As you can see, there are players that prefer vertical skillbar over horizontal one. The main problem is, when you manually resize hotkey bar that way, let say, like on Tryble's screenshot, you pretty soon find out that hotkey assignment still going from left top to the end of the string and then contionues on the second, and so on. For example, for standart hotkey assignments:
horizontal hotkeys:
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this:
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The QoL suggestion: it's mainly for atouse items. To be honest, i'm trying to do it myself 3 or 4 times (after find, that custom autouse addon is buggy). The main problem is autouse doesn't available for arcane eye's hat, wands of clairvoyance, gloves/chest armor of tracking, because these skills are disabled for npc use, and therefore doesn't appear on skill menu (m press in game). So the 2 ways you can use it: through click in inventory, and through hotbar. But current state is, the right click on item on hotbar doesn't support autouse. So with 5/5 charm mastery, wand of clairvoyance cooldown is 5 turns (gloves of thacking in this case have 9 turns), and its pretty tedious to manually use it every 5 turns (while exploring maze, for example), to know what's going on and have that sweet tracking buff on

Meanwhile, there are no problems for autouse steady shot from gloves(it's still a bit tricky that you need to do it through m menu).
Another good option implemented in custom autouse, and extended autouse addon is menu to set priority of use talents, setted to be autouse. I'm would glad to see this menu in core game. Let say you have a shield rune and a movement infusion. and they both setted to autouse when enemy is visible, but if you use movement infusion first, when you activate shield rune, bonus movement speed will expired, so you want use shield rune first, and movement infusion last.