In 2019, WAHTN was awarded $4.14 million in the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation (RART) program. This round of RART grants was targeted to primary care research, with an emphasis on multidisciplinary care and public health interventions which address lifestyle factors which lead to chronic disease.
The grant provided funding for 12 research projects from WAHTN’s Health Service Translational Research Projects (HSTRP) initiative. The successful projects, listed in the table below, were awarded $2.84 million in MRFF funding, with matched funding from the health services.
HSTRP Recipients
| Name | Health Service | Project Title | Grant | Media Summary |
|---|---|---|---|---|
| Dr Christopher Brennan-Jones | Telethon Kids Institute | PCH Ear Portal: Improving access to specialist ENT and Audiology services in metropolitan Perth | $175,752 | This PCH Ear Portal project has developed an effective telehealth pathway within the Child and Adolescent Health Service to provide rapid access to specialist ENT and Audiology outpatient services. The project has become fully integrated with the operations of the ENT and Audiology departments at Perth Children’s Hospital. The median time for participants to receive their first Ear Portal assessment was 14 days and they received their ENT care plan in a median of 28 days from referral. This is a significant improvement compared to standard outpatient waiting times which are often between 6 to 24 months if waiting for a face-to-face ENT outpatient appointment. The PCH ENT and Audiology departments have facilitated the integration of the Ear Portal pathway into the referral processes at PCH. In addition, an associated database for this project has been developed to capture outcomes for participants in the Ear Portal and will build significant future capacity for research, improved clinical management and nested clinical trials. |
| Dr André Schultz | Child and Adolescent Health Service | Implementation of solutions to improve follow-up for Aboriginal children hospitalised with lower respiratory tract infections | $235,983 | Aboriginal children hospitalised with chest infections are vulnerable to developing a serious chronic lung disease called bronchiectasis. In fact, almost 20% will have bronchiectasis within 2‐years of discharge from hospital. However, if children receive routine receive high quality follow‐up a month after discharge from hospital, they can receive screening and management for persistent symptoms. This way bronchiectasis can potentially be prevented in many children. Unfortunately, there is currently no routine follow up for these at‐ risk children. We studied the barriers and enablers to high quality follow‐up, and then developed and implemented a program to address the problem. The program was successfully implemented. Hospital clinicians significantly improved provision of lung health information to parents (19% to 55%) and follow‐up instructions for both parents (15% to 56%) and local primary care doctors (8.5% to 47%, through careful discharge instructions). There was a significant increase in the number of children attending medical follow‐ up a month after hospital discharge (14% to 58%) and an improvement in children’s respiratory health as measured indirectly through cough related quality of life. |
| Prof Graham Hillis | East Metropolitan Health Service | Community based education and exercise training in heart failure: Harnessing an existing resource to bridge a gap | $249,789 | Heart failure (HF) is a common condition and has a prognosis worse than most cancers. Patients who have recently been admitted to hospital with HF are at particularly high-risk both of readmission and death. For example, over 1 in 5 will be readmitted by 30 days and up to 50% by 6 months. Exercise training is one potential way to improve outcomes, increasing survival and reducing the risk of requiring further hospital treatment. However, exercise training is not routinely used in the early period after discharge; partly due to limited evidence in this setting and partly due to the logistical difficulties in providing exercise programs to the large number of often elderly patients with HF. We identified several barriers faced by patients with heart failure in accessing cardiac rehabilitation following discharge from a tertiary hospital. Specialised community-based rehabilitation services run by trained staff are a safe and viable solution. This study has resulted in an update of the Australian exercise guidelines for patients with heart failure in conjunction with ESSA, the national body for accredited exercise physiologists. This will generate safer referral pathways and also enable more practitioners to supervise exercise rehabilitation for heart failure patients across Australia and internationally. |
| Prof Christobel Saunders | East Metropolitan Health Service | Measuring the cost of continuous improvement in care-cancer at Royal Perth Hospital – a ‘proof-of-concept’ | $211,500 | The outcomes of this research project have provided valuable insights into appropriate methods for analysing patient outcomes and cost data. This will inform other projects looking to use longitudinal data to identify drivers of health system value (success or failure) and sustainability. Analysis of patient-reported outcome measures and costs has allowed a beginning understanding of what is important to patients about their cancer care, differences in cumulative costs, the primary drivers of cost, and the potential relationship between quality of life and health costs for people with breast, lung, or colorectal cancer. Measurement of adherence to optimal care pathways has allowed for identification of instances where a patient's care varied from evidence-based best practice, the type of variation that occurred, and why it may have occurred. Combined, this information has provided important information for health executives and clinicians about areas where the quality of clinical care provision can be improved. Results have already provided a platform for engaging clinical staff and collaboratively progressing cancer service improvements with discussions underway about how to act on the information. |
| Assoc Prof Paul Cohen | North Metropolitan Health Service | Getting the MOST out of follow-up: a randomised controlled trial to compare three-monthly nurse-led telephone follow-up, including monitoring serum CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic-based follow-up, following completion of first-line chemotherapy in patients with epithelial ovarian cancer | $240,000 | The project aims to improve ovarian cancer patients’ experience by offering holistic follow up care and relieving the stress of travelling to appointments by using nurse-led follow up via telehealth, and a standardised, patient-reported symptom assessment – the ‘MOST’ questionnaire. Traditional models of follow up care focus on detecting cancer recurrence and involve regular clinic visits and examinations by a doctor with psychosocial needs often inadequately addressed. Anxiety, depression, fear of recurrence and fatigue are all common following treatment for ovarian cancer and most people would like help to deal with these symptoms. The trial is important for ensuring the psychological wellbeing of patients, in addition to assessing physical symptoms. Current follow up methods are not evidence-based, with no high-quality trials ever conducted in this space. For the one third of Australia’s ovarian cancer patients living in rural and remote locations, treatment can involve travel and a considerable cost in terms of time, transport, and accommodation, as well as time away from work and loved ones. The trial provides patients with an alternative method of follow up that is convenient and does not require attendance at hospital thereby reducing the burden on both them and their families, and busy hospital clinics. |
| Prof Michael Millward | North Metropolitan Health Service | Integrating Tumour Mutational Burden (TMB) testing for appropriate selection of immuno-oncology therapy in metastatic melanoma fit for the modern era | $246,000 | This project involved measuring the amount of genetic change (mutations, called tumour mutational burden) in melanoma samples from patients with melanoma being treated with new immune activating drugs. These drugs can be effective but can also have serious side-effects so it is important to try and work out which patients will do well before treatment is started. The results showed patient with melanoma that has a high tumour mutational burden had a much greater chance of showing a favorable response to treatment. |
| Prof Girish Dwivedi | South Metropolitan Health Service | High Performance Medicine through Artificial Intelligence in the Emergency Department | $235,000 | Our project has taken an active role in advancing Artificial Intelligence (AI) research within the medical field. As a part of our efforts, we extensively investigated the application of AI in analysing cases of chest pain during emergency situations, its role in clinical decision making and its role in point-of-care ultrasound and echocardiography, aiming to understand how these technologies impact emergency physicians. Moreover, our research also delved into the perspectives of emergency doctors, medical students, and health consumers from both Australia and New Zealand. By gaining insights into their perceptions of AI's role in emergency medicine, we aimed to provide a comprehensive understanding of the potential implications and benefits. In addition, our project extended its focus to include patient viewpoints on the integration of AI into emergency care and overall health management. By considering a wide spectrum of opinions, we aimed to offer a holistic view of AI's potential contributions across various aspects of medical practice and patient well-being. In summary, our investigations collectively shed light on the multifaceted potential of AI, spanning different dimensions of medical practice and patient care. |
| Assoc Prof Andrew Maiorana | South Metropolitan Health Service | Primary Care Adherence to Heart Failure guidelines IN Diagnosis, Evaluation and Routine management (PATHFINDER) Study | $249,936 | Heart failure is a condition which frequently results in admission to hospital. The objective of the PATHFINDER project was to support GPs in managing the care of patients with heart failure. This involved a three phase process - an audit of hospital discharge practices, engagement with key stakeholders including patients and healthcare providers, to determine barriers and facilitators to heart failure management, and a randomized, control trial of an intervention to support GPs in managing heart failure (guided by the stakeholder engagement). A recurring theme from the stakeholder engagement was that many GPs might benefit from guidance from hospital specialists to optimise heart failure medications. To address this, a Medication Optimisation Guide was implemented for patients to take to appointments with their GP at 1 week, 1 month and 3 months after they were discharged from hospital due to a heart failure admission. By 6 months after leaving hospital, approximately twice as many patients who were in the group receiving the Medication Optimisation Plan were taken an optimal dose of core heart failure medication, compared with patients who received usual care. This is likely to help people with heart failure to lead longer lives with less illness. |
| Dr Wei-Sen Lam | WA Country Health Service | TeleTrials in WA: A feasibility study to develop and pilot a TeleTrials framework to bring clinical trials closer to home for country patients | $250,000 | The benefits of clinical trials to patients include allow patients access to new treatments and diagnostic tests, access to specialists and improves care through closer monitoring for patients. Sadly, rural, regional and remote patients are less likely to participate in clinical trials as majority of trials are based in the metropolitan area. In 2016, the Clinical Oncology Society of Australia developed the national guide for implementation for the implementation for the Australian Tele-trial model to improve access to clinical trials for rural, regional and remote patients. The benefits of the tele-trial model include • Increased access to clinic trials and thereby reducing travel for country patients to metropolitan area • Improving collaboration with metropolitan health service provides, universities and non-government organization allowing greater engagement in research activity • Improve rates of recruitment of patients in clinical trials and reduce disparity in outcomes between metropolitan and rural, regional and remote patients • Improve clinical trial capacity and provide workforce development and training of regional sites • Improve access to novel therapies and innovative approaches to health care The WAHTN Grant has helped facilitate the implementation of the Australian Tele-trial model in Western Australia. |
| Ms Jo Moore | WA Country Health Service | A community and health system partnership to prevent hospitalisation and improve outcomes through a Compassionate Communities Model of End of Life Care | $250,000 | This pilot project developed, implemented and evaluated a model of care delivered by community volunteers, identified as Compassionate Communities Connectors, to support people living with advanced life limiting illnesses/palliative care needs, by enlisting Caring Helpers from the community. The benefits included improvement in social connectedness between families and their social networks, reduction in social isolation, better coping with daily activities, an increase in community links and enhancement of social networks. Families, volunteers and service providers reported the program to be feasible and acceptable and should be continued and embedded in routine practice, as it fills the gaps in social and practical support that formal services cannot, particularly for people who live alone, and those who are socially isolated in more rural communities. Ongoing work is focused on rolling out the connector training to a number of interested communities in other geographical regions to help them establish a similar model of care, meaning further program applications and better integration of formal and informal services. This pilot project has laid solid grounds for community capacity building and replication into other communities with successful measurable outcomes which are in line with what is reported in the international literature for similar programs. |
| Prof Desiree Silva | Ramsay Health Care | Embedding E-Health (Pregnancy Lifestyle, Activity, Nutrition (PLAN)) into routine clinical practice pathways to provide a healthy start to life | $250,000 | Pregnancy Lifestyle Activity Nutrition (PLAN) mobile app is an evidence-based nutrition and lifestyle app designed to improve the health and wellbeing of pregnant women and reduce excess gestational weight gain (GWG). An increasing body of evidence has highlighted early excess GWG as a risk factor for increased non communicable diseases including obesity in offspring. The app provides women with evidence-based nutrition information, goal setting and personalised weight tracking with the aim to prevent excess GWG and improve the long-term health outcomes of the infants. The app was implemented at Joondalup Health Campus (JHC) Antenatal Clinic, with the aim to embed the app into routine antenatal care. From June 2021-November 2022 analysis shows that the app has been useful for women that start pregnancy above a healthy weight range to stay within optimal GWG range. It also helped women that start pregnancy within the healthy weight range to remain within GWG guidelines. With commencement of online promotion in November 2022, downloads increased from approximately 100 active users per month to 677 downloads per month. Considering the major benefits advertising had on reach, future strategies would benefit from media advertising to foster the ongoing impact of the app in improving optimal pregnancy health. |
| Mr Richard Varhol | WA Primary Health Alliance | Unlocking the potential of health system integration through data linkage: Combining primary and secondary data across the continuum of care to support policy development and clinical management of chronic disease in WA | $243,500 | Through a series of studies involving patients, general practitioners (GPs), and data custodians across Australia, this project explored the dynamics associated with healthcare data sharing. Insights highlight intricacies and nuances of perceptions towards data sharing. Patients were open to sharing health data for research and clinical practice, with a preference for government oversight and transparency, however were apprehensive towards sharing with insurance and private companies. GPs recognised data sharing potential but expressed concerns over workload and data misuse. Data custodians, while emphasising commitment towards social-license, highlighted the need for standardised data governance amid complex, varied data sharing practices. Examination of primary care data quality will demonstrate data linkage potential, assisting in providing comprehensive overview of a patient’s journey from doctor to hospital with recommendations developed to optimise the effectiveness of general practice data. Additionally, we conducted an in-depth investigation of diabetes management in primary care using linked data, providing valuable insights into the key determinants influencing blood sugar control. Recognising diverse attitudes towards data sharing, our research underscores the importance of data linkage in bridging gaps between regular and specialist care; further shaping Western Australia’s data linkage strategies by influencing data governance policies and driving research that addresses population needs. |