ArticlemedRxiv : the preprint server for health sciences2026
Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation.
Article in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
Funding
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Abstract
Background: This study focused on adults with complex care needs due to problems on multiple life domains and consequent high acute care use. The Hotspotters Project was undertaken to assess the effects of proactive integrated care on health outcomes and healthcare costs in this group. We evaluated the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the Hotspotters Project in order to identify factors that influenced implementation and outcomes. Method: This mixed method study followed the RE-AIM-framework, using validated questionnaires, routine care data and semi-structured interviews. Qualitative data from patients and care providers offered insight in the quantitative outcomes. Quantitative data were analyzed descriptively (SPSS), and interview transcripts were analyzed using inductive thematic content analysis (Atlas.ti). Results: As acute care use was lower than expected, few patients were eligible (153/1403) and subsequent low enrollment (n=30) limited conclusions regarding effectiveness. Nevertheless, the intervention improved collaboration with social work, and the structured intake was valued for the overview of patients' complex needs. Many practices adopted the intervention into regular care, despite the complex inclusion process. Care providers proposed revising the target population and recruitment to better reflect the Dutch context. Conclusion: Although cost-effectiveness could not be assessed, this study nonetheless provides insights that can help future interventions and trials to better match patients' needs, adapt to local context and reduce patients' study burden. Adapting the definition of 'patients with complex needs' to a local context can strengthen the rationale for implementation and enhance patient motivation.
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