| Sumario: | Background Preventive strategies aim to reduce older adults' emergency department (ED) visits and related adverse health outcomes, but their impact on healthcare system utilisation remains unclear. This can be investigated using system dynamics modelling, which uses data to explore effects and test strategies across populations. Aim In this study, we simulated and studied how preventive measures affect acute hospitalisations, intermediate care, home care, and nursing home admissions among community-dwelling older adults after an ED visit. Methods We developed a system dynamics simulation model tracing older adults from ED visit to hospitalisation, intermediate care, discharge home (with or without care), nursing home admission, or death within 30 days. Simulated strategies included proactive care, geriatric emergency medicine, and hospital-at-home. Data from Amsterdam residents aged ≥65 who visited the ED in 2019 were used. Patients were categorised by home care status. Results 31,049 patient journeys were used in the modelling. Of the simulated strategies, hospital-at-home demonstrated the largest potential reductions in institutionalised care use after ED visits in the total cohort: acute hospitalisations (−10.2%), intermediate care (−16.7%), nursing home care (−10.7%). Furthermore, it showed a reduction in personal home care (−1.8%), and limited increases in household help (+2%) and nursing home care at home (+1.5%). Conclusion Of the simulated strategies, hospital-at-home reduced healthcare use post-ED most effectively, causing the greatest decrease in institutional care without requiring a meaningful increase in home care services during one year of follow-up.These findings can guide policymakers, insurers, and institutions in choosing effective preventive strategies for regional populations.
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