Feasibility, safety and efficacy of a care model based on multidimensional frailty assessment (3D/3D+), implemented in a hospital emergency department

Objectives.

To evaluate the feasibility, safety and efficacy of a care model based on multidimensional frailty assessment (3D/3D+), progressively implemented in a hospital emergency department (ED) for patients aged 75 years or older.

Methods.

A type 1 hybrid effectiveness–implementation study. All medical emergency episodes involving patients aged 75 years or older attended from January 1st, 2018 through December 31st, 2023, were included. Multivariable autoregressive moving average (ARMA) time-series models were used to estimate the impact on hospital admission conversion rate, length of hospital stay, discharge destination from the ED, and revisits at 72 hours and 30 days.

Results.

A total of 66,422 episodes were included, with a median age of 83.9 years (IQR, 79.4–88.3); 58.1% were women, and 61.5% had Model Andorrà de Triatge (MAT-SET) triage levels I–III. The multivariable time-series model adjusted for age and sex showed a 5–percentage point reduction in the proportion of hospital admissions in 2023 (β = −0.055; 95% CI, from −0.090 to −0.020) among high-priority episodes. In addition, there was a reduction in hospital stays > 2 days, an increase in referrals to intermediate care hospitalization, and a decrease in 30-day revisits, in both low- and high-priority episodes.

Conclusions.

The study demonstrates the feasibility and effectiveness of transforming emergency care toward integrated, value-based practices centered on frailty using 3D/3D+ multidimensional assessment.