• Winston Liaw, Alex H Krist, Sebastian T Tong, Roy Sabo, Camille Hochheimer, Jennifer Rankin, David Grolling, Jene Grandmont, and Andrew W Bazemore.
• From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL). winston.liaw@uth.tmc.edu.
• J Am Board Fam Med. 2018 May 1; 31 (3): 342350342-350.

PurposeLittle is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation).MethodsAcross 12 practices, we assessed the relationship between cold spots and clinical outcomes (obesity, uncontrolled diabetes, pneumonia vaccination, cancer screening-colon, cervical, and prostate-and aspirin chemoprophylaxis) for 152,962 patients. We geocoded and linked addresses to census tracts and assessed, at the census tract level, the percentage earning less than 200% of the Federal Poverty Level, without high school diplomas, and the social deprivation index (SDI). We labeled those census tracts in the worst quartiles as cold spots and conducted bivariate and logistic regression.ResultsThere was a 10-fold difference in the proportion of patients in cold spots between the highest (29.1%) and lowest practices (2.6%). Except for aspirin, all outcomes were influenced by cold spots. Fifteen percent of low-education cold-spot patients had uncontrolled diabetes compared with 13% of noncold-spot patients (P < .05). In regression, those in poverty, low education, and SDI cold spots were less likely to receive colon cancer screening (odds ratio [CI], 0.88 [0.83-0.93], 0.87 [0.82-0.92], and 0.89 [0.83-0.95], respectively) although cold-spot patients were more likely to receive cervical cancer screening.ConclusionLiving in cold spots is associated with worse chronic conditions and quality for some screening tests. Practices can use neighborhood data to allocate resources and identify those at risk for poor outcomes.© Copyright 2018 by the American Board of Family Medicine.

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