Dear Editor,
We agree with Lee et al.1 and Kanzaria and Hoffman2 that individual high-utilizer patients, aka “hot spots,” are not the problem. While we agree that high utilization may represent a failure of the current healthcare system, we also believe high utilization goes beyond a failure of U.S. healthcare and represents a disintegration of our community social determinants of health. Hot-spotting identifies individual patients with high utilization of emergency and hospital care and aims to provide individual services to improve individual health. It is effective at reducing the number of hospitalizations by replacing acute illness care with comprehensive chronic disease management, community health workers, and improved home care and self-management.3 “Cold spots” are communities where the social determinants of health, community organizations, public and community health, and access to integrated primary care and behavioral health have broken down. Cold-spotting derives from the 1967 Folsom Report4 that promotes building communities of solution by identifying and addressing the local problem sheds, that is, the community or region suffering a particular health problem.5 A community of solution addresses that problem shed by identifying the local community assets, bringing them together to improve the social determinants of health. As Lee et al. found, the healthcare problems and exorbitant costs are not just due to individual patients who show up frequently in the ER. As Kanzaria and Hoffman point out, our healthcare problems are systemic and, we might add, often community-based. The problem sheds are not in individual homes or with individual patients, “hot spots”. The problem sheds are larger, wider community cold spots. Cold-spotting can help identify the communities in need of building local assets, linking primary care, behavioral health, public health, and community organizations to create local communities of solution.6 When we address these cold spots, community health improves, and individual patients can live healthier lives.
Compliance with Ethical Standards
Conflict of Interest
The authors report no conflicts of interest.
References
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