Finalised Research Projects
Appropriate Care in the Appropriate Setting:
The Impact of the Health Service Executive Transformation Programme on Utilisation,
Patient Experience, Safety and Outcome in Urgent and Emergency Care
Aims of the Programme
The overarching aim of this programme is to describe and evaluate the development and performance of different EUCS (Emergency and Urgent Care Systems) models in Ireland. There are four objectives:
- To identify geographical networks of emergency and urgent care in Ireland and describe the model of EUCS configuration planned/implemented in each region.
- To analyse the process by which plans for EUCS reconfiguration were developed with a specific focus on the use of evidence and the roles of different internal and external stakeholders.
- To analyse the relationship between different EUCS models of governance and provision, and system-level indicators of activity, process and clinical outcome.
- To develop, implement and test a comprehensive evaluation framework for EUCS.
PI: Prof John Browne, Epidemiology and Public Health, UCC
Centre Co-PI: Dr Steve Thomas
Centre Researcher: Dr Bridget Johnston
Systematic Review of International Best Practices on Waiting Time and Waiting List
Reporting Models for Elective Treatment
PI: Dr Steve Thomas
Co-PI: Mandy Lee
Research Assistants: Margaret Martin-Carroll, Wendy Von Mollendorff and Haines Fleshman
Mapping the Pathways to Universal Health Care in Ireland
Mapping the Pathways to Universal Health Care in Ireland is a three-year Health Research Board research project. Dr Steve Thomas is the principal investigator on the project, along with Prof Charles Normand, Dr Sarah Barry and Dr Sara Burke.
The project is a collaboration between the Centre for Health Policy and Management, TCD and staff from the Health Systems Strengthening Offices of WHO Europe and the European Observatory.
The research project aims to provide an excellent evidence base that will inform the strategic direction and implementation of universal health care in Ireland. There are three components to the research project:
1) Assessing the gap between current Irish health system performance and universal health care, using and adapting WHO concepts.
2) Evaluating the strengths and weaknesses of different models of universal health care and assessing their feasibility of implementation within the current context according to key criteria such as affordability, human resources and complexity of design.
3) Assessing the organisational challenges of moving to universal health care by reviewing the experience of other countries and exploring the current capacity and constraints facing decision makers throughout the system.
This project is a collaboration with King's College London and is funded through the Atlantic Philanthropies by Cecily Saunders International.
The purpose of this grant is to build capacity in the field of palliative care by supporting the creation of PhD Studentship and Faculty Scholarship Programmes and the expansion of a unique Research Study. This Project seeks to create a 'sea change' in the way palliative and end of life care is regarded, implemented and prioritised internationally. It is envisaged that the activities undertaken will substantially enhance the practice of palliative and end of life care by helping to build a long term and sustainable capacity. They will improve access, empower patients and families and result in better care for millions of patients and their families worldwide.
PI: Prof Irene Higginson (KCL)
Trinity lead: Prof Charles Normand
Trinity Researchers: Dr Katy Tobin and Bridget Johnston
Living and Dying with Amyotrophic Lateral Sclerosis: A Population based Analysis of Palliative Needs, Services and Outcomes in Non-malignant Terminal Illness
HRB Interdisciplinary Capacity Enhancement Award
A consortium led by Professor Orla Hardiman, Consultant Neurologist, Clinical Professor of Neurology , has received a HRB Capacity Enhancement Award for the programme entitled:
Living and Dying with Amyotrophic Lateral Sclerosis: A Population based Analysis of Palliative Needs, Services and Outcomes in Non-malignant Terminal Illness.
Members of the Consortium include Prof.Charles Normand (TCD Health Policy Unit), Prof.Virpi Timonen (TCD Social work & Social Policy), Prof.Ivan Perry (UCC Population Health), Prof.Anthony Staines (DCU Health Systems) and Dr.Regina McQuillan (St.Francis Hospice). The research programme will be organised in three specific and interlinked work packages relating to Amyotrophic Lateral Scerosis, spanning clinical, epidemiological and health services research including health economics. The completed project will provide a best practice framework for future management of neurodegenerative disease, including an embedded rating scale that will trigger specialist palliative intervention in accordance with recent Irish health policy.
PI: Prof Orla Hardiman
Co-PI: Prof Charles Normand
Post-doctoral researcher: Dr Katy Tobin
Efficiency Review of the BreastCheck Screening Programme
The Efficiency Review of the BreastCheck Screening Programme was commissioned by the Department of Health in order to prepare for the age extension of BreastCheck to women up to the age of 69 years, as provided for in the Programme for Government.
This review was a collaboration with University College Cork.
Development of a Predictive Model for the Treatment of Edentulous Patients
Complete loss of natural teeth (edentulism) is a chronic disabling condition that impacts on an individual’s health, self-perception and social interaction. Edentulism is common in the Irish population, occurring in 40.9% of those over 65 years, with a higher prevalence in people holding medical cards and those in poorer general health. Despite the fact that edentulous people present with a wide range of functional and psychological needs, which may require different levels of intervention, there is no systematic approach to their diagnosis and treatment. The lack of data supporting patient-appropriate treatment means that many individuals do not receive treatment suited to their needs and health service providers have no way to rationally plan services for this population. While advanced, implant-based, treatment for edentulism is reported to be very successful, there is also evidence that many patients neither need nor want this level of intervention. We hypothesise that a set of baseline clinical and patient-reported measures will be predictive of patient treatment outcomes. We aim to use patient-based data to develop a standardised clinical diagnostic tool that will predict the most appropriate treatment for an edentulous individual. The objectives of this project are first, to identify the key needs of edentulous people using qualitative methodology, purposive sampling and semi-structured interviews ; these needs will be used to produce a condition-specific subjective health status measure, mapped to a taxonomy for quality of life. Second, we will investigate edentulous individuals before and after conventional, then complex treatment to find the baseline characteristics of patients who achieve success with the different treatments. Third, we will measure the health gain and cost of conventional and complex treatments. This information will form the basis for more equal access to care and efficient use of health resources at primary and multidisciplinary care levels.
PI: Prof Brian O’Connell (Dental Science)
Co-PI: Prof Charles Normand
Research Assistant: Bridget Johnston
All-Ireland Institute of Hospice and Palliative Care (AIIHPC) Structured Research Network (SRN) Funding
On behalf of Our Lady’s Hospice, AIIHPC have confirmed the award of funding from the Health Research Board (HRB) for the establishment of a single Structured Research Network (SRN). The two participating Lead Collaborating Institutions are University College Dublin (UCD) and Trinity College Dublin (TCD). The overseeing organisation will be AIIHPC.
The Network will initially consist of two Research Strands. Professor Charles Normand is the Lead Principal Investigator for Research Strand 2: Measurement and Evaluation (MES). It is envisaged that the Network will offer the all-Island palliative care research community significant opportunities to create and engage in excellent and innovative research projects that will occur within a supportive and collaborative environment and that will ultimately advance understanding of AIIHPC’s research agenda. A significant set of Network activities will include research capacity building, dissemination and knowledge transfer, policy engagement, development of new areas of research and other areas of work aligned to AIIHPC’s strategic objectives. A Network Committee will be established to oversee the operational and financial management of the overall Network.
Strand 1: ‘PATHWAYS TOWARD SOCIAL JUSTICE: UNDERSTANDING EQUALITY AND INCLUSION IN PALLIATIVE CARE’ led by Prof. Phil Larkin, Associate Professor of Clinical Nursing (Palliative Care), University College Dublin.
The Social Justice Strand (SJS) is based on the premise that inequality exists in relation to palliative and hospice care access and service delivery across the island of Ireland for certain groups of people. This strand will examine the experience of inequality towards and through hospice and palliative care service delivery across the island of Ireland as reported by individuals, their families and the health and social care workers who support them. It will utilise generated evidence to develop best practice approaches which strengthen relationships and facilitate greater awareness of the hospice and palliative care needs of people currently excluded by virtue of misunderstanding, diminished recognition and/or prejudice.
Strand 2: ‘MEASUREMENT AND EVALUATION OF OUTCOMES FOR PALLIATIVE CARE’ led by Prof. Charles Normand, Edward Kennedy Professor of Health Policy and Management, Trinity College, Dublin.
The Measurement and Evaluation Strand (MES) will explore methodological development for palliative care research with a focus on measurement of needs, measurement of impact and evaluation of service priority and delivery. MES will develop better understanding on how best to elicit preferences and views for service users and families and will support the development of measurement tools for palliative care research. This strand will utilise evidence to examine how best to disseminate complex findings in palliative care research. The MES team shares the social justice perspective of SJS, that access to care should depend on needs and not circumstance.
For more information: www.aiihpc.org
Photo AIIHPC launch
Caption: Pictured at the launch of the AIIHPC – Mo Flynn, Phil Larkin, Charles Normand, Joan Regan, Edwin Poots, Max Watson and Judith Hill
The Resilience Project was a three year research programme (2012-2014) assessing the resilience of the Irish health system during the economic crisis. Dr Stephen Thomas of the Centre for Health Policy in Trinity College Dublin was the principal investigator (PI) and it was funded by the Irish Health Research Board.
From the work, guidelines were developed to suggest how health systems can withstand and be strengthened during times of significant cuts and disturbances to the health system.
Research Study on Clinical Care Pathways in Ophthalmology
In common with other specialties, ophthalmology services have developed over many years, and have adapted to new challenges and new techniques and technology. The current pattern of delivery of services has some obvious inefficiencies, and it will be possible to provide improved services within current resources by changing the pathways followed by patients. The purpose of this study is to provide an understanding of current patterns of use of services, to identify scope for improved efficiency in the delivery of care and to analyse the feasibility and cost of developing new pathways. The research will be linked closely to the Clinical Programme in Ophthalmology and the wider set of HSE Clinical Programmes.
PI: Prof Charles Normand
Research Assistant: Giulia Faedo
Cost effectiveness of palliative care services in the Republic of Ireland
This project examines evidence on the cost and cost effectiveness of alternative models of specialist palliative care (SPC) (e.g., variations in the mix of specialist palliative in-patient, day and home care) in Ireland.
This research was funded by the Atlantic Philanthropies.
Doctor Migration Project
The HRB funded Doctor Migration Project, a collaboration between TCD and RCSI, aims to provide a better understanding of the needs, aspirations and career plans of non-EU doctors. In addition the project aims to help policy makers identify strategies for providing employment to non-EU doctors in ways that meets their career goals and the needs of the Irish health system. The project will build on the HRB funded RCSI Nurse Migration Project (2006 to 2010) and PhD research carried out at TCD on South African doctors in Ireland (current).
Ireland has the second highest level of dependency in the OECD on foreign-trained doctors (OECD 2010). 33% of doctors registered with the Irish Medical Council in 2010 were from non-EU countries. According to 2006 figures 54% of Ireland's Non-Consultant Hospital Doctor (NCHD) posts are filled by non-Irish nationals (PMDB, 2006). A high proportion of these non-Irish NCHDs are in posts that are not recognised for higher professional training, which has implications for their future careers and for health workforce planning in Ireland.
Despite the important contribution of non-EU doctors to the Irish health system, little is known about them – whether they intend to settle permanently in Ireland or move on, and their satisfaction with career and training prospects. These factors will influence whether these doctors remain in Ireland, return home or emigrate onwards. Such personal decisions (to stay or leave) could have significant implications for health workforce planning and for Ireland’s ability to staff its health system. Given that Ireland could not continue its current system of health provision without migrant doctors, it is crucial to address this information deficit.
Lead researcher: Dr Niamh Humphries (RCSI)
Researcher: Ms Ella Tyrrell
PI: Prof Ruairi Brugha
Co Investigators: Prof Charles Normand, Dr Stephen Thomas
Economics of Tobacco Control
Sponsored by the Research Institute for a Tobacco Free Society (RIFTFS)
The workplace smoking ban was introduced into Ireland in March 2004 and has subsequently been an effective public health policy measure. There was concern that it might have had a negative economic impact on the hospitality industry and on the economy overall. To examine this issue further RIFTFS funded a PhD studentship and in December 2006 Ms Laura Maran was appointed as a PhD student under the direction of Prof Charles Normand. The research is also considering some important related issues on tobacco taxation and pricing, especially around the substitutability of different tobacco products. RIFTFS will fund the studentship for a further year to November 2009.
Project Researchers: Charles Normand & Laura Maran
For more information: http://www.tri.ie/
Foundations for Social Health Insurance in Ireland
Sponsored by the Adelaide Hospital Society
These reports, commissioned by the Adelaide Hospital Society, explore the prospects for introducing Social Health Insurance (SHI) in Ireland. The Irish healthcare system is unusual in having no subsidy for access to GP services for the majority of the population, and a high proportion of the population with supplementary private medical insurance. This has produced unplanned inequities which are exacerbated by a lack of transparency in health financing. The previous reports on SHI (Thomas, Normand and Smith, 2006 & 2008) explored the options for SHI design that would be most relevant for the current challenges. Selected scenarios for SHI were set out and costed, and their financing implications calculated for households. In addition, the reports highlighted the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which need to be addressed if SHI is to become a reality.
A third report has been prepared which constructs a relevant and viable design for both the financing and organisation of SHI in Ireland.
Stephen Thomas, Charles Normand and Samantha Smith (2006) “Social Health Insurance: Options for Ireland.” Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.
Stephen Thomas, Charles Normand and Samantha Smith (2008) “Social Health Insurance: Further Options for Ireland.” Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.
Stephen Thomas, Padhraig Ryan, Charles Normand (2010) Effective Foundations for the Financing and Organisation of Social Health Insurance in Ireland". Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.
Mary O’Riordan, Stephen Thomas, (2011) “Support for Policy Development of SHI in Ireland: A Review of Stakeholder Views and Values”. Prepared for the Adelaide Hospital Society. Health Policy and Management, Trinity College Dublin and National University of Ireland, Galway
Revolutionising Chronic Disease Management with ICT: A socio-technical project applied to epilepsy care in Ireland
Sponsored by the Health Research Board
Principal Investigator: Mary Fitzsimons
Project Researchers: Charles Normand & Jarlath Varley
The Evaluation of Clinical Nurse and Midwife Specialists and Advanced Nurse and Midwife Practitioners in Ireland (SCAPE)
Sponsored by the National Council for the Professional Development of Nursing and Midwifery
Researchers: Professor Cecily Begley, Professor Imelda Coyne, Professor Agnes Higgins, Dr. Joan Lalor, Dr. Fintan Sheerin, Dr. Naomi Elliott, Professor Charles Normand and Professor Catherine Comiskey in partnership with a group from NUIG including Professor Kathy Murphy, Dr Declan Devane, Dr Dympna Casey, Ms Adeline Cooney, Ms Frances Farrelly, Dr Maura Dowling and Ms Miriam Brennan
HRB Report on Demographic Change
This is a collaboration with the Economic and Social Research Institute, and examines the implications of the changing demographic conditions for the health and social services. It is estimating the likely changes in the population numbers and structure till 2021, and how these are likely to affect hospital care, pharmaceuticals, long term care and primary and community care.
Departmental Researchers: Charles Normand, Steve Thomas, Maev-Ann Wren
A predictive model of long-term care demand
This project is funded by CARDI and is a collaboration with Queen’s University Belfast and Age Action Ireland which aims to analyse factors affecting residential and community long-term care (LTC) demand for older people in Northern Ireland and the Republic and to develop a model for forecasting future demand. The model will supply an interactive tool for policy-makers that will assist in planning for the care needs of older people and also supply an evidence-based assessment of present and future needs that will assist advocates for older people in making a case for improved care provision and in analysing the impact on care of proposed policy changes.
Amnesty International - Costing Implementation of Vision for Change Mental Health Service Provision
Vision for Change (VfC), published in 2006, provides a blueprint for the delivery of modern mental health services in Ireland, including adopting a ‘recovery’ approach that entails person-centred, self-determined and empowering care, and enabling social inclusion. Progress towards implementation of the new models of service provision has been slower than planned, and there is a risk that the current crisis in Government finance may slow the process further.
To avoid further delay and policy stagnation it is important to develop a better understanding of progress to date in implementing VfC, what changes may be sensibly made in the light of emerging evidence and experience in service innovations and to strengthen the basis for future planning. A key task is to look in more detail at what resources are being used for provision of the current mental health services, what would be saved if existing services were replaced, and what would be the costs associated with feasible (if not necessarily ideal) provision of services within the VfC models that would reflect a recovery approach. This may point the way to areas where more rapid progress might be made even when resources are very scarce. It would also allow investigation of more limited versions of the change in service configuration to be considered that could nevertheless represent an improvement on the current patterns of services as a first step towards full implementation of VfC. It may also help make a strong case for additional resources should the advantages be clearly large and the additional costs modest.
The purpose of this project is to work with managers and clinical staff in the HSE to develop better understanding and tools to take forward the implementation of VfC in the context of the very scarce resources available to the health sector and to provide an evidence base for lobbying Government.
PI: Prof Charles Normand
Research Assistant: Giulia Faedo