Current Research Projects
Health system foundations for effective Regional Integrated Care Areas (RICAs) – co-producing evidence to inform the design of regional areas to support integrated care in Ireland
Dr Sara Burke, Research Assistant Professor in the Centre for Health Policy and Management, is Principal Investigator of a new research project designed to generate evidence that will drive innovation and transformation in the health system. Funded under the HRB’s Applied Partnership Award programme, the project will use a variety of research methods and tools to harness the latest national and international evidence and experience to inform the roll out of the six new RICAs.
Lead knowledge user – Laura Magahy, Sláintecare Implementation Office, Department of Health
Co-applicants - Steve Thomas, Sarah Barry, Centre for Health Policy and Management, Trinity College Dublin, Colm Henry, Dean Sullivan and Liam Woods, HSE, Colm O’Reardon – Department of Health, Josep Figueras, European Observatory on Health Systems and Policy.
Collaborators - Teresa Maguire, Department of Health, Paul Kavanagh, PJ Harnett and Philippa Ryan Withero, HSE, Nuala Doherty, Centre for Effective Services.
Ireland has a poor track record of introducing organisational change in the health system, often causing great turmoil to the staff without improving access or quality of care for the people who use the service. We also have a health system that is overly-dependent on hospitals, difficult to access and fragmented in nature.
The Sláintecare Implementation Strategy outlines how Regional Integrated Care Areas (RICAs) will be the mechanism to fund and provide integrated care locally. It is imperative that these new structures are designed and implemented so that they result in universal access to more responsive care, which better meets the needs of individuals and communities. Through analysing, synthesising and translating international and national theory, evidence and experience, this research will feed into the real-time RICA development process. Using methods including rapid reviews, mapping exercises, documentary analysis, key informant interviews, participant observation, secondary analysis of data and co-design techniques, findings will be instrumental to designing a Living Implementation Framework with Evaluation (LIFE), which is expected to be utilised beyond the timeframe of this project. Central to this project will be identifying the best data sources to measure impact of RICAs on integrated care and ensuring evidence-informed decision-making.
This research will be carried out by the Trinity team, whose technical advice formed the basis of the Sláintecare Report, in partnership with the most senior leadership in the Department of Health, the Sláintecare Implementation Office, the HSE and the European Observatory on Health Systems and Policy.
The real-time, iterative, nature of this research means it will impact as the project progresses, continuously learning and refining with the aim of developing an evidence-informed Regional Integrated Care Area (RICA) Living Implementation Framework with Evaluation (LIFE), which facilitates bounded regional autonomy within national policy, that is person-centred, empowers staff and communities, is effective and efficient.
Enhancing the Evidence Base for Cost-Effectiveness Analysis in Ireland: Building Improvements from the Intervention-Specific to System-Wide Levels
Dr James O'Mahony, Assistant Research Professor at the Centre for Health Policy and Management, is Principal Investigator of a research programme titled "Enhancing the Evidence Base for Cost-Effectiveness Analysis in Ireland: Building Improvements from the Intervention-Specific to System-Wide Levels". Funded under the HRB’s Emerging Investigator Award scheme, the programme runs from August 2018 to September 2022. It involves three primary components: (i) enhancing cost-effectiveness modelling methods in cancer screening; (ii) improving our understanding of cost-effectiveness thresholds in the context of Ireland's hospital waiting lists; and, (iii) continued research within the CERVIVA consortium on the optimal prevention of HPV-related disease, including cervical cancer. Dr O'Mahony will be supervising a PhD candidate as part of the project. The programme involves collaboration with research partners from TCD, RCSI, Erasmus University Rotterdam, the NTPF and the ESRI
Palliative Care Economics (PaCE)
The Palliative Care Economics (PaCE) research group at Trinity College Dublin is among the most active in the field worldwide.
In the context of rising costs and poor outcomes associated with serious illness, we work with clinicians, policymakers and other social scientists to generate high-quality evidence on what care and interventions should be provided to and prioritised for which groups of patients.
Our current research programme covers studies in Ireland, England, the United States, Jordan, and elsewhere. We welcome collaboration with other investigators and centres interested in questions that relate to the quality, cost-effectiveness and appropriateness of care for people with serious and life-limiting illness.
INCA: Interaction Analytics for Automatic Assessment of Communication Quality in Primary Care
At the core of health care is the relationship between clinician and patient. Clinical communication skills play a key role in accurate diagnosis, effective treatment, and motivating patients to adopt healthier lifestyles. Poor communication imposes avoidable costs of billions of euros across Europe each year. There is urgent need for better tools to assess clinical communication skills.
The INCA project leverages cutting edge techniques in signal processing and computational linguistics to analyse key features of clinicians' communication styles. INCA uses audiovisual recordings of interactions with patients, in real life settings and in role plays, to train machine learning algorithms to parameterise features such as:
- Turn-taking: how often a patient speaks, how long before a patient is interrupted
- Prosodic features such as pitch, pace, related to intonation and perceptions of empathy
- Use of medical terminology
- Repetition of key concepts as an indicator of shared understanding
- Body language
The project is funded by a three year Health Research Award grant from the Health Research Board (2016 – 2019). The Principal Investigator is Professor Charles Normand. He works with Centre colleague Dr Padhraig Ryan and a Trinity College Dublin team spanning the School of Medicine, the School of Computer Science and Statistics, together with strong input from the University of Edinburgh and Dartmouth College. Padhraig's role is in content analysis - he conducts sentiment analysis, produces algorithms to quantify repetition of key concepts and effectiveness of knowledge transfer during emergency responses, and evaluates clustering algorithms that characterise the nature of each interaction. This project seeks to enhance the scalability and affordability of quality assessment, and to create actionable knowledge for improved care and value.
PI: Prof. Charles Normand
Project Co-ordinator Dr. Padhraig Ryan
CERVIVA - Cervical cancer and HPV-related disease prevention
CERVIVA (www.cerviva.ie) is a multidisciplinary research consortium with components drawing from the fields of health psychology, epidemiology, health economics and molecular medicine. CERVIVA's initial research focus was on cervical cancer prevention through screening, but this has broadened in recent years to encompass the prevention of other diseases caused by the human papillomavirus (HPV).
CERVIVA is led by Principal Investigators Professor John O'Leary and Assistant Professor Cara Martin, both of whom hold positions at the Coombe Women and Infants University Hospital and Trinity College Dublin. Professor Charles Normand of the Centre for Health Policy and Management is the Principal Investigator on the health economics component of CERVIVA's research programme. He works with Dr James O'Mahony, a health economist investigating the cost-effectiveness of alternative HPV-associated cancer prevention strategies.
James' role with CERVIVA primarily concerns the simulation modelling of the cost-effectiveness of cervical cancer screening. The objective of which is to determine what novel screening tests offer the most appropriate balance of improved screening effectiveness to women and costs to the health system. This research relates both to current screening technologies of cervical cytology and HPV testing and to a new generation of potential testing technologies including p16(INK4a) dual staining and HPV mRNA testing. James is also considering the potential for a candidate screening test for head and neck cancer to be cost-effective, given what is currently known about the incidence of HPV-positive cancers and their health burden.
The need for an ongoing research effort on HPV-associated disease stems from Ireland's relatively high incidence of cervical cancer and the emerging threat of HPV-positive head and neck cancer. Ireland had lagged behind other countries in establishing an organised, population based national screening programme. Accordingly, screening coverage and consequent disease prevention had been less complete than that achieved in other countries. While Ireland has now achieved good screening coverage there remain challenges in deciding what novel screening tests to apply within CervicalCheck. Similarly, although HPV vaccination has been offered in Ireland since 2009, there is an emerging problem of incomplete vaccination coverage due to unfounded fears of adverse effects of the vaccine. Over the past decade there has been growing recognition of the role of HPV as a cause of head and neck cancer. CERVIVA recently extended its research programme to investigate if the success of cervical cancer prevention through screening can be replicated using analogous testing technologies in head and neck cancer.
PI: Prof Charles Normand
Centre Researcher Dr James O'Mahony, Dr Padhraig Ryan and Margaret Martin-Carroll
The Irish Longitudinal Study of Aging (TILDA)
The Irish LongituDinal Study on Ageing (TILDA) is a large-scale, nationally representative, longitudinal study on ageing in Ireland, the overarching aim of which is to make Ireland the best place in the world to grow old.
TILDA collects information on all aspects of health, economic and social circumstances from people aged 50 and over in a series of data collection waves once every two years. TILDA is unique amongst longitudinal studies in the breadth of physical, mental health and cognitive measures collected. This data, together with the extensive social and economic data, makes TILDA one of the most comprehensive research studies of its kind both in Europe and internationally.
The study is a multidisciplinary project supported and guided by a cross-institutional team of experts from the Dundalk Institute of Technology, the Economic and Social Research Institute, the National University of Ireland Galway, Queen’s University Belfast, the Royal College of Surgeons in Ireland, Trinity College Dublin, University College Cork, University College Dublin and the Waterford Institute of Technology.
Funding has been provided by Irish Life, the Atlantic Philanthropies and the Department of Health.
Principal Investigator: Prof Rose-Anne Kenny
Co-PI:Professor Charles Normand
For more information: https://www.tcd.ie/tilda/