“Hotspotting” intervention for hospital superusers did not decrease readmission rates

THURSDAY, January 9, 2020 (New England Journal of Medicine) – An attempt to mitigate hospital superusers did not achieve a significant decrease in readmission rates, according to a study published in the January 9th issue of the New England Journal of Medicine.

Superusers are patients with medically and socially complex conditions that require high levels of healthcare use. “The Hot Spotters” is a program created by the Camden Coalition in an effort to improve the cost and standard of treatment for superusers.

In an effort to measure the impact of “hotspotting,” Amy Finkelstiein, Ph.D., of the Massachusetts Institute of Technology, and colleagues measured the readmission rates of 800 superuser patients randomly assigned to the hotspotting program care-transition plan or to usual care.

The hotspotting intervention did not have a significant impact on readmission rates after 180 days: the 180-day readmission rate for the hotspotting group was 62.3%, compared to 61.7% for the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% CI, −5.97 to 7.61).

“Our results suggest that there are challenges for superutilizer programs aimed at medically

and socially complex populations,” noted the authors. “It is possible that approaches to care

management that are designed to connect patients with existing resources are insufficient for these complex cases. The Coalition has continually worked to adapt the model to the needs of its patient population, and both the Coalition and others are exploring models that involve more complete redesigns of care provision.”

Finkelstein A, Zhou A, Taubman S, Doyle J. Health Care Hotspotting - A Randomized, Controlled Trial. N Engl J Med. 2020;382(2):152-162. doi: 10.1056/NEJMsa1906848.