We're working to develop and deliver workable, evidence-based solutions for real-world problems in the health system to improve care experiences and outcomes for individuals, families, communities, and the health workforce.
The Healthcare Transformation program is unique in that it incorporates a whole of system approach and is not specific to one disease or condition.
Our collective purpose is to optimise healthcare experiences and outcomes for individuals, families, communities and health care providers. We're a transdisciplinary group committed to transcending jurisdiction, disciplinary and geographic boundaries. We combine our clinical and research skills to undertake transformative, person-centred, practice-based research. Our work has impact and relevance for people and communities with diverse health-care needs. These health care needs extend across the life span, from pre-conception to end of life, and are delivered across diverse contexts in metropolitan, regional and remote settings.
Our key strategies are to:
Implement innovative, evidence-based, cost-effective, culturally safe, person-centred models of care (MoC). These will integrate and co-ordinate care, deliver workable solutions for real-world problems and priority populations, and also build resilience in the healthcare system.
Build a research enabling environment for HPRs through research education, training, opportunity and support that develops and embeds research capacity and capability.
Health services are currently fragmented, lacking coordination and integration between providers and across health care settings, with insufficient focus on the person at the centre of care. This results in gaps in care, conflicting advice or treatments, duplication of services and wastage of resources. This undermines the quality of care and negatively impacts experiences and outcomes of care, particularly for priority populations.
Research demonstrates that integrated care models and inter-professional practice approaches can address complex problems through the development of innovative solutions.
We are a transdisciplinary group (all disciplines working together to create novel solutions for improving care delivery). We cross jurisdiction, disciplinary and geographic boundaries, combining the experiences and knowledge of healthcare consumers with our clinical (Nursing, Midwifery, Allied health, Medicine), research and service innovation expertise to transform healthcare experiences and outcomes. This program fosters new transdisciplinary clinical, academic and industry partnerships and supports co-designed research that translates into improved health, system and service outcomes for priority populations, transforming healthcare service delivery models.
Our research is person-centred and has impact and relevance for people and communities with diverse healthcare needs, including areas such as Maternal and Infant Health, Pain, Drug and Alcohol, Mental Health and Older Person Care, underpinned by a focus on Healthcare Innovation and Safety.
Our collective purpose is to optimise healthcare experiences and outcomes for individuals, families, communities and health care providers.
Transfer of people who are residents of residential aged care facilities (RACF) to emergency departments (ED) is common, risky and expensive. Up to 44% of transfers are considered unnecessary. Avoidable ED transfers expose residents to additional investigations and treatments that may not enhance care, but cause additional harm through emotional stress and iatrogenic (illness caused by medical examination or treatment) complications. There is no previous evidence of nurse-led models of care (MOC) being in operation in Australia or elsewhere. Ample studies demonstrate the effectiveness of telehealth generally, but very few examine its use linking RACFs with EDs; and most are condition specific and not nurse-led.
The PACE-IT project implemented and evaluated whether enhancement of the well-established nurse-led telephone-based aged care emergency (ACE) service, with the addition of an interactive visual telehealth assessment and clinical decision-making model of care (MOC) called PACE-IT achieved the following;
A randomised-controlled stepped wedge implementation study was undertaken in two NSW Local Health Districts (Hunter new England and Western NSW LHDs) involving four Emergency Departments and 16 RACFs across metropolitan, regional and rural areas in NSW.
Findings demonstrated a 53% uptake of the PACE-IT model of care and a clinically significant 14% reduction in ED presentations (Count Ratio 0.86 [95% CI 0.65, 1.18] p.0.373). Qualitative data indicates that PACE-IT is highly acceptable to RACFs and aged care emergency service teams who describe how their clinical assessment and decision-making was enhanced.
The PACE-IT project has been an extensive collaborative effort between many different stakeholders, including HNE LHD executives, and across service executives, managers and clinicians at four hospital EDs and 16 RACFs. This collaboration has enabled an integrated approach to care, facilitating shared decision making between ED and RACF staff and the resident, their families and GPs, provided better understanding of the challenges faced in each facility, has reduced the number of unnecessary ED transfers for RACF residents to and facilitated a smoother transition of care for the resident if ED transfer is required.
Resident and staff from RACF taking part in a PACE-IT telehealth consultation with an ED ASET Nurse
In addition, the model of care has empowered residents and their families through their inclusion in decision making related to care options and brings a more person-centred approach to management planning. RACF and ED staff have been empowered through involvement in implementation groups and through building their skill to better communicate through the use of telehealth and use of the ISBAR communication framework. RACF staff are better supported in their decision making re alternative care options.
Overall, this initiative is embedded in routine aged care emergency practices and has optimised the benefits of both ACE/ASET and telehealth in addressing avoidable RACF transfers, building and strengthening relationships, support and communication between EDs, RACFs, residents, their families and GPs.
The project provided the platform for research capacity building for an early career health practitioner researcher who was supported in completing a PhD during this study.
PACE-IT Publications to date
Opioids, or morphine-type medications can make chronic pain worse, cause side-effects, serious harm, and even death. Every year, more people die from prescription opioid overdoses than from car accidents, or heroin overdoses. Stopping opioids when you have chronic pain can be difficult. This research will use expertise from patients, specialist clinicians and researchers to develop a healthcare intervention that supports people with chronic pain to reduce and stop their opioids whilst managing pain.
Despite a lack of evidence to support the efficacy and long-term safety of opioids for the treatment of chronic non-cancer pain (CNCP), many Australians continue to take opioids to manage CNCP. In Australia, approximately 60% of all opioids prescribed are for the treatment of CNCP. Prescribing rates are higher in regional and rural areas, and three times more likely in Aboriginal and low-socioeconomic populations.
Whilst the role of opioids in the management of acute and cancer related pain are well documented, long-term use of opioids for CNCP has been associated with poor functional outcomes, increased healthcare utilisation, opioid-induced hyperalgesia and in up to 18% of people commenced on opioids, development of an opioid use disorder.
Escalating rates of opioid prescribing over the past three decades has been meet with an associated rise in opioid-related harm and misuse. More than 70% of all opioid-related overdoses involve prescription opioids. Each day prescription opioids are and account for 160 hospitalisations, 14 emergency department admissions, and three deaths every day.
Coming off opioids is associated with improved treatment outcomes for patients attending specialist pain services. However, there is a question of whether these results can be achieved in primary care settings, and if specialist support of general practitioners can help this. The primary directive of clinical practice guidelines centres on patient referral to specialist multidisciplinary pain services for support in helping patients wean opioids and manage their pain. However, putting this into practice is challenging.
To date, no studies globally have addressed the problem utilising a comprehensive intervention that accounts for the system, patient and provider influences underpinning inappropriate opioid prescribing for CNCP.
This transdisciplinary study brings together key stakeholders including patients, general practitioners, service managers, specialist pain, drug and alcohol, addiction medicine, allied health, Aboriginal chronic disease with academic and clinician researchers. They'll aggregate experiential, clinical and research expertise to co-design, implement and test an integrated specialist supported prescription opioid tapering (iSPOT) model of care. This will aim to support adults with chronic non-cancer pain to wean and cease prescription opioids and transition to non-pharmacological management strategies for CNCP.
The program of research includes four studies, and the development of education, infrastructural supports, an IT platform, health care professional training, population-based health promotional information and any other required deliverables determined during stakeholder consultation.
Study one is a mixed-method observational study. It's utilising a cross-sectional survey, focus group, individual interviews and nominal group workshops. Once stakeholder needs are understood, it will co-design and refine the model, gain consensus on requisite infrastructures, supports and processes required to implement iSPOT across diverse clinical settings. Study two, a pilot feasibility study, will inform subsequent intervention refinement and implementation processes and strategies. Study three is a comparative effectiveness trial to test effectiveness, cost-effectiveness and implementation uptake and strategy. Study four is a mixed-method observational study to identify antecedents and effects of multi-disciplinarity inputs on patient, clinician and service outcomes and impact.
Attention will be given to adapting and adopting the intervention for priority populations, including Indigenous, rural and remote dwellers across all phases of the study. Research conducted with Indigenous peoples will utilise Indigenous methodologies, led by an Aboriginal Researcher, in partnership with local communities, nominated elders, patients and Aboriginal health workers to ensure research processes and deliverables are culturally safe, appropriate, meet community needs and empower Aboriginal health staff.
This study supports the opportunity for several early career health practitioner researchers to undertake a PhD.
Executive Leadership Committee
Operations Leadership Committee