Hotspotting Trial Shows Minimal Effect on Readmission Rates

The highly-anticipated superutilizer intervention program from the Camden Coalition of Healthcare did not significantly reduce readmission rates for randomly selected patients compared with those who received regular care, according to a study published in The New England Journal of Medicine.

The Coalition’s “hotspotting” program is aimed at curbing costs and improving care quality for patients who are considered “superutilizers” based on their high usage of health care services.

Study author, Amy Finklestein, PhD, Massachusetts Institute of Technology, and colleagues from National Bureau of Economic Research, sought to measure the impact of the Coalition’s care management program on hospital readmission rates.

The trial consisted of randomly assigning 800 hospitalized patients, with a variety of medically and socially complex conditions, with at least one prior hospital admission in the last six months, to either be placed in the coalition’s program or receive usual care as comparison.

After 180 days following patients’ discharge, the readmission rate for the intervention group was 62.3% compared to 61.7% in the control group.

“Our results suggest that there are challenges for superutilizer programs aimed at medically and socially complex populations,” wrote Dr Finklestein and colleagues. “They are consistent with the mixed results on hospital admissions from randomized evaluations of care-management programs for chronically ill populations, although those programs, unlike the Camden model, did not focus on the postdischarge transition.”

In terms of approaches to care management, the authors explained that programs designed at connecting patients with existing resources might not be sufficient for more complex cases. The Coalition has since started “exploring models that involve more complete redesigns of care provision.”

In a corresponding blog published in Health Affairs, Kathleen Noonan, JD, CEO of the Camden Coalition of Healthcare Providers, wrote, “To be sure, we were disappointed. We’re also now motivated by two important lessons from the [randomized controlled trial] that have powerful implications for the field of complex care.”

She continued, “First, we learned that all of us focused on health need to widen the aperture on our metrics for success…The second lesson: Health services interventions in complex care are only as effective as the resources available in the communities in which those interventions are applied.”

Although the results of the trial proved disappointing, the authors remain hopeful that it will open doors for further research in the area and more improvements to Coalition programs.

“The results suggest both the challenges of reducing readmissions in a medically and socially complex superutilizer population and the importance of conducting randomized evaluation of interventions such as this one, which, because they target high-cost patients, are likely to show substantial regression to the mean in observational studies,” concluded Dr Finklestein and colleagues.

—Edan Stanley

Reference:

1. Finkelstein A, Zhou A, Taubman S, Doyle J. Health care hotspotting—a randomized, controlled trial [published online January 9, 2020]. N Engl J Med. 2020;382:152-162; doi:10.1056/NEJMsa1906848. 
2. Noonan K. Disappointing randomized controlled trial results show a way forward on complex care in camden and beyond [blog published online January 9, 2020]. Health Aff. doi:10.1377/hblog20200102.864819.