Aims
Geriatric Care Australia (GCA) is a national provider of community-based geriatric medicine. Over the past two years, GCA has developed an integrated, multidisciplinary model of care, combining geriatricians, registered nurses, and general practitioners (GPs) to improve access to specialist care for older Australians. This initiative seeks to:
- Overcome geographic and financial barriers
- Enhance continuity of care across hospitals, aged care facilities, and primary care.
- Leverage Artificial Intelligence (AI) and data analytics to predict at-risk patients.
Methods
GCA has implemented a structured, data-driven approach through:
- Geriatrician-led multidisciplinary teams integrating nurses and GPs to deliver frontline care and reduce preventable hospital admissions.
- Strategic collaborations with hospitals, Primary Health Networks (PHNs), and aged care facilities to strengthen care transitions.
- AI and data analytics tools to assess patient trends, predict risk factors, and enable early interventions.
- Professional development pathways to support career sustainability and growth in community geriatric medicine.
Results
- Improved care coordination across healthcare settings, ensuring seamless integration of services.
- Strengthened workforce capacity by embedding specialist geriatric care within the community.
- AI-driven insights identifying early indicators of frailty and acute deterioration, facilitating timely interventions.
- A structured professional development program enhancing geriatrician recruitment and retention.
- Early data indicates reductions in avoidable hospital admissions and better patient outcomes.
Conclusions
GCA’s approach demonstrates the impact of geriatrician-led, integrated, community-based care. Combining clinical expertise with AI-driven analytics strengthens aged care service delivery and supports proactive identification of at-risk older adults.