RESUMO
OBJECTIVE: We aimed to in-depth analyse the Integrated Care Programme for older in- and out-patients implemented for more than 25 years at the Hospital Universitario de Getafe, in Madrid, Spain. We identify the strengths and barriers hindering the full operation, and we proposed a technological solution that overcame these constraints and facilitated integration. DESIGN: First, we carried out a comprehensive analysis of the integrated care program at the HUG following Case Study Research; the primary unit of analysis was the Geriatrics service and its clinical units. Secondary sources of analyses were professionals' insights (obtained thought direct observation and interviews) and statistics on the service. After the identification of the barriers preventing complete success; we designed a Health Information System and developed a mock-up that was validated with the professionals. Finally, we passed the specifications to the Information System Unit at the Hospital to develop and integrate the system into the hospital one. SETTING: The Geriatrics Service of the University Hospital of Getafe, pertaining to the public Healthcare System of the Region of Madrid (Spain). PARTICIPANTS: No patient participated in the study. All staff from the Geriatrics Service and the ICT manager of the hospital contributed to the design of the Health Information System; and 3 geriatricians from the Service and 1 primary care physician validated it. MEASUREMENTS: First, we qualitative analysed the Integrated Care Program taking as dimensions eight facilitators towards integrated care. In response, we proposed an integrated information system solution. Later, we interviewed the staff geriatricians to analyse the Integrated Care Programme. Finally, we validated our proposed system in terms of usability and user experience using the System Usability Score-SUS and the User Experience Questionnaire-UEQ, respectively. RESULTS: The Integrated Care Program has demonstrated a high impact since its launch; however, the lack of integration in terms of information system was hindering the full deployment. We have designed an integrated information system which has been validated by physicians and nurses from the Geriatrics Service in terms of usability. We obtained a SUS score of 81 (68 is considered to be the cut-off point for usable systems). Besides, the perception of these professionals on our system was 'Excellent' in 5 out of the 6 items covered by UEQ (Attractiveness, Perspicuity, Dependability, Stimulation and Novelty) and 'Good' in terms of the 1 remaining (Efficiency), where there is still room for improvement. CONCLUSIONS: Our dedicated Health Information System is a robust solution to bridge information gaps and facilitate the complete integration of our Integrated Care Programme for older in- and outpatients.
