This study provides a unique opportunity to explore the integration of services between primary, secondary and community health care among a community dwelling population of residents over time and its impact on health service use and health outcomes. The aims and objectives of this project are:
1. To establish the 45 and Up: Primary and Community Health Cohort to support research and evaluation of primary care activities and integrated care
2. To examine the influence of participant and system factors on integration of health services and its impact on health outcomes and health service use over time.
3. To determine the health outcomes and service needs of older residents.
4. To identify the factors associated with ‘healthy’ ageing and older residents’ trajectory towards higher care need.
5. To identify the care pathways for a cohort of older people
6. To identify predictors of health service use and develop interventions to address them
7. To monitor the impact of integration programs on health service use and patterns of hospitalisation.
8. To evaluate interventions and policies to improve health outcomes of older residents.
9. To enhance the effective implementation of successful strategies based on study findings by working with health service staff, management and policy makers.