Health Care Hotspotting - A Randomized, Controlled Trial

Abstract

To the Editor: Regarding the study by Finkelstein et al. (Jan. 9 issue),¹ we worry that readers will interpret the results in the simplest terms, assuming that “hotspotting” doesn’t work and that further efforts to address the needs of medically and socially complex patients who are frequently hospitalized will not be worthwhile. Hotspotting is best understood as a complex intervention that is embedded in complex systems.² Randomized, controlled trials (RCTs) risk oversimplification of complex phenomena by standardizing interventions, controlling for context, and using narrowly defined quantitative outcomes. Hotspotting interventions are adaptive, interacting with context and evolving over time.³ Potential effects . . .