Negative RCT of health care hotspotting in NEJM: What outcomes are important?

At the Upstream Lab, we’ve started up a regular journal club as part of our weekly meetings. We’ll be sharing a brief summary here on our blog. This week we looked at this study: Health care hotspotting – a randomized controlled trial (NEJM 2020; 382: 152-162). This was also the focus of discussion last week at MAP, the centre where we are based.

You may remember Atul Gawande‘s 2011 article on “The hot spotters”, profiling the work of the Camden Coalition of Healthcare Providers in Camden, New Jersey. This article got a lot of people interested in the idea that the solution to rising health costs was to focus on the people who were disproportionately using a huge amount of health services. Here in Ontario, we also started to focus on so-called “high-cost users”, leading to a new program called Health Links. I was involved in a study led by my colleague Dr. Laura Rosella that essentially found that social determinants played a big role in who would end up being a high-cost user. Maybe not surprising to visitors of this blog, but we thought it was really important to point this out. Most of the solutions being proposed were focused on just getting these folks more traditional health services.