Do Hotspotting Programs Improve Patient Outcomes? A Systematic Review

Background Hotspotting programs train interprofessional teams of health students and professionals to engage with healthcare “super-utilizers” to address individuals’ social needs and coordinate ongoing care and social services. The goal is to improve care for individuals who demonstrate high levels of health care utilization, or “super-utilizers” to reduce future utilization while improving health outcomes, particularly while transitioning from a recent hospital utilization event. Debate exists whether hotspotting programs are effective at both reducing utilization and improving patient wellness. Aims To systematically review the literature on the effect of hotspotting and similar models of transitional care on rates of health care utilization, (hospital admissions, emergency department and primary care visits) health outcomes (e.g., perceived health), and satisfaction with care and behavioral outcomes (e.g., medication adherence). Methods PubMed, EMBASE, SCOPUS, and CINAHL were searched from 2010 through April 2022 for RCTs and controlled observational studies, cohort studies, and before-after studies of hotspotting and similar interprofessional transitional care programs set in the US. Results A total of 10 studies were included, 5 were RCT or non-randomized controlled studies, 3 were cohort studies, and 2 were pre-post intervention studies. All studies reported on rates of hospital admissions, and 8 found lower rates in the hotspotting group than controls over 1-12 months, with 6 of these being statistically significant. In 6 studies reporting on ED visits, 5 were consistent in showing an association between hotspotting and lower rates of ED visits over 1-12 months. However, results were statistically significant in only 2 studies. In four studies that reported on primary care provider (PCP) visits, 1 did not compare results to a control group, and 2 found statistically significant increases in PCP visits 14 days to 1 year following enrollment in the intervention. Only 2 studies reported on outcomes related to patient behaviors and perceptions of health care. One reported on rates of medication adherence >80% after 6 months, finding no effect. The other reported on measures of self-rated physical health, mental health, and patient activation, finding no effect, as well as care quality (comprehensiveness and supportiveness of self-management) and demonstrated a significant benefit. Conclusions The evidence suggests hotspotting demonstrates a relationship with improved healthcare utilization outcomes overall, albeit results of studies are imprecise. A high level of heterogeneity was found among population descriptions, time points, outcomes, and outcome measures across studies. Further evaluation of hotspotting programs’ effects via longitudinal controlled trials will allow for better evaluation of the efficacy of hotspotting in improving rates of health care utilization, overall health, and quality of life for high-needs individuals.Master of Public Healt