Development and feasibility of 'G-COACH: geriatric co-management for cardiology patients in the hospital' - A case example of a mixed methods research project.

Background Older patients are at increased risk of adverse outcomes because of inappropriate hospital care. There is an urgent need to explore innovative care models that are able to sustain or improve healthcare outcomes for older adults as the current number of geriatricians and geriatric wards are inadequate to cope with the ageing population. G-COACH aims to test the efficacy of a geriatric co-management care model in cardiac patients. Geriatric co-management is characterized by collaboration and shared decision-making between the interdisciplinary geriatric team and treating physician. Materials and methods G-COACH is a multi-phase mixed methods research project incorporating: 1) a systematic literature review to identify structure, process and outcome variables; 2) a two-round international Delphi study to determine appropriate and feasible indicators; 3) a pre-post intervention study to test the efficacy of a geriatric co-management intervention based on the selected indicators; and 4) a qualitative evaluation using focus groups and individual interviews with core members of the co-management team in order to evaluate the feasibility of a large scale implementation study. Results Data extraction is currently being conducted on 44 publications included in the review. Results of the review and meta-analysis are expected in April. Fifteen US and 16 European experts participating in the first Delphi round, evaluated 5 structure, 12 process and 12 outcome indicators. Results of the final round are expected by the end of March. Conclusion A complex geriatric co-management intervention will be developed using program theory in collaboration with local stakeholder groups (May 2016), and subsequently evaluated in a before-after study (September 2016 - 2017). G-COACH is an exemplary case project that demonstrates the added value of using the MRC framework and incorporating a mixed methods approach. [ABSTRACT FROM AUTHOR]