessment method may generate considerable cost savings and dramatically extend the availability of high quality specialist comprehensive geriatric assessment across Australia and the world.