Impact of School-Based Health Centers on Improving Health and Promoting Equity

校本健康中心对改善健康和促进公平的影响

• 批准号: 10656891
• 负责人: Ashley Kranz
• 金额: $ 69.6万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656891
• 关键词: Adolescent; Award; Black race; COVID-19; COVID-19 pandemic; California; Caring; Characteristics; Child; Child Care; Child Development; Child Health; Childhood; Communities; Comprehensive Health Care; Congresses; Counseling; Data; Data Set; Delaware; Diet; Dimensions; Disparate; Disparity population; Education; Enrollment; Equity; Ethnic Origin; Funding; Future; Growth; Health; Health Care Costs; Health Insurance; Health Services Accessibility; Health Surveys; Healthcare; Healthcare promotion; High School Student; Hispanic; Household; Immunization; Income; Insurance; Link; Location; Low income; Medicaid; Mental Health Services; Methods; Modeling; National Institute of Child Health and Human Development; Oregon; Outcome; Patients; Population; Population Heterogeneity; Positioning Attribute; Primary Care; Race; Recommendation; Reduce health disparities; Reporting; Reproductive Health Services; Research; Sample Size; Sampling; School-Age Population; Schools; Selection Bias; Services; Site; Strategic Planning; Students; Surveys; Time; Transportation; United States Health Resources and Services Administration; Vaccination; Variant; Well Child Visits; adolescent health; barrier to care; cost; design; disparity reduction; elementary school; experience; health care disparity; health care service utilization; health disparity; health disparity populations; health equity promotion; improved; insurance claims; member; operation; pandemic disease; protective effect; rural area; rurality; school based health center; screening; service delivery

Project Summary Disparities in health outcomes and access to care for children and adolescents are large and persistent, with worse outcomes observed among children and adolescents who are Black and Hispanic, enrolled in Medicaid, live in low-income households, and live in rural areas. School-based health centers (SBHCs) may help to promote health equity by making care more accessible and affordable to school-aged children, meaning SBHCs are well-positioned to reduce disparities in health care use and health outcomes. Prior research generally suggests benefits from SBHCs. However, most studies only examine a few SBHCs and report correlational associations rather than causal evidence. This proposed study of SBHCs in California and Oregon will overcome the limitations of prior studies by using a large sample and rigorous causal inference methods. Because both states have experienced recent growth in SBHCs, we will exploit variation in availability of SBHCs over time and across schools to compare the impact of SBHCs on students before and after the opening of SBHCs in treatment schools (with SBHCs) and control schools (without SBHCs). Using multiple years of health insurance claims data, survey data, and education data, we will: (1) characterize SBHCs, including the services they provide, the patients receiving care at SBHCs, and changes since the start of the COVD-19 pandemic; (2) estimate the impact of SBHC access on health care utilization, cost, health outcomes, and education outcomes overall and for members of health disparity populations (defined by race/ethnicity, household income, and rurality); and (3) examine the dimensions on which SBHC characteristics vary, including location, services offered, size, and the pandemic to inform the operation of current SBHCS and design of future SBHCs. The proposed research is timely and important due to longstanding and new barriers to health care and the increasing recognition of the importance of schools in promoting the healthy development of children and adolescents.

项目概要 儿童和青少年的健康结果和获得护理的机会存在巨大且持续的差异， 在参加医疗补助的黑人和西班牙裔儿童和青少年中观察到更糟糕的结果， 居住在低收入家庭，居住在农村地区。学校健康中心 (SBHC) 可能有助于 通过让学龄儿童更容易获得和负担得起护理来促进健康公平，这意味着 SBHC 处于有利地位，可以减少医疗保健使用和健康结果方面的差异。先前的研究 通常表明 SBHC 的好处。然而，大多数研究仅检查少数 SBHC 并报告 相关性关联而非因果证据。这项针对加利福尼亚州 SBHC 的拟议研究 俄勒冈州将通过使用大样本和严格的因果推断来克服先前研究的局限性 方法。由于这两个州最近都经历了 SBHC 的增长，因此我们将利用变化 SBHC 随时间推移和跨学校的可用性，以比较 SBHC 在之前和之后对学生的影响 在治疗学校（有 SBHC）和对照学校（没有 SBHC）开设 SBHC 后。使用 根据多年的健康保险理赔数据、调查数据和教育数据，我们将：（1）表征 SBHC，包括它们提供的服务、在 SBHC 接受护理的患者以及自成立以来的变化 COVD-19 大流行； (2) 估计 SBHC 获取对医疗保健利用、成本、健康的影响 总体成果和教育成果以及健康差异人群的教育成果（定义为 种族/民族、家庭收入和农村地区）； (3) 检查 SBHC 的尺寸 特征各不相同，包括位置、提供的服务、规模和流行病，以告知运营情况 当前的 SBHC 和未来 SBHC 的设计。所提出的研究是及时且重要的，因为 医疗保健方面长期存在的和新的障碍以及人们对学校重要性的日益认识 促进儿童、青少年健康成长。