Health Services Research
Health Research Board Applied Partnership Award “Enhancing the reach and sustainability of an integrated falls prevention pathway”
Falls are one of the most serious and common threats to older people. It is possible to reduce the risk of falls by assessing individuals’ risk factors and providing appropriate treatment if necessary. Within the Irish health system, such a service is provided by the pioneering Integrated Falls Prevention Pathway in Cork. The Integrated Falls Prevention Pathway provides access to falls risk assessment for older people in Cork city and county in purposefully established Falls Risk Assessment Clinics. This initiative is one example of an integrated care pathway in the National Integrated Care Programme for Older People.
Health services researchers, Dr Sheena McHugh, Project Lead, and Ms Rebecca Dennehy, together with stakeholders in the Health Service Executive (HSE) Services for Older People, local hospitals, and community services in Cork Kerry Community Healthcare, are investigating the sustainability of the Integrated Falls Prevention Pathway. The research aims to establish an agreeable way to increase the service’s capacity to prevent falls and identify any gaps or delays in the provision of treatment to older people at risk of falls. Findings from this study will have a direct impact on decision-making regarding the provision of services to older people.
HRB Interdisciplinary Capacity Enhancement Award (ICE)
HRB Interdisciplinary Capacity Enhancement Award (ICE)
Lifestyle Transitions and Trajectories through the Life course: Enhancing capacity in Irish cohort and cross-sectional studies
The aim of this programme of research is to describe transitions and trajectories in lifestyle factors at different stages of the life course, and to assess how different lifestyles impact on health outcomes and health care utilization. The three year programme, led by Dr Patricia Kearney, is part of the HRB’s postdoctoral fellowship scheme aimed at building capacity in population health and health services research. Three post-doctoral researchers have been recruited in the areas of biostatistics, chronic disease epidemiology and health services research.
The research programme will consist of three inter-related work packages. Dr. Xia Li will work on the development of statistical methods to model complex functional accelerometer data, to identify subgroups based on dietary and physical activity data, and to model longitudinal associations between time-dependent factors, their trajectories, and subsequent health outcomes. Dr. Darren Dahly will assess dietary and physical activity patterns across the life course, and investigate the diet and lifestyle determinants of diet-related disease. Dr Sheena Mc Hugh will examine the predictors of health service utilisation across the life course including the influence of lifestyle factors on the use of preventative and treatment services.
The research programme is based on maximizing the use of data from 9 observational studies (6 cohorts, 3 cross-sectional) that collectively span the life course. These studies were undertaken or are ongoing in a range of populations including pregnant women (SCOPE, PRAMS), neonates (SCOPE), children (GUI, CCLaS), and middle aged and older adults (SLAN physical exam sub-study, Phases I and II Cork and Kerry Heart Disease studies including Mitchelstown cohort, and TILDA).
There are a team of PIs involved in this research fellowship scheme including Dr Tony Fitzgerald and Prof. John Browne in the School of Public Health UCC; Prof. Louise Kenny Professor of Obstetrics, UCC; Prof. Joe Eustace, Director of the HRB Clinical Research Facility, and Prof. Ciaran O’Neill at the Department of Economics at NUIG. This team have partnered with a number of external collaborators and international institutions to provide training and mentoring including the ESRI, RAND, University of Leeds, Australian National University, University of Oxford, Trinity College Dublin and the National Perinatal Epidemiology Centre.
Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks (SIREN)
HRB Collaborative Applied Research Grant
The aim of this research programme is to describe and evaluate the development and performance of different emergency and urgent care systems (EUCS) in Ireland and produce a framework for the future evaluation of EUCS in this country. The programme, led by Prof. John Browne, involves six inter-related work packages to address the following 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.
The study will use mixed methods, combining data collected through interviews, documentary analysis, routinely available datasets and original quantitative surveys. Documentary analysis and stakeholder interviews will be used to identify networks of care and evaluate implementation of a systems-based model of provision. Cross-network quantitative comparison will be conducted using established indicators of process (e.g. Emergency Department activity), patient experience (through telephone surveys) and outcome (e.g. case fatality ratios).
This four year programme of research is being undertaken in collaboration with a number of co-applicants; Dr Steve Thomas at the Centre for Health Policy and Management, Trinity College Dublin; Professor Susan Smith in the Department of General Practice at the Royal College of Surgeons Ireland; Professor Ronan O' Sullivan, consultant in emergency medicine and Director of the Paediatric Emergency Research Unit at the National Children's Research Centre; Dr Orla Healy, public health specialist with the HSE South; and Dr Sheena McHugh and Dr Tony Fitzgerald here in the School of Public Health, University College Cork (UCC). A number of national and international collaborators are involved in the research including the School of Health and Related Research (ScHARR) at the University of Sheffield; College of Medicine and Health in UCC; Health Information Systems Research Centre (HISRC) in UCC and National Directorate for Quality and Patient Safety in the HSE.
For future information, please see the SIREN website
Patient-Reported Outcomes : PROFILE Trial
Patient-Reported Outcomes: Feedback Interpretation and Learning Experiment (PROFILE) Trial
Patient-Reported Outcome Measures (PROMs) are questionnaires that assess patients’ health, Health-Related Quality of Life (HRQoL), and other health-related constructs. PROMs can be used in research (e.g. clinical trials) and audit (e.g. quality assurance). The National Institute for Clinical Excellence (NICE) in the UK and the Food and Drug Authority (FDA) in the USA endorsed the use of PROMs for research purposes to understand the impact of disease and treatment from the perspective of the patient. Two key organisations- BUPA (UK) and Medicare (USA) - played a major role in promoting the use of PROMs as an audit tool to monitor professional’s performance. These organisations use PROMs to assess the variation in surgical outcomes which they believe stimulates improvements in care by identifying and sharing best practice, and in turn promoting a learning culture. Furthermore, in 2009 the NHS in England made an innovative decision by introducing PROMs as a national performance indicator for four common elective procedures (hernia repair, varicose veins, and hip/knee replacement). The outcomes of patients are compared at a hospital-level and reported publically to promote quality improvements. The rationale behind performance monitoring and public-disclosure is to stimulate competition and influence resource allocation. While the views of patients undoubtedly have a role to play in improving the quality of health care, there is currently no strong evidence to confirm the effectiveness of PROMs in achieving this objective. A recent review by the PROFILE research team found that the decision to use PROMs as a performance measure is not based on evidence of effectiveness and is not underpinned by a theoretical framework which may help understand how quality improvements may occur.
This research aims to evaluate the effectiveness of using PROMs as a performance measure and involves a mixed-methods approach including a cluster randomised controlled trial and semi-structured interviews with surgeons. The trial is testing whether providing benchmarked PROMs feedback to surgeons improves outcomes for patients undergoing hip replacement surgery. This involves collecting data from up to 1,500 hip replacement patients across 16 hospitals in Ireland. The qualitative aspect of this study aims to investigate surgeon’s opinions on the use of PROMs as a measure of their performance and to gain a deeper understanding into the mechanisms by which quality improvements may occur. This study commenced in 2011 and we hope to complete the data collection in December 2013.
This is the first study to evaluate the use of PROMs as a measure of professional performance. The findings will not only be relevant to those involved in the PROMs Programme in England, but also to healthcare professionals, research and policy makers in Ireland and other countries who are interested in adopting the use of PROMs as a quality improvement tool.
National Suicide Research Foundation Research Strategy
National Suicide Research Foundation (NSRF) Research Strategy
General Objective: To produce a nationally and internationally recognised body of reliable knowledge from a multidisciplinary perspective on the risk and protective factors associated with suicidal behaviour.
Outcome: A solid evidence base for policy development and intervention in the prevention of suicide and the management of patients presenting with self-harm.
For further information on the Research Strategy, please see the below document:
Evidence to Support PRevention Implementation and Translation (ESPRiT)
HRB Research Leader Award in Diabetes
The HRB Research Leader Award is part of a significant investment to ensure that the health research community in Ireland are in a position to provide strong research and evidence in relation to current, emerging and often complex challenges in healthcare that are of concern to decision makers, practitioners and policy makers. In 2013, Professor Patricia Kearney was one of six researchers to secure the award.
The focus of the National Clinical Programme for Diabetes (NCPD) is on the reorganization of services and it does not have the capacity to undertake research. The rational of the partnership between the NCPD and UCC, led by Professor Kearney, is based on a shared vision to improve care for people with diabetes in Ireland and to reduce the preventable economic and societal burden of diabetes.
Data from existing studies will be used to determine the prevalence of diabetes and to provide a dynamic evidence base of trends in the incidence of diabetes and diabetes-related complications and associated healthcare utilization costs. A process evaluation of the implementation of the NCPD will be undertaken with the use of interviews and documentary analysis to determine barriers and facilitators to change in the Irish health system. A feasible lifestyle intervention will be developed to prevent diabetes.
- The specific objectives of the 5 year programme of research are as follows:
- To measure the public health burden of diabetes
- To evaluate the implementation of the National Clinical Programme in Diabetes
- To model current and future diabetes care costs
- To develop, implement and assess a lifestyle intervention in women at risk of gestational diabetes
This partnership between the highest levels of academia and service provision in Public Health in Ireland is ideally positioned to ensure the research is undertaken with academic rigor and will translate directly into policy and service delivery. Ultimately the impact of the programme will be to reduce the clinical, financial and societal burden of diabetes.
Centre for Ageing Research and Development in Ireland (CARDI) Project
In total, four fellowships were awarded across the country (North and South of Ireland) and this is the first fellowship that has been awarded to a researcher in UCC.
The CARDI leadership programme is aimed at supporting and building capacity in ageing research across the island of Ireland and promoting the development of future leaders. Dr Mc Hugh’s programme of research focuses on the development of a falls prevention intervention for older people with diabetes. Her mentors are Professor Patricia Kearney (Epidemiology & Public Health) and Dr Suzanne Timmons (Centre for Gerontology and Rehabilitation, UCC). Sheena will also be working with a number of national and international collaborators including the Irish Longitudinal Study of Ageing (TILDA).
If you would like to take part in this research, please see the ESPRiT online form.
For further information, please see the ESPRiT website.