Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation
- 1Leiden University Medical Center
Abstract
BackgroundThis 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.
MethodThis 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).
ResultsAs 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.
ConclusionAlthough 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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BibTeX
@misc{tiemes2026lessons,
title = {{Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation}},
author = {V. Tiemes and M. Verdonk and M. Van Der Wel and M. Adriaanse and L. Van Gestel and M. Ephraim and S. Van Bruggen and M. Bruijnzeels and M. Numans and H. Borgdorff and R. C. Vos},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.15.26362413},
url = {https://www.medrxiv.org/content/10.64898/2026.09.15.26362413v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation
AU - V. Tiemes
AU - M. Verdonk
AU - M. Van Der Wel
AU - M. Adriaanse
AU - L. Van Gestel
AU - M. Ephraim
AU - S. Van Bruggen
AU - M. Bruijnzeels
AU - M. Numans
AU - H. Borgdorff
AU - R. C. Vos
PY - 2026
DA - 2026/09/15
PB - medRxiv
DO - 10.64898/2026.09.15.26362413
UR - https://www.medrxiv.org/content/10.64898/2026.09.15.26362413v1
AB - BackgroundThis 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. MethodThis 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). ResultsAs 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. ConclusionAlthough 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.
ER -