Case management in emergency care: insights on health-related quality of life from the Case management for At-Risk patients in the Emergency Department (CARED) programme

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INTRODUCTION: The effects of emergency department (ED) transition care programmes on health-related quality of life (HRQoL) remain underexplored. This single-centre study examined the changes in HRQoL following the implementation of the Case management for At-Risk patients in the ED (CARED) programme, explored associations with frailty and identified factors linked to low HRQoL. METHODS: A quasi-experimental pre-post design was employed. Participants were recruited from the ED over 6 months as part of the CARED programme. At intake, trained case managers verified demographic and medical details and conducted a comprehensive geriatric assessment incorporating the Clinical Frailty Scale (CFS; version 2.0). The EQ-5D-5L was administered at baseline and repeated 3 months post-CARED. Analyses included the chi-square test, Mann-Whitney U test, Wilcoxon signed-rank test and logistic regression (α = 0.05). RESULTS: The final sample comprised 151 participants (mean age 77.4 ± 6.9 years; 75.5% female). Most (80.1%) had no-to-mild frailty, while 19.9% exhibited moderate-to-very severe frailty. Post-CARED, significant within-group improvements were observed in the overall cohort and those with no-to-mild frailty across EQ-5D-5L scores and domains ( P < 0.001), whereas improvements among individuals with greater frailty were limited. Between-group comparisons showed significantly poorer baseline and follow-up HRQoL among those with greater frailty, particularly in mobility, self-care and usual activities ( P < 0.05). Logistic regression identified male sex as the sole independent risk factor for low post-CARED EQ-5D-5L index scores (adjusted odds ratio 3.14, 95% confidence interval 1.40, 7.00). CONCLUSION: The CARED programme was associated with improved HRQoL, particularly among less frail individuals, while male participants had a three-fold higher likelihood of low post-intervention HRQoL.

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