Smoking is harmful to human health and programmes to help people stop smoking are key public health efforts that improve individual and population health outcomes. Research shows that financial incentives improve the success of stop smoking programmes. However, a better understanding of how they work is needed to better inform policy and to support building capability for implementation.

The research is a realist review investigating how, why, for whom and to what extent financial incentives impact on the success of individuals' efforts to stop smoking. The project is undertaken using realist review in the school of Pawson and Tilley and guided by the RAMESE project quality standards.

Data from international literature sources will be searched, screened, selected and synthesised into a set of explanatory findings. These findings will explain:

1. Individual, community and programme level causal mechanisms that impact positively and negatively on the success of financial incentives in aiding efforts to stop smoking among a) general populations and b) pregnant women
2. Which individual, community and programme level contexts are likely to enable both the success and failure of financial incentives in aiding in efforts to stop smoking among a) general populations and b) pregnant women
3. How a health system can facilitate the provision of financial incentives in a manner that best supports the success of efforts to stop smoking among a. general populations and b. pregnant women.

The review is registered with Prospero and can be accessed here. A study protocol published in the BMJ-Open is forthcoming.

Dr Rikke Siersbaek, Research Fellow, is the lead methodologist and researcher on the project, supported by Research Fellow Dr Sarah Parker and Researcher Luisne Mac Conghail. Dr Sara Burke, Research Assistant Professor, is the Principal Investigator on this one-year research project with Dr Paul Kavanagh from the HSE's Health Intelligence Unit and the Tobacco Free Ireland programme as the lead knowledge user. Dr John Ford from the University of Cambridge is the senior methodologist providing oversight and support. This work is funded under the HSE’s Financial Incentives and Stop Smoking Services Research Award 2021 (FISSS2021)

PI: Associate Professor Sara Burke
Centre Researchers: Dr Rikke Siersbaek, Dr Sarah Parker, Luisne Mac Conghail

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.

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Health system foundations for Sláintecare implementation in 2020 and beyond - co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system’s response to COVID-19 is a Health Research Board Applied Partnership Award funded from 2019 to 2021.

A study protocol published on HRB Open is available here https://hrbopenresearch.org/articles/3-70/v1

Learn much more about the project and its outputs on the project’s stand-alone website.

PI: Dr Sara Burke
Centre Researchers: Dr Sarah Parker, Luisne Mac Conghail, Dr Rikke Siersbaek

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The aim of this project is to build a demographic/economic microsimulation model to predict the future older population in Ireland using TILDA data, and to evaluate policy options ex ante. In collaboration with University of Southern California and the Irish Department of Health.

For more details, please email pemay@tcd.ie.

PI: Dr Peter May
Funding: Health Research Board, ARPP awards

Improving palliative and end-of-life care requires good data on current practices. However, we currently know little about the end-of-life phase in Ireland: where people die, what health care they use, how family and friends provide unpaid care, and how palliative care shapes these experiences. This project aims to improve knowledge and understanding of these questions. In collaboration with the HSE, Irish Hospice Foundation, HIPE and the All Ireland Institute for Hospice and Palliative Care. This project has a dedicated website with much more information about the aims and outputs of the project and with useful links.

For more details, contact pemay@tcd.ie.

PI: Dr Peter May
Funding: Health Research Board, SDAP awards

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.

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

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:

1. To identify geographical networks of emergency and urgent care in Ireland and describe the model of EUCS configuration planned/implemented in each region.
2. 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.
3. To analyse the relationship between different EUCS models of governance and provision, and system-level indicators of activity, process and clinical outcome.
4. 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

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 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.

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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

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

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

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.

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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

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.

READ FINAL REPORT PDF

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.

http://www.doctormigration.com/

Lead researcher: Dr Niamh Humphries (RCSI)
Researcher: Ms Ella Tyrrell
PI: Prof Ruairi Brugha
Co Investigators: Prof Charles Normand, Dr Stephen Thomas

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/

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.

References:

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

Sponsored by the Health Research Board

This is a health services research and development programme about aligning people, processes and technology to optimise chronic disease management. The People - patients with chronic disease, their families and healthcare providers; Processes - access to healthcare services, the manner and location of service delivery, procedures for follow-up care, and the interface between clinical care and clinical research environments; Technology - the application of information and communication technology (ICT) in healthcare practices. Timely sharing and exchange of standardised information and efficient communication both within and across organisational boundaries is key to achieving an effective management of chronic diseases. An eHealth domain linking healthcare services to healthcare constituencies and patients and healthcare professionals at any location facilitates information sharing and exchange and promotes a continuum of healthcare services for the benefit of the patient. eHealth is defined as the transaction of healthcare services over an electronic medium such as the Internet (including the World Wide Web, intranet, extranet). Using epilepsy as an ideal exemplar of a chronic disease, this research programme is a socio-technical enquiry aimed at designing, developing, deploying and evaluating an eHealth domain for epilepsy care and research in Ireland. An epilepsy electronic patient record (EPR) which has been developed at Beaumont Hospital, Dublin will be the foundation upon which the eHealth domain will be established and assessed in terms of user acceptability, clinical outcomes, benefits to clinical research and cost-effectiveness. Lessons learned from the model applied in this programme will benefit others who undertake similar projects in the future.

Principal Investigator: Mary Fitzsimons
Project Researchers: Charles Normand & Jarlath Varley

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

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.

TCD lead authors Dr Maev-Ann Wren and Prof Charles Normand with Prof Davis Coakley and Prof Bob Stout, co-chairs of CARDI at the launch of the CARDI funded report Towards the Development of a Predictive Model of Long-Term Care Demand for Northern Ireland and the Republic of Ireland.

READ FINAL CARDI REPORT

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