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The journal of nutrition, health & aging

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01-10-2017

Integrated Care Programme for older adults: Analysis and improvement

Authors: A. Sánchez, Elena Villalba-Mora, I. Peinado, L. Rodriguez-Mañas

Published in: The journal of nutrition, health & aging | Issue 8/2017

Abstract

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.

Salive, M. E. Multimorbidity in older adults. Epidemiologic Reviews, 2013;35(1), 1–75. Available at: https://epirev.oxfordjournals.org/content/35/1/75.full.pdf+htmlCrossRef

Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., & Fratiglioni, L. Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 2011;10(4), 4–430. Available at: https://www.researchgate.net/profile/Bettina_Meinow/publication/50394378_Aging_with_multimorbidity_A_systematic_review_of_the_literature/links/561cc76308ae044edbb50cfb.pdfCrossRef

Villalba, E., Sánchez, A., Peinado, I., Mansoa, F.J. Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3)–Integrated care programme for older in-and out-patients Geriatrics Service. University Hospital of Getafe Case Study Report. Institute for Prospective and Technological Studies, Joint Research Centre, 2015. Available at: http://publications.jrc.ec.europa.eu/repository/bitstream/JRC95548/jrc95548.pdf

Kodner, D. L., & Spreeuwenberg, C. Integrated care: meaning, logic, applications, and implications–a discussion paper. International Journal of Integrated Care, 2002;2. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480401/pdf/ijic2002-200212.pdf

European Commission. European Innovation Partnership on Active and Healthy Ageing 2013. Reference Sites. Excellent innovation for ageing A European Guide. Available at: https://ec.europa.eu/research/innovation-union/pdf/active-healthyageing/rs_catalogue.pdf

Yin, R. K. Case study research: Design and methods 2013. Sage publications. Available at: http://faculty.washington.edu/swhiting/pols502/Yin.pdf

Baxter, P., & Jack, S., Qualitative case study methodology: Study design and implementation for novice researchers. The qualitative report, 2008;13(4), 4–544. Available at: http://www.nova.edu/ssss/QR/QR13-4/baxter.pdf

Runeson, P., Host, M., Rainer, A., & Regnell, B.. Case study research in software engineering: Guidelines and examples, 2012. John Wiley & Sons. Available at: http://www.egov.ee/media/1267/case-study-research-in-software-engineering.pdfCrossRef

Villalba, E., Casas, I., Abadie, F., & Lluch, M. Integrated personal health and care services deployment: experiences in eight European countries. International journal of medical informatics, 2013;82(7), 7–626. Available at:http://ac.els-cdn.com/S1386505613000609/1-s2.0-S1386505613000609-main.pdf?_tid=42940fec-6103-11e5-a684-00000aacb361&acdnat=1442910413_dc33c9f9f0237f324fe156910e87ca2cCrossRef

10.

Weidenhaupt, K., Pohl, K., Jarke, M., & Haumer, P. Scenarios in system development: current practice. Software, IEEE, 1998;15(2), 2–34. Available at: http://ieeexplore.ieee.org/xpl/abstractAuthors.jsp?arnumber=663783CrossRef

11.

Börjeson, L., Höjer, M., Dreborg, K. H., Ekvall, T., & Finnveden, G. Scenario types and techniques: towards a user’s guide. Futures, 2006;38(7), 7–723. Available at: http://ac.els-cdn.com/S0016328705002132/1-s2.0-S0016328705002132-main.pdf?_tid=ec6643e2-dad8-11e5-9e74-00000aab0f27&acdnat=1456306271_345f8fb06 34545cf95fba7e765cebb9dCrossRef

12.

Sutcliffe, A. Scenario-based requirements engineering. In Requirements engineering conference, 2003. Proceedings. 11th IEEE international 2003;(pp. 320-329). IEEE. Available at: http://csis.pace.edu/~marchese/CS775/Papers/sutcliffe_scenario_based.pdf

13.

Rosson, M. B., & Carroll, J. M. Scenario based design. Human-computer interaction. Boca Raton, FL, 2009;145–162. Available at:https://books.google.at/books?hl=es&lr=&id=sRPg0IYhYFYC&oi=fnd&pg=PP2&dq=Scenario+based+design.+Human-computer+interaction.&ots=mGIp-bSMFS&sig=1grKGlVGAUP4ebTt3ln3W k8l6gM#v=onepage&q=Scenario%20based%20design.%20Human-computer%20interaction.&f=falseCrossRef

14.

Abras, C., Maloney-Krichmar, D., & Preece, J. User-centered design. Bainbridge, W. Encyclopedia of Human-Computer Interaction. Thousand Oaks: Sage Publications, 2004;37(4), 4–445. Available at:http://www.e-learning.co.il/home/pdf/4.pdf

15.

Sauer, J., & Sonderegger, A. The influence of prototype fidelity and aesthetics of design in usability tests: Effects on user behaviour, subjective evaluation and emotion. Applied ergonomics, 2009;40(4), 4–670. Available at: https://www.researchgate.net/profile/Andreas_Sonderegger/publication/23160376_The_influence_of_prototype_fidelity_and_aesthetics_of_design_in_usability_tests_effects_on_user_behaviour_subjective_evaluation_and_emotion/links/02e7e52c41c5b689b9000000.pdfCrossRef

16.

Dahl, Y., Alsos, O. A., & Svanæs, D.. Fidelity considerations for simulation-based usability assessments of mobile ICT for hospitals. Intl. Journal of Human–Computer Interaction, 2010;26(5), 5–445. Available at: http://folk.ntnu.no/oleanda/papers/Fidelity%20considerations%20-%20IJHCI.pdfCrossRef

17.

Blackler, A.. Applications of high and low fidelity prototypes in researching intuitive interaction, 2009. Available at: http://shura.shu.ac.uk/458/1/fulltext.pdf

18.

Blackler, A., Popovic, V., & Mahar, D. Studies of Intuitive Interaction employing observation and concurrent protocol. In DS 32: Proceedings of DESIGN 2004, the 8th International Design Conference, Dubrovnik, Croatia. Available at: http://m.designsociety.org/download-publication/19745/studies_of_intuitive_interaction_employing_observation_and_concurrent_protocol

19.

Brooke, J. SUS-A quick and dirty usability scale. Usability evaluation in industry, 1996;189(194), 194-4. Available at: http://cui.unige.ch/isi/icle-wiki/_media/ipm:testsuschapt. pdf

20.

Rauschenberger, M., Schrepp, M., Cota, M. P., Olschner, S., & Thomaschewski, J. Efficient measurement of the user experience of interactive products. How to use the user experience questionnaire (UEQ). example: spanish language version. IJIMAI, 2013;2(1), 1–39.Available at: http://scholar.google.at/scholar_url?url=http:/dialnet.unirioja.es/descarga/articulo/4221411.

21.

Laugwitz, B., Held, T., & Schrepp, M. Construction and evaluation of a user experience questionnaire (2008;pp. 63-76). Springer Berlin Heidelberg. Available at: http://www.ueq-online.org/wp-content/uploads/Construction_of_UEQ1.pdf

22.

Kaplan, B., & Shaw, N. T. Future directions in evaluation research: people, organizational, and social issues. Methods of Information in Medicine-Methodik der Information in der Medizin, 2004;43(3), 3–215. Available at: http://www.researchgate.net/profile/Nicola_Shaw/publication/8480043_Future_directions_in_evaluation_research_people_organizational_and_social_issues/links/0046351dac3d0e0c5b000000.pdf

23.

Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., & McBurnie, M. A. Frailty in older adults evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2001;56(3), M146–M157. Available at: http://www.hopkinsmedicine.org/geriatric_medicine_gerontology/_downloads/readings/section10_1.pdfCrossRef

24.

Lawton, M. P. The functional assessment of elderly people. Journal of the American Geriatrics Society, 1971;19(6), 6–465. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1971.tb01206.x/abstractCrossRef

25.

Ellis, Graham, and Peter Langhorne. «Comprehensive geriatric assessment for older hospital patients.» British medical bulletin 2005;71.1: 45–59. Available at: http://www.bmj.com/content/bmj/343/bmj.d6553.full.pdfCrossRefPubMed

26.

Welsh, T. J., Adam L. Gordon, and J. R. Gladman. Comprehensive geriatric assessment–a guide for the non-specialist. International journal of clinical practice 2014;68.3: 290–293. Available at: http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12313/pdfCrossRefPubMedPubMedCentral

27.

Yoon, J., Zulman, D., Scott, J. Y., & Maciejewski, M. L. Costs associated with multimorbidity among VApatients. Medical care, 2014;52, S31–S36. Available at: http://journals.lww.com/lww-medicalcare/Abstract/2014/03001/Costs_Associated_With_Multimorbidity_Among_VA.8.aspxCrossRefPubMed

28.

Dolin, R. H., Alschuler, L., Boyer, S., Beebe, C., Behlen, F. M., Biron, P. V., & Shabo, A. HL7 clinical document architecture, release 2. Journal of the American Medical Informatics Association, 2006;13(1), 1–30. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380194/CrossRef

29.

Bangor, A., Kortum, P., & Miller, J. Determining what individual SUS scores mean: Adding an adjective rating scale. Journal of usability studies, 2009;4(3), 3–114. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380194/pdf/30.pdf

30.

Hebert, R. An urgent need to improve life conditions of seniors. The journal of nutrition, health & aging, 2010;14(8), 8–711. Not available in the public domain.CrossRef

31.

Lee, J. C., McCrickard, D. S., & Stevens, K. T. Examining the foundations of agile usability with eXtreme scenario-based design. In Agile Conference, 2009. AGILE’09. 2009;pp. 3-10). IEEE. Available at: http://people.cs.vt.edu/~mccricks/papers/lms09-agile.pdf

32.

Hwang, M. I., & Thorn, R. G. The effect of user engagement on system success: a meta-analytical integration of research findings. Information & Management, 1999;35(4), 4–229. Available at: http://faculty.cba.cmich.edu/webs/hwang1m/images/userengagement.pdfCrossRef

33.

Preece, J., Rogers, Y., & Sharp, H. Interaction design: Beyond human-computer, 2002. Available at: https://books.google.at/books?hl=es&lr=&id=n0h9CAAAQBAJ&oi=fnd&pg=PA350&dq=Interaction+design:+Beyond+human-computer.&ots=23AMx3fAiQ&sig=DX5y9YbW6PtvChYlrmh7t-vmCM0#v=onepage&q=Interaction%20 design%3A%20Beyond%20human-computer.&f=false

34.

Wright, P., & McCarthy, J. Empathy and experience in HCI. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2008;pp. 637–646. ACM. Available at: https://www.researchgate.net/profile/Peter_Wright7/publication/221515988_Empathy_and_experience_in_HCI/links/0912f50b88c115634f000000.pdf

35.

Paixão Jr, C. M., & Reichenheim, M. E. Uma revisão sobre instrumentos de avaliação do estado funcional do idoso A review of functional status evaluation instruments in the elderly. Cad. Saúde Pública, 2005;21(1), 1–7. Available at: http://www.scielosp. org/pdf/csp/v21n1/02.pdfCrossRef

36.

Sourial, N., Bergman, H., Karunananthan, S., Wolfson, C., Payette, H., Gutierrez-Robledo, L. M., & Guralnik, J. Implementing frailty into clinical practice: a cautionary tale, 2013. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, glt053. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806754/pdf/nihms2968.pdf

Title: Integrated Care Programme for older adults: Analysis and improvement
Authors: A. Sánchez
Elena Villalba-Mora
I. Peinado
L. Rodriguez-Mañas
Publication date: 01-10-2017
Publisher: Springer Paris
Published in: The journal of nutrition, health & aging / Issue 8/2017
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI: https://doi.org/10.1007/s12603-016-0860-5

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