Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation

The Hotspotters Project focused on adults with complex care needs due to problems across multiple life domains and high acute care use. The study employed a mixed-methods approach using validated questionnaires, routine care data, and semi-structured interviews with patients and care providers. Of 1,403 patients, only 153 were eligible and 30 were enrolled, which limited conclusions about effectiveness. Nevertheless, the intervention improved collaboration with social work, and the structured intake assessment was valued for providing an overview of patients' complex needs. Many healthcare practices adopted the intervention into regular care despite the complex inclusion process. The study provides insights that can help future interventions better adapt to local contexts and reduce patient burden. Adapting the definition of patients with complex needs to local context can strengthen implementation rationale and enhance patient motivation.