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This multicentre, non-randomized, quasi-experimental study evaluated the effectiveness of the ADLIFE digital toolbox—comprising clinical decision support, care-plan management, and patient empowerment—for patients aged >55 with chronic obstructive pulmonary disease and chronic heart failure. Across four pilot sites (Spain, UK, Denmark, and Israel), 185 patients received the intervention and were compared with 185 retrospective standard-of-care control matched using propensity score. The primary outcome was the number of emergency room (ER) visits, analyzed through multivariate hurdle regression. Results in the pooled analysis (N = 370) indicated that while ADLIFE was associated with a significant reduction in the likelihood of an initial ER visit (OR 0.55; 95% CI: 0.31–0.96), no significant differences were found for subsequent visits among patients who had already utilized emergency services (IRR 1.74; 95% CI: 0.88–3.43). Significant effect heterogeneity was observed, with a reduction achieved in only one location (AMCA: OR 0.30; 95% CI: 0.15–0.63). These findings suggest that while digitally enabled care models hold potential for initial acute care prevention, their effectiveness is heavily contingent upon complex contextual factors. Given the small sample size and site-specific results, these data should be interpreted with caution.

Trial registration: ClinicalTrials.gov; NCT05575336; September 2022.