Project Title: A multidisciplinary model of primary care to minimise unplanned care transitions in older Australians
Principal Investigator: A/Prof Joel Rhee
Co-Investigators: Dr Jitendra Jonnagaddala, Prof Anna Williams, Dr Stephanie Champion, A/Prof Margo Barr, Dr Rebecca Bilton, Dr Anthony Marinucci, Prof Gideon Caplan, A/Prof Ben Harris-Roxas, Dr Brendan Goodger, Dr Narelle Mills, Prof Nick Zwar, Ms Samantha Edmonds, Dr Shruti Yardi, Dr Amber Ye, A/Prof Russell Pearson, Dr Kate Marshall
Amount: $150,000
Imagine being able to identify older patients at risk before a health crisis occurs. This research will develop an AI-powered tool that uses routine general practice data to help GPs identify older people at increased risk of hospitalisation or entering residential aged care. By supporting earlier intervention and more coordinated care, the project aims to reduce crisis-driven transitions, help older people remain independent for longer, and improve quality of life. Practical tools and training will also be developed to help GPs and practice teams embed this proactive approach into routine care.