Annual Report 2024
Our Partners
A word from our CHAIR
As Chair of SPHERE, I am proud to reflect on 2024 as an exceptional year of collaboration, innovation, and impact. Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) is an academic health science partnership that brings evidence to outcomes, discovery to practice and innovation to life.
This year has demonstrated our collective commitment to driving impactful health service research and fostering meaningful change.
Here are a few of the year’s achievements: Our flagship Big Ideas Grant Scheme supported groundbreaking projects that addressed critical challenges, including transitions of care, sustainable prevention strategies, and innovations in homebased and primary care models.
SPHERE brought together a vibrant network of researchers and collaborators to submit 13 applications to the National Health and Medical Research Council’s (NHMRC) Health Services Research Grant this year. In these applications, consumers play an integral role, actively participating as investigators, helping to shape the future of healthcare.
Our Platforms played a pivotal role in bridging research and practice, fostering innovation, and supporting the next generation of leaders in health service research. The contributions of Early and Mid-Career Researchers across various disciplines exemplify SPHERE’s commitment to nurturing future talent and developing practical solutions.
In advocacy and policy, SPHERE made a significant contribution. We responded to the Australian Senate’s enquiry into menopause, supported a consensus statement in diabetes care, and launched
a pioneering initiative on the use of technology to support healthy ageing at home, at a landmark parliamentary forum. These efforts highlight SPHERE’s leadership in influencing healthcare policy and advancing national conversations on critical health issues.
These accomplishments are a testament to the power of collaboration and shared vision.
I extend my deepest gratitude to everyone who contributed to making this year truly remarkable, with special recognition and praise for the core SPHERE team. Following last year’s organisational restructure, which brought many new members to the team, their ability to achieve impactful results reflects their dedication, talent, and resilience. Together, we are shaping a brighter future for the health of our nation and the care of our communities.
Council Chair
“These efforts highlight SPHERE’s leadership in influencing healthcare policy and advancing national conversations on critical health issues.”
Professor Rod McClure
Professor Rod McClure
A word from our EXECUTIVE DIRECTOR
Translational research and research translation are complementary but not identical nor interchangeable. Translational research is a journey of persistence and precision, navigating a linear path from discovery to understanding. Researchers often progress methodically driven by rigorous processes and a focus on unveiling the mysteries of science. Yet, translating research into practice demands an entirely different approach.
As a dynamic and multifaceted process, research translation is driven by the seamless alignment of three essential elements: desire, talent, and opportunity. Desire reflects a shared commitment and determination to transform research into real-world impact. For SPHERE, this drive stems from the Council’s unwavering mandate to bring innovation to life for the communities it serves. Talent encompasses the collective expertise of researchers, clinicians, consumers, and community advocates who are equipped to lead and sustain change. Finally, opportunity refers to the enabling environment—comprising funding, collaboration, and the right conditions—that allows innovation to take root and thrive. Together, these elements form the foundation for meaningful and sustainable change.
When these three elements intersect, true transformation occurs. This alignment isn’t accidental; it requires strategic effort, team-based collaboration, and a readiness to adapt.
At SPHERE, research translation is more than a process; it’s a mission. We are a collaborative enterprise uniting diverse talents from clinical, academic, and community sectors to tackle complex health challenges. Our work amplifies BIG ideas, bringing them to the forefront of health systems transformation, with the aim of solving a wicked problem.
To achieve this, we focus on empowering communities by engaging consumers to articulate unmet needs that help guide our priorities. We foster
collaboration by creating partnerships that bridge boundaries between government agencies, health services, and academic institutions. Additionally, we scale innovations by supporting projects at various stages of readiness, ensuring they are positioned to make a measurable impact.
In 2024, knowing what not to do was an important step in refining our product, developing our method and establishing our brand. We are now an agile network of clinicians, consumers, researchers and managers who worked together to deliver a Technology Enabled Collaboration in Health.
We amplify good ideas like virtual care for chronic conditions and ageing and transform health systems like the community-based care for patients with diabetes, in a sustainable way. Our impact stories will be reflected in doing things like Omics, in ways we never thought of doing them before or consider doing again in any other way in the future.
The impact case studies in this Annual Report not only highlight our four pillars – collaborate, amplify, transform and impact – but are also excellent examples of how aligning talent, desire, and opportunity enables sustainable health system change.
We are a collaborative enterprise, ready with innovations, evidence and a pipeline of projects at different levels of technology and research readiness. Harnessing opportunities and increasing our talent pool and process for change, we are spread across boundaries and committed to facilitating sustainable change in health for the communities we serve.
When desire, talent and opportunity align, the magic truly happens – and SPHERE is focused on making that magic a reality.
Professor Chris White SPHERE Executive Director
Professor Chris White
$1M funding $8.2M
in-kind and cash co-contributions pledged including $4.1M from 67 new partners in Industry, Agency, Philanthropy and Health Service Providers for 7 BIG IDEAS returning $5M to SPHERE researchers
1016 subscribers to SPHERE’s monthly e-newsletter 735 followers on LinkedIn Over 1250 readers of In-SPHERE magazine
Launched our new website: www.thesphere.com.au
Parliamentary submission to Australia Senate Inquiry into Menopause Launch of Reception of Care Technologies at Home at Parliamentary Forum “Building a technologyenhanced care economy”
260 collaborators including:
24 Consumers as investigators, submitting 13 applications with more than 70 individual projects to the 2024 NHMRC
Collaborations in Health Service Research Grant
71
EMCRs:
56 Co-Investigators: 6 as CIA, and
15 Associate Investigators from 26 Health Service Research Grants submitted in 2024
15 partner organisations:
2 Local Health Districts
2 Speciality Health Networks
4 Universities
7 Medical Research Institutes
SPHERE Team
Professor Chris White
Executive Director
Ms Elizabeth Henness
Operations Manager
Ms Linda Music
Communications Officer
Mrs Bianca Badolato
Administration Officer
Dr Brigitte Gerstl
Research Outcomes Coordinator
Dr Natalie Walsh
Research Support Officer
Dr Sophie Gates Research Support Officer
Dr Maf Hasan Research Support Officer
Many thanks to SPHERE for your assistance preparing the grant. You were not only friendly and accommodating to our every need (and mistake) but you did it in such a professional way. In the background you were providing the same service to all the other applicants. Nevertheless, you made us feel special.
Professor Ken Hillman AO, Professor of Intensive Care, SWS Clinical School, UNSW
I would like to express my appreciation for the SPHERE team’s foresight, facilitating our application teams’ collaborative effort through the strategic EOI process, in true fidelity to the SPHERE mission. It was clearly an enormous undertaking and collectively the team is deeply appreciative of the opportunity it has afforded us.
Kate Saw, Research Nurse | Connie Johnson Breast Cancer Research
COLLABORATE
We bring people together through partnership across health, research and industry to generate innovations and big ideas
SPHERE facilitated opportunities for me to connect with senior researchers across SPHERE Themes and Platforms, which has been extremely helpful for expanding my network and collaboration with experienced academics from different institutions.
Dr. Oscar Lederman, Lecturer, Master of Clinical Exercise Physiology | University of Technology Sydney (UTS)
COLLABORATE
TECH: A Collaborative Model for Health Innovation & Equity
SPHERE’s Technology Enabled Collaboration in Health (TECH) project exemplifies a groundbreaking model for fostering health innovation through collaboration.
Launched as an incubator with input from diverse partners, TECH unites stakeholders from various fields, including clinicians, healthcare providers, researchers, industry experts, and consumer advocates, to address complex health challenges with real-world impact. This unique approach is grounded in the philosophy that health solutions are most effective when co-designed by those who will implement and benefit from them. It also adheres to the principle that technology enabled solutions may address the “postcode lotteries” that define some of the health inequities that exist in our societies. By bridging the gaps between the healthcare, academic, implementation and industry sectors, TECH has created a platform to engage innovations at different technology readiness levels (TRL) that can progress through this medtech environment with direct applications to patient care.
Building a Multisector Network for Health Innovation
The TECH project leverages SPHERE’s extensive network, which includes existing and new local health districts and networks (SESLHD, SCHN, SWSLHD and NSWHP), universities and research institutes (UTS, UNSW, WSU and IIAMR), industry partners, philanthropy and consumers. This collaborative model brings together diverse perspectives with the shared goal of advancing healthcare innovation along a development pipeline as quickly as possible. Each partner contributes specialised knowledge, resources, and connections crucial for moving projects from concept to implementation. This level of cross-sector collaboration is rare in traditional health research but is essential for developing practical, scalable
solutions that address the needs of a rapidly evolving healthcare landscape.
A key strength of the TECH model is its adaptability and bidirectional applicability. By including various stakeholders at different stages in the product development process, TECH can prioritise and address pressing health and innovation needs with greater flexibility. Health districts provide insights into operational and patient care challenges with “wicked problems” requiring ingenuity to solve. Our university partners drive research and enterprise solutions through technological development while industry partners can repurpose existing products, expand their offerings and the infrastructure for scaling. Consumer representatives with lived experience and relevant skills ensure solutions do not stray from solving the unmet need. Implementation science addresses barriers to widespread adoption. This networked approach enables TECH to test and refine innovations with real-world input, increasing their chances of evidence gathering, refinement, adoption and clinical or commercial success.
TECH’s Collaborative Framework:
Building a Sustainable Model for Health Innovation
The TECH project’s collaborative framework is structured to not only drive but also sustain innovation. By embedding this model within SPHERE’s network, TECH creates a longterm pathway for healthcare advancements. The framework includes mentorship, resource sharing, and pathways for commercialisation, supporting projects beyond initial pilots.
A central aspect of the TECH framework is its focus on consumer involvement. By incorporating the perspectives of patients and end-users at every stage, TECH ensures that innovations are
genuinely patient-centred. It is not always the same consumer who is involved at proof-of-concept to commercialisation when transition across a TRL platform may require different lived experience for relevance at different stages. This adaptive approach is crucial for developing products that are functional and widely accepted by those they aim to serve.
Five Pilot Projects Focused on RealWorld Impact
To demonstrate the efficacy of its collaborative model, TECH is supporting five pilot projects across early, mid and late TRL, targeting distinct healthcare challenges. Each project was initiated based on direct clinical needs, with a focus on using technology to deliver high-impact, accessible solutions. By engaging clinicians and researchers who encounter these challenges firsthand, TECH ensures that each project is firmly rooted in practical application rather than being curiosity driven.
Minimally Invasive Diagnostics for Prostate Cancer (Early TRL)
Prostate cancer is one of the most common cancers affecting men, and early diagnosis is crucial for successful treatment. Traditional diagnostic methods can be invasive, expensive, and uncomfortable for patients. TECH’s prostate cancer project focuses on taking laboratory data and developing a minimally invasive diagnostic tool that can detect cancer earlier and more accurately than existing methods. By simplifying the diagnostic process, this project aims to make screening more accessible and less intimidating, particularly for underserved populations who may have limited access to regular healthcare.
Consumer engagement also plays a critical role in validating each project’s relevance and effectiveness, as real-world insights help guide ongoing refinement and improvement.
User-Friendly Splints for Diabetic Foot Ulcer Healing (Early TRL)
Diabetic foot ulcers are a frequent complication for people with diabetes, often leading to prolonged healing times and, in severe cases, amputation. TECH’s project seeks to redesign the standard foot splint to be more comfortable with effective and safe unloading, encouraging better patient compliance and promoting faster recovery. The reimagined splint, developed with feedback from diabetic patients and healthcare providers, could reduce the burden on healthcare systems by decreasing the frequency of wound care visits and preventing complications that lead to hospital admissions.
Handheld Scanner for Paediatric Craniofacial Abnormalities (Mid TRL)
Early detection of craniofacial abnormalities in children can significantly improve treatment outcomes. However, access to diagnostic tools is often limited, especially in rural or resourceconstrained areas. TECH’s paediatric craniofacial scanner project is developing a portable, handheld device that healthcare providers can use to detect abnormalities in young children during routine checkups. By enabling early intervention, this device could improve quality of life for affected children and reduce the need for complex surgeries later in life.
Credit: Prostock-Studio (istock)
Digital Mental Health Platform for Children (Mid TRL)
Mental health support is a growing need, especially among children and adolescents facing increasing stressors in today’s digital world. The TECH project in mental health aims to create a digital platform that provides children with access to supportive resources, tools for managing stress, and connectivity to professional help when needed. Using existing gaming technology with an established manufacturer and start-up, co-designed with input from mental health professionals, educators, and parents, this platform aims to address the accessibility barriers that prevent children from receiving timely mental health support, particularly in remote and underserved communities.
Affordable Electron Microscope for Early Renal Disease Diagnosis (Late TRL)
Renal disease is often detected at advanced stages
due to limited access to diagnostic imaging, especially in remote and under-resourced regions. TECH’s final pilot project focuses on the development of an affordable “benchtop” electron microscope that can be deployed in regional clinics and hospitals with limited funding. By facilitating early-stage renal disease diagnosis, in partnership with an established industry sponsor, this tool could save lives and reduce healthcare costs by enabling proactive treatment and management.
By connecting technology, healthcare, and consumer needs, TECH has created a sustainable framework for medtech innovation. The five pilot projects showcase the versatility and impact of TECH’s model, tackling health challenges across various fields and populations. Each project highlights the power of collaborative innovation to produce solutions that are practical, scalable, and capable of driving meaningful change.
TECH brings people together across the spectrum – from those at the forefront of developing innovative technologies, to the health professionals and consumers needing better healthcare solutions. I am truly grateful to SPHERE for bringing together our diverse team, and providing a breeding ground for new ideas, crosssectoral partnerships, and TECH to grow and prosper.
Jiao Jiao Li, Snr Lecturer, School of Biomedical Engineering | UTS
Credit: Maria Garcia (istock)
COLLABORATE
Aged care reform through innovation, research, and community
SPHERE’s Collaboration pillar is about bringing together health, research, and industry to create innovative solutions and impactful ideas. A standout example of this is the ‘Towards a NSW Alliance for Ageing: Aged care reform through innovation, research and community’ initiative led by SPHERE’s Age and Ageing Clinical Theme, which lays the foundation for the NSW Alliance for Ageing.
This strategic, consumer-driven collaboration unites consumers, health service providers, researchers, and industry partners to tackle key challenges in aged care through five interconnected projects. The initiative is a prime example of integrated collaboration, involving multiple stakeholders working together to co-design solutions around three core priorities: Healthy Ageing, Community Engaged Care, and Sustainable Collaborations. Each project was developed in response to real needs identified by health service partners and consumers, ensuring the solutions are both relevant and practical. The projects not only address critical aged care challenges but also lay the groundwork for scalable, evidence-based solutions that can be integrated into clinical practice and health policy.
At the heart of this initiative is the active involvement of consumers. Through co-design workshops and ongoing feedback via advisory groups, older adults and caregivers have shaped the projects to ensure they reflect real experiences and priorities.
Reducing frailty and preventing falls.
The project, “Implementing a State-Wide Approach to Prevent Falls and Reduce Frailty,” evaluates NSW Ambulance’s “The Older Patient” Clinical Practice Guidelines (CPG) to see how well they address frailty and falls in older adults across NSW. Working with SESLHD and SWSLHD, the team is looking at how the guidelines impact
patient outcomes and paramedic decision-making while also creating referral pathways to quickly connect patients with community services after a fall. By combining data analysis and feedback from stakeholders like paramedics, healthcare providers, and patients, the project aims to reduce repeat callouts and ED visits, improve care coordination, and foster stronger collaboration across the health system.
From Play to Practice
The “From Play to Practice” project is a collaborative effort that brings together older adults, caregivers, and healthcare providers to codesign a gamified health education platform. By incorporating elements of play, competition, and social connection, the platform aims to make health education more engaging and effective, encouraging active lifestyles and improving health literacy among older adults. Caregivers also benefit from empathy training, which strengthens patient-caregiver relationships. The collaborative approach ensures the platform is tailored to real-world needs, with feedback from participants shaping its development and implementation. Insights from the pilot will help create a scalable model for health promotion, supporting broader adoption and more integrated, compassionate care systems.
Improving Healthcare Delivery and Access to Community End-of-Life Care.
This project focuses on enhancing communitybased end-of-life care for older adults, particularly in underserved areas. By implementing the PEACH (Palliative Care in the Home) model, this project aims to improve the delivery of person-centred care, reduce avoidable hospital admissions, and increase access to home-based care for those with lifelimiting illnesses. Multidisciplinary healthcare teams, community health services, and patient caregiver
groups will come together to evaluate the model’s effectiveness through a combination of quantitative and qualitative data. Insights gained from the project will help refine care coordination models, ensuring more patients can receive compassionate care at home, and inform broader healthcare practices and policies for community-based end-of-life care. The collaborative approach and ongoing feedback will make the model adaptable to different settings, promoting sustainable healthcare solutions across regions.
Virtual Medication Management (VMM) ePrescribing for Rural Aged Care
This project was developed in response to the complex medication management systems in rural NSW health facilities, which can lead to medication errors and poor clinical outcomes. By implementing the VMM ePrescribing system within the Oracle Cerner electronic medical record (eMR), the project aims to streamline medication processes, reduce errors, and enhance workflow efficiency for aged care residents in rural areas. In collaboration with Western NSW PHN, Murrumbidgee LHD, and other healthcare partners, the project will assess current medication management practices, pilot the new system, and evaluate its impact on medication
safety and clinical outcomes. Through a combination of quantitative data and qualitative feedback from healthcare providers, patients, and carers, the project will refine the system and promote its scalability across rural settings. The initiative will not only improve patient safety but also serve as a model for digital health innovations in aged care, contributing to more efficient and effective healthcare delivery in underserved regions.
Impact of Service Intensity on Refractures and mortality
Evaluating the effectiveness of Fracture Liaison Service (FLS) models across NSW, the “Impact of Service Intensity on Refractures and Mortality” project seeks to identify the most successful approaches for reducing refractures and mortality in older adults with osteoporosis. By combining quantitative data from the NSW Linked Cohort and qualitative insights from FLS coordinators, the project will assess the impact of FLS intensity and follow-up protocols on patient outcomes. The findings will provide evidence-based recommendations to optimise FLS delivery, reduce healthcare costs, and improve care, with the potential for broader application in areas like communitybased end-of-life care and out-of-hospital care pathways.
Credit:istockphotos
AMPLIFY
We amplify and uplift knowledge creation and embed a research and innovation culture
“I want to express my sincere thanks to SPHERE, for their tremendous support offered to our research team throughout the grant development process. SPHERE’s invaluable guidance on the written content—often, at times, beyond reasonable expectations—made a significant difference.”
Professor Jason Prior | Professor of Planning, Health and Environment | Institute for Sustainable Futures (ISF), UTS
AMPLIFY
Amplifying Healthcare Innovation: SPHERE’s partnership supports major funding boost
SPHERE’s funding is often the support that grows big ideas into larger-scale, game-changing healthcare projects. This research investment approach acts as a launchpad, driving groundbreaking research to new heights and amplifying its impact far beyond its starting point. Such is the case for Scientia Professor Nigel Lovell, one of the recipients of this year’s investigator-initiated SPHERE Big Ideas Partnership Support Grant Scheme whose digital health solution, TeleClinical Care (TCC), has attracted further substantial funding from the National Health and Medical Research Council (NHMRC) and the Medical Research Future Fund (MRFF), totalling nearly $4 million.
SPHERE’s Seed Funding Building a Foundation for Health Innovation
SPHERE awarded Professor Lovell’s team
$200,000 through an Investigator-Initiated Partnership Support Grant this year. This funding framework supports ambitious, large-scale projects that bridge gaps across diverse research disciplines, technology, and patient care. SPHERE’s focus is on “wicked problems” in healthcare, encouraging new approaches that not only offer immediate solutions but also have the potential to scale and sustain.
“The projects backed by SPHERE’s Partnership Support Grants amplify the potential of innovative research and technology enabled solutions to transform healthcare. Research funding bodies external to SPHERE are increasingly looking for partners committed enough to their projects to put some skin in the game. The initiatives we want to support, address significant gaps in our current healthcare models, aiming to deliver substantial improvements in health outcomes and quality of life for priority populations with unmet needs,” explains SPHERE Executive Director, Professor Chris White.
Professor Lovell’s project is a prime example. With clinical colleague, Prof Sze-Yuan Ooi, their digital health platform, TeleClinical Care (TCC), integrates with the Hospital in the Home (HITH) service within the South Eastern Sydney Local Health District (SESLHD). TCC empowers patients with chronic comorbidities to manage their conditions from home, combining real-time monitoring with telehealth capabilities. This approach brings together cuttingedge technology with a patient-centric model, supporting continuous improvement in healthcare delivery.
Amplifying Innovation: Leveraging NHMRC Funding for Broader Impact
Hospital in the Home (HITH) has a well-established role in managing patients in their communities, safely and effectively. With support from the SPHERE grant, Professors Lovell and Ooi’s TCC project has gained traction, subsequently securing $1.5 million from an NHMRC Partnership Grant. By partnering with SESLHD, the TCC platform will now be able to support a wider range of health conditions at home, expanding beyond its original cardiovascular
Scientia Professor, Nigel Lovell
and COVID-19 roles, to manage multi-morbidities including respiratory disease, stroke, post-surgical rehabilitation, and aged care.
The NHMRC funding will allow the team to refine TCC’s capabilities, enabling real-time physiological measurements, secure teleconferencing via integration with Microsoft Teams, and advanced rehabilitation features through collaboration with Neuroscience Research Australia (NeuRA). This new iteration, TCC-360, acts as a digital backbone for SESLHD’s virtual care strategy, enhancing HITH services by seamlessly connecting patients and clinicians.
MRFF Funding Propels Project to Tackle Aged Care Needs
With the TCC platform able to be adapted across different patient populations and conditions, the project will also expand into aged care thanks to a further $2.33 million MRFF Aged Care and Dementia Mission Grant. Under this funding, Prof Lovell and Prof Ooi will work with Chief Investigator, Prof Peter Gonski to adapt the TCC Platform to serve the geriatric population through the Geriatric Outreach Service (GOS) in SESLHD.
The MRFF grant will enable the co-design, implementation, and evaluation of a tailored version of the TCC platform—TeleClinical CareCommunity (TCC-Community)—specifically for aged care. By incorporating remote monitoring, predictive analytics, medication tracking, and telehealth consultations, TCC-Community will improve the quality and safety of care for older patients, while enhancing communication between care staff, general practitioners, and the hospital team. The platform’s data-driven approach aims to deliver value-based healthcare, ultimately creating a
scalable, cost-effective solution that can be adopted nationwide.
SPHERE’s Amplification Strategy in Action
“Professor Lovell’s journey from pilot proof of concept projects to one attracting nearly $4 million in further funding illustrates SPHERE’s strategic focus on amplification. SPHERE’s commitment to amplifying “Big Ideas” goes beyond financial support. We foster partnerships with academic, healthcare, and industry stakeholders and nurture the projects with the greatest potential to transform healthcare. With SPHERE’s funding, TCC is not only revolutionising the management of chronic conditions but is also setting the stage for a future where digital health solutions are an integral part of aged care and chronic disease management,” says Prof White.
“The SPHERE grant will greatly help in fast-tracking the development work of the project so that we can deliver in a timely manner.”
Scientia Professor, Nigel Lovell, UNSW
Credit: ismagilov (istock)
TRANSFORM
We drive and accelerate the translation of evidence into value-based healthcare
SPHERE has been transformative for our research, providing not only seed funding to collect pilot data but, more importantly, strengthening collaborations with health partners and universities across the network. These collaborations have been invaluable and continue to open doors for impactful research and translation into practice.
Professor Kim Delbaere | Senior Principal Research Scientist, NeuRA
TRANSFORM
Transforming diabetes care through integrated models
Diabetes management is inherently complex, often requiring coordinated efforts between various levels of healthcare. Recognising the challenges associated with traditional care models was the reason why SPHERE’s Diabetes, Obesity, and Metabolic Disease (DOM) Clinical Theme launched the Integrated Diabetes Action Group in 2018. This initiative identified a gap in services: the need to change diabetes care by improving integration between primary and specialist care. The development of this action group paved the way for the creation of Diabetes Case Conferencing, an ongoing innovative model that is now transforming diabetes care by enhancing collaboration, reducing service pressures, and improving patient outcomes.
The Challenges in Traditional Diabetes Care
In the conventional model, General Practitioners (GPs) manage most cases of Type 2 diabetes. For less complex cases, GPs are well-equipped to handle the initial stages of care, including lifestyle advice, initial medications, and monitoring. However, more complex cases requiring specialist expertise are referred to hospital-based diabetes services, where endocrinologists and multidisciplinary teams provide comprehensive care.
Despite this structure, many newly diagnosed patients are referred to specialist services early, even when their cases are manageable within primary care. These premature referrals—often made before patients have initiated medication or received education about managing their condition— contribute to the overburdening of specialist services. In regions like South Western Sydney, where the incidence of diabetes is rising rapidly, wait times for specialist appointments have extended to eight months or more.
This issue is exacerbated by the increasing prevalence of diabetes in the area. Without a change in the model of care, specialist services face the risk of becoming even more overwhelmed. To address these systemic challenges, the Integrated Diabetes Action Group prioritised the development and implementation of innovative care models.
The Introduction of Diabetes Case Conferencing
The Diabetes Case Conferencing model, first introduced in Wollondilly in 2017 before being rolled out across South Western Sydney changes the interaction between primary care providers and specialists by facilitating collaborative case discussions.
The case conferencing approach involves GPs, diabetes educators or practice nurses, and endocrinologists meeting to discuss patient management without the patient being present. This setup maintains the GP and primary care team as the primary caregivers, with the specialist team providing guidance and support in the background.
Credit: Halfpoint (istock)
“What an amazing team!!! THANK YOU, everyone for your incredibly hard work.”
Associate Professor Deborah Debono, University of Technology, Sydney (UTS)
This structure allows for efficient case review, enabling the discussion of multiple patients within a single session. The endocrinologist offers specific recommendations for medication adjustments or treatment plans, while the diabetes educator provides strategies for lifestyle and behavioural changes. This dual-pronged approach not only enhances patient outcomes but also empowers GPs by equipping them with the knowledge and confidence to manage diabetes more effectively within their practice.
Measurable Outcomes
The success of Diabetes Case Conferencing has been supported by robust data. A study published in the International Journal of Integrative Care analysed the clinical outcomes of this program, examining data from 645 patients with an average age of 64 years. The findings demonstrated significant improvements in key health metrics, including reductions in HbA1c levels, blood pressure, weight, and body mass index (BMI).
Advancing Integrated Care with Enhanced Models
Building on this success, the SWS Primary Health Network (PHN) proposed a model with greater collaboration involving the endocrinologist and diabetes educator visiting the GP practice and meeting face-to-face with the GP and patient. Patients are then reviewed again at six months.
GPs have reported increased confidence and competence in managing diabetes, while patients have provided positive feedback on their experiences.
Addressing Systemic Challenges
The innovative approaches address broader systemic challenges in diabetes care. By reducing unnecessary referrals to specialist services, these models alleviate the strain on hospital-based teams, allowing them to focus on patients with the most complex needs.
Furthermore, these initiatives recognise the important role GPs play in diabetes management. By equipping GPs with the skills and support needed to manage diabetes effectively, the case conferencing models not only improve patient outcomes but also build capacity within the primary care system. This approach supports a culture of collaboration, where GPs and specialists work together to deliver integrated, patient-centred care.
The transformative potential of integrated care models is demonstrated by these initiatives. By fostering closer collaboration between primary and specialist care providers, these initiatives not only reduce the burden on specialist services but also ensure that patients receive timely, and effective care. As healthcare systems grapple with the challenges of managing chronic diseases, the lessons learned from these programs offer a promising pathway toward more sustainable and impactful care delivery.
Credit: amenic181 (stockphotos)
Credit: Amenic181 (istockphotos)
IMPACT
Improving the health of our community and beyond
Credit: Merc67 (istock)
IMPACT
Delivering impact: SPHERE’s role in transforming cancer care
A cutting-edge model of personalised cancer care is revolutionising treatment in Australia, driven by the research expertise of SPHERE.
The Precision Care Clinic, based at the Prince of Wales Hospital in Sydney, integrates genomic profiling with advanced clinical strategies to deliver tailored cancer therapies. Professor David Thomas, who leads SPHERE Cancer Theme’s ‘Bringing OMICs into Clinical Practice’ area of focus, together with SPHERE cancer researchers Associate Professor Natalie Taylor, Dr Frank Lin, and Dr Milita Zaheed, have been instrumental in shaping the clinic’s design, implementation, and ongoing operations, ensuring that precision oncology becomes a cornerstone of modern cancer care.
Research Driving Precision Care
The clinic is a perfect example of SPHERE’s Impact pillar, improving health outcomes within communities and beyond. A research-driven foundation underpins every aspect of the clinic’s operations. Prof Thomas’ longstanding research and work in omics forms the backbone of the Clinic while A/Prof Natalie Taylor, Director of SPHERE’s Implementation Science Platform and Deputy Director of SPHERE’s Cancer Theme, leads the development of protocols to address the complexities of precision oncology. Her focus on integrating clinical and implementation science ensures the clinic remains adaptable and effective in the face of rapid advancements in cancer treatment.
The clinic’s approach incorporates tumour profiling to identify genetic mutations that inform treatment strategies. SPHERE Cancer Fellow, Dr. Frank Lin, has contributed to this integration of genomic data with multidisciplinary care, enabling oncologists to tailor therapies for patients with complex cases. His
work ensures that treatment recommendations are supported by the latest evidence and are personalised to the unique genetic characteristics of each patient.
Transforming Genetic Testing and Family Health
The clinic also addresses hereditary cancer risks by using tumour profiling to identify potentially inherited gene faults. Unlike traditional methods that rely on family history, this approach uncovers genetic predispositions that might otherwise go undetected.
SPHERE Clinical PhD Scholarship Top-Up Award recipient, Dr Milita Zaheed, has played a vital role in embedding genetic counselling into the clinic’s workflows. By managing the complexities of germline testing, her work ensures that patients and their families are informed of hereditary risks and can take proactive steps to safeguard their health. This approach empowers families to understand their genetic risks and pursue preventive measures where necessary.
A Model for Nationwide Impact
The Precision Care Clinic is not only transforming cancer care locally but is also paving the way for a scalable model that can be implemented nationwide. SPHERE’s researchers have meticulously documented the challenges and lessons learned during the clinic’s initial rollout, creating a scale-up toolkit to guide the establishment of similar clinics across Australia.
This toolkit will ensure that the benefits of precision oncology extend beyond the clinic’s current reach. By optimising workflows, addressing barriers, and refining multidisciplinary processes, the toolkit
provides a roadmap for integrating genomic profiling into routine cancer care at other sites.
Advancing Health Outcomes
The Precision Care Clinic exemplifies SPHERE’s dedication to delivering Impact through innovative research and implementation. By bridging the gap between cutting-edge science and clinical practice, SPHERE is transforming how cancer is diagnosed and treated, ensuring better outcomes for patients and their families.
As the clinic continues to expand its reach, SPHERE’s leadership will remain integral to driving its success and scaling its benefits to communities across the nation. This is research in action, improving lives today and creating a positive impact in the future of cancer care.
The Precision Care Clinic is not only transforming cancer care locally but is also paving the way for a scalable model that can be implemented nationwide.
Credit: wildpixel (istock photos)
