School-Based Health Centers Found to Improve Access, Quality of Care for Low-Income Adolescents Judged by visit rates, emergency care use, and markers of quality care, researchers who looked at a Denver, Colorado, safety-net system found that school-based health centers (SBHCs) served uninsured or underinsured adolescents better than traditional outpatient care sites such as community clinics. Using Denver Public Schools enrollment data and electronic medical chart data and immunization registries from Denver Health, investigators examined the experiences over a one-year period of a cohort of 14- to 17-year-old high school students who were either uninsured or insured by Medicaid or the State Children’s Health Insurance Program (SCHIP). Noting that children of racial or ethnic minorities, low-income children, and children who are underinsured or uninsured may lack a usual source of health care, the report describes the development of school-based health centers as a potential solution to improving access to care. "Based on evidence that SBHCs improve access to health care and a belief that they may also result in improved quality of care and better long-term outcomes, the number of SBHCs has increased over the past decade from fewer than 200 centers to 1500 centers nationwide. Approximately one-third of these centers are located in high schools and the majority are in urban locations." Intended to provide primary care, SBHCs are usually staffed by health care professionals such as nurses, nurse practitioners, physician assistants, behavioral health specialists, and physicians who provide physical and mental health services with an emphasis on prevention. In Denver, a health safety-net system that serves one-fourth of the city's population is made up of 11 SBHCs, 9 community clinics, 2 urgent care centers, and a tertiary care hospital with an emergency department. At the time of the study--August 1, 2002, to July 31, 2003—SBHCs existed in 7 of the 11 Denver public high schools targeted as serving racial or ethnic minorities or low-income families. In its annual report, the Denver SBHC said 94 percent of students attending a school with a SBHC were enrolled and 35 percent to 60 percent of them actually used the center during the school year. Denver SBHC services include preventive and primary health care, including immunizations, mental health services, referrals to specialty services, and access to after-hours telephone advice and urgent care. The SBHCs provide pregnancy testing, diagnosis and treatment of sexually transmitted infections, and family planning and birth control counseling, but students are referred to community clinics for prenatal care and contraception management. The centers are open during hours of school operation and are closed on school holidays. Analyzing their findings from the one-year study, researchers found that in comparison with community clinic users, • SBHC users had higher visit rates, often for preventive services, possibly because there was no charge for the care, students did not require transportation since the centers were on school ground, and adolescents were able to visit the centers during school hours; • SBHC users were less likely to have used emergency care; • SBHC users were more likely to have received an influenza vaccine, a tetanus booster, and a hepatitis B vaccine. The researchers commented, however, that the existence of a school-based health center on a school campus does not in and of itself overcome adolescents' barriers to health care access. In the study, many students did not use the service, possibly because they had other health care available or because they were not convinced that they needed health care. And the researchers pointed out that there have been few studies of the quality of care provided by SBHCs nationally. "SBHCs that are not part of an integrated system of care may not have the resources, such as an immunization registry, to perform as well on quality-of-care measures." But because the Denver study was able to use a large data set with detailed information about visits and linkages to immunizations, it was able to make accurate comparisons between groups and subgroups and its conclusions were strengthened because the results were consistent across multiple outcome measures. On that basis, the researchers concluded, "SBHCs are an effective way for health care systems to improve access to health care and quality of care for underserved adolescents. In an era when health care funding is limited, these data may be used to advocate for increased resources for SBHCs." The research report, "School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents," is published in the October 2007 issue of the journal Pediatrics. E-mail correspondence may be addressed to Mandy Allison at mandyallison@hsc.utah.edu. |
