How best to deliver Comprehensive Geriatric Assessment in a cost-effective way
As the population ages, growing numbers of older people are admitted to hospital each year, creating a major challenge for the health services. Previous research suggests that frail older adults admitted to hospital will do much better if a specialist assesses their health problems and co-ordinates their care: this is known as Comprehensive Geriatric Assessment (CGA). Other research has suggested that programmes to keep frail older people out of hospital and cared for in their own homes (admission avoidance hospital at home) may result in better survival and lower costs, as well as being preferred by patients and their carers. However, there is considerable uncertainty about how robust these findings are. HERC researchers, along with other colleagues within the Nuffield Department of Population Health and collaborators in the University of Glasgow and the NHS in Scotland, Wales and England, have recently received funding from the NIHR to undertake a study which will improve the evidence base used to plan health care for acutely unwell and frail older people. The research will include a national survey and follow-up interview study to collect information on the different models of CGA already is use across the NHS, and the collection of data to calculate the costs of delivering these different models. We will also assess previous research in detail by contacting researchers from around the world to see if they will contribute their research data to a pooled analysis of all the data. This will help us establish exactly which patients benefit the most from specialist care, how effective the different models of CGA are, and how much they cost the health service. This collaboration will build on a a similar review group successfully established five years ago to evaluate the effectiveness of different ways of organising services designed to provide an alternative to hospital care. Finally, this research will examine how CGA is implemented by healthcare professionals in the NHS and ask patients and caregivers to give their views on this type of care. The results will help in deciding how best to deliver CGA in the NHS, and what type of research is still needed.