The University Hospital of Getafe (HUG) provides service to over 200,000 patients, covering 13 municipalities including urban centres such as Getafe (over 170,000 inhabitants) and Pinto (over 47,000 inhabitants in 2014). The HUG is a Level 2 hospital with a staff of around 2,300 people. It offers up to 39 specialties, including key specialties such as General Surgery, Cardiology, Paediatrics, Genetics or an Intensive Care Unit (ICU). Despite its youth, the HUG is recognised as a reference hospital in specialties such as the Burn Unit, the Geriatrics Service, the Transplants Unit or the Tissue Bank. Moreover, as a University Hospital, the HUG also has a teaching facility, and is accredited to teach the Degree of Medicine in collaboration with the Universidad Europea de Madrid.
The HUG is one out of 7 hospitals in Madrid that has a Geriatrics Service. The Geriatrics Service in the HUG works since 1991 and currently attends more than 5,000 older patients/year along its Units: the Acute Care Unit (1800 patients/year), the Orthogeriatric and Interconsultation Unit (800 patients/year), the Day Hospital (300 patients/year), the Outpatient Office (4000 patients/year) and the Domiciliary Care Unit.
The HUG has set one of its main official research programs on Aging Frailty and Disability. Several research groups at the Hospital are engaged in different activities related to this field, and a Clinical Research Unit specifically designed for older people has also been developed. The Geriatrics Service leads a number of European projects including the coordination of 3 PF7 Research Projects, the participation in 2 H2020 projects and a project funded by the Second Health program of the DG SANCO, all of them focused on frailty and funded by the European Commission. In 2013 the Region of Madrid, through the HUG, was awarded by the European Commission as one of the 32 European Reference Sites on innovation in active and healthy aging due to the innovation-based approach of the hospital’s geriatric department to active and healthy ageing. More specifically, the Falls and Fracture Clinic and the integrated care programme for older in- and out-patients were awarded with 3 stars.
Finally, the team of HUG participates actively in all the Actions Groups of the EIP-AHA, the European Innovation Partnership on Active and Healthy Ageing leading the Sub-group of Frailty within the A3 Action Group (Frailty and Functional Decline, both physical and cognitive).
Care of older adults with MCI and dementia
Within the region of Madrid, there is not a regional strategy for the care of patients with cognitive impairment or dementia. Consequently, there is not a specific care pathway at the HUG for patients with mild cognitive impairment. Older adults with MCI or dementia are attended by the Memory Unit in the Geriatrics Service of the HUG. The Memory Unit carries out the follow-up of older adults with MCI and dementia and collaborates with the rest of the units in the Geriatrics Service in the integrated care programme for older in- and out-patients that aims to provide all patients with integrated care, to promote healthy living and to improve the functional status of older adults. The integrated care program for in- and out-patients offers continued, progressive and coordinated attention to patients, at home or in residential care, at high risk of functional decline, institutionalization and hospitalization. The main goal is to offer the most appropriate care to the changing needs of the patients. The program is organised in two parts: for the people admitted to the hospital, the caring teams responsible for the different phases of the treatment are coordinated through periodic meetings (both physical and remote, to coordinate care with other hospitals) and connect before discharge with the primary care team; for the patients at homes or in residential care structures, the program includes follow-up of the patient, directly or in close collaboration with Primary Care and social care agents when needed.
The integrated care program has been adjusted and modified over time in order to take account of new standards of care and new clinical research findings. The Geriatrics Service in the HUG currently has a Community Care Unit (hereafter CCU) that comprises two geriatricians who visit patients at home on a regular basis. The geriatricians in the CCU carry a ‘medical toolkit’ comprising a laptop, a small printer and a 3G USB drive that allows them to remotely connect to the Hospital’s Virtual Private Network, as well as some measuring devices such as blood pressure cuffs or an oxygen saturation meter. The geriatricians can access the patient’s medical record from the Hospital’s Health Information System at the beginning of the visit, and can upload the information gathered during the visit (measurements, questionnaires, etc.) to the Hospital’s HIS. Moreover, professionals in Primary Care can access this information later. On the other hand, integration with other stakeholders such as nursing homes and social services is carried out in an informal way, usually via telephone or face-to-face meeting.
DECI and the Geriatrics Service of the HUG
The care culture adopted by the Geriatrics Service in the HUG, based on continuous and integrated care, has demonstrated to produce good results in both economic and healthcare terms. This model has been implemented thanks to the commitment of the professionals in the Geriatrics Service and the collaboration between different tiers of care and among different departments of the Hospital. Moreover, as this system is flexible and the environment is appropriate for deploying ICT solutions, the DECI platform could be easily integrated into the coordinated in- and out-patient program and therefore complement and complete the care provided by the Geriatrics Service to older adults with MCI and dementia.