Representatives of the DELIVER Research Team, L-R: Back row – Sue Leibling, Grampians Health; Dr Debbie Pu, Monash University; Jade Odgers, Grampians Health; Stuart Squire, Grampians Local Health Service Network; Dr Kate Huggins, Deakin University; Narelle Ryan, Grampians Local Health Service Network; Ingrid Tudias, Grampians Health Horsham; Front row – Nomvelo Thebe, Grampians Health; David, Resident, Grampians Health Ballarat; Dr Mark Yates, Grampians Health and Deakin University.
This launch marks the beginning of a 14-month evaluation in partnership with the DELIVER research team, which is investigating evidence-based solutions to support clinical care delivered at or closer to home for older adults. DELIVER aims to improve community health and wellbeing through evidence-based and research informed healthcare. The evaluation uses a novel trial-design and is the first of its kind in Australia to assess a region-wide residential in-reach model in a rural setting.
DELIVER is a cross-sector partnership funded through the Australian Government’s Medical Research Future Fund (MRFF). The Grampians RIR Program was funded through the 2023–2024 Victorian State Budget and is being delivered by eight health services across the Grampians region.
The RIR Program introduces a nurse-led, telehealth-enabled service operating from Grampians Health Ballarat, available 7:30am to 7:30pm, seven days a week. The service, which commenced in May 2025, accepts referrals from Grampians region aged care staff, GPs and health services, and from the Victorian Virtual Emergency Department (VVED). The Program is designed to improve the health and wellbeing of aged care residents by ensuring they receive care appropriate to their individual needs and preferences.
By reducing the need for emergency department visits and hospital admissions, the model aims to promote continuity of care and minimise disruption for residents. It also aims to facilitate smoother transitions from hospital back to aged care, ensuring residents return to familiar environments with appropriate support.
Using telehealth, the service extends its reach across the region, making specialist care accessible, even in remote and geographically isolated communities.
The RIR Program was developed through extensive collaboration with a wide range of partners, including public and private aged care homes, nurse practitioners, geriatricians, general practitioners, palliative care teams, the Western Victoria Primary Health Network, VVED, Ambulance Victoria, the Department of Health, and research partners from Deakin University and Monash University.
The evaluation will measure clinical effectiveness, hospital avoidance, staff and resident experience, and system-level cost-efficiency—providing critical insights for potential scale-up across Victoria and nationally.
“This is a true collaboration between health services, universities, and aged care providers. It reflects the strength of our regional partnerships and our shared commitment to delivering better care, closer to home, for older people in our communities.” said Dale Fraser, Grampians Health Chief Executive Officer.
