{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:57Z","timestamp":1792790397996,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,21]]},"group-title":"Primary Care Research","reference-count":48,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Netherlands Organization for Health Research and Development","award":["80-85200-98-210"],"award-info":[{"award-number":["80-85200-98-210"]}],"id":[{"id":"https:\/\/ror.org\/01yaj9a77","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Stichting Fonds Huisartsen in Achterstandswijken Haaglanden","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]},{"name":"Stichting Achtertandswijken Nijmegen","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]},{"name":"Menzis Zorgverzekeraar n.v.","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]},{"name":"CZ Zorgverzekeraar n.v.","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>This study focused on adults with complex care needs due to problems on multiple life domains and consequent high acute care use. The Hotspotters Project was undertaken to assess the effects of proactive integrated care on health outcomes and healthcare costs in this group. We evaluated the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the Hotspotters Project in order to identify factors that influenced implementation and outcomes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>This mixed method study followed the RE-AIM-framework, using validated questionnaires, routine care data and semi-structured interviews. Qualitative data from patients and care providers offered insight in the quantitative outcomes. Quantitative data were analyzed descriptively (SPSS), and interview transcripts were analyzed using inductive thematic content analysis (Atlas.ti).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>As acute care use was lower than expected, few patients were eligible (153\/1403) and subsequent low enrollment (n=30) limited conclusions regarding effectiveness. Nevertheless, the intervention improved collaboration with social work, and the structured intake was valued for the overview of patients\u2019 complex needs. Many practices adopted the intervention into regular care, despite the complex inclusion process. Care providers proposed revising the target population and recruitment to better reflect the Dutch context.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Although cost-effectiveness could not be assessed, this study nonetheless provides insights that can help future interventions and trials to better match patients\u2019 needs, adapt to local context and reduce patients\u2019 study burden. Adapting the definition of \u2018patients with complex needs\u2019 to a local context can strengthen the rationale for implementation and enhance patient motivation.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.15.26362413","type":"posted-content","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:35:19Z","timestamp":1790015719000},"source":"Crossref","is-referenced-by-count":0,"title":["Lessons learned from a trial on integrated and proactive care for patients with complex needs (Hotspotters project): a process evaluation"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-203X","authenticated-orcid":false,"given":"Vera","family":"Tiemes","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marije","family":"Verdonk","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0690-4620","authenticated-orcid":false,"given":"Mark","family":"van der Wel","sequence":"additional","affiliation":[{"name":"Radboud Institute of Health Sciences, Department of Primary and Community Care, Radboud University Nijmegen, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2218-4723","authenticated-orcid":false,"given":"Marieke","family":"Adriaanse","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"},{"name":"Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-4301","authenticated-orcid":false,"given":"Laurens","family":"van Gestel","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"},{"name":"Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ephraim","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1717-2338","authenticated-orcid":false,"given":"Sytske","family":"van Bruggen","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7317-6494","authenticated-orcid":false,"given":"Marc","family":"Bruijnzeels","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0368-5426","authenticated-orcid":false,"given":"Mattijs","family":"Numans","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4277-9377","authenticated-orcid":false,"given":"Hanneke","family":"Borgdorff","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1074-6255","authenticated-orcid":false,"given":"Rimke","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care\/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092406150854000_2026.09.15.26362413v1.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017775"},{"key":"2026092406150854000_2026.09.15.26362413v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-5890.2016.12114"},{"key":"2026092406150854000_2026.09.15.26362413v1.3","unstructured":"Gawande A . 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