Impact of Rural School-Based Health Centers on Asthma Management

Abstract

To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access. Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a healthcare system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n=15) or without (n=23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using ICD diagnosis codes from visits in the two calendar years prior to each analysis year. Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (OR=2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR=1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR=0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC. Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.