Presentation (CTI)

OBJECTIVES: Electronic frailty indices (EFIs) have emerged as validated predictors of hospitalization and mortality. However, less is known about how frailty severity influences healthcare utilization across care settings and which patient factors modify this relationship.
METHODS: This retrospective cohort study analyzed electronic health record data from Meuhedet Health Services for patients ≥65. Baseline frailty was assessed using the Meuhedet Electronic Frailty Index and categorized as fit, mild, moderate, or severe. Generalized linear models evaluated outpatient, acute-care, hospitalizations and home-care utilization during 1-year follow-up. Interaction analyses examined effect modification by sex, age, sector, and socioeconomic status.
RESULTS: The cohort included 128,375 patients. Increasing frailty severity was associated with greater utilization across all healthcare services after adjustment for demographic and clinical covariates. Among severely frail versus fit patients, the largest increases among outpatient and acute-care services were observed for emergency department visits, physiotherapy visits, and medication count (IRRs 3.89, 3.23, and 2.81, respectively), while home-based services demonstrated substantially larger effects, including dietitian home visits, nurse home visits, and housebound status (IRRs 17.7, 14.2, and 11.5, respectively). Associations remained significant when severe versus moderate frailty were compared, supporting a dose-dependent relationship. Frailty-related utilization differed by sex, with men showing larger increases in outpatient and home-based services and women in hospitalization outcomes, whereas older age attenuated the rise in healthcare utilization.
CONCLUSIONS: Frailty severity is independently associated with healthcare utilization across outpatient, hospital, and home-care settings. Incorporating age and sex may improve the use of EFIs for healthcare planning and resource allocation.