School Based Health Centers - An approach to address health disparities among rural youth.

项目摘要 低收入农村青年面临着健康方面的负面社会决定因素和获得保健服务方面的挑战。 以学校为基础的保健中心是一种创新的应对措施，以增加获得服务的机会，但其在农村地区的影响 社区没有很好的记录。本计画提出一个多层次混合方法的SBHC评估 该网络在纽约州的4个低收入农村县运营。由巴塞特医疗保健网络运营， 这些SBHC是永久性的，现场的，全年的，并照顾到全方位的医疗保健需求（身体， 牙科、精神、慢性和急性），患者无需自付费用。该设置允许准实验性 设计评估SBHC的影响，比较16个学区与SBHC和22个学区没有。的 该项目涉及康奈尔大学和巴塞特研究人员和社区合作伙伴的多学科团队。 该项目将使用定性数据（来自半结构化访谈和焦点小组）和定量数据。 数据（管理数据、调查和患者医疗访视数据）和多层次分析方法， 三个目标：目标1。评估SBHC对医疗保健利用的影响。我们将组装一个面板数据集 12年（2011-2022年）内访问巴塞特医疗机构的所有患者，以衡量医疗利用率 （频率、地点、服务）进行预防性护理（例如，保健、疫苗接种）和急性和慢性 条件（例如，哮喘，精神健康）在有和没有SBHC的学区的儿童中。目标二。 评估SBHC对跨机构协作的影响。我们会评估社会服务的提供情况， 通过文献研究、焦点小组、学校和社区访谈等方法，对4个县研究区进行了研究 领导人，以及对机构领导人的调查。我们将确定和衡量区分交叉水平的因素- 医疗保健提供者、社区机构和地方政府为每所学校开展机构合作 区的目标3。评估SBHC和跨机构合作对学校绩效的影响， 社区医疗利用率。结合来自多个层面（患者、学区和县）的数据 将使我们能够评估SBHC在解决健康的社会决定因素方面发挥的不同作用。社区 结果测量包括入学率和更广泛的社区卫生保健利用率。研究结果将 加强理解SBHC如何影响健康结果，并为个人和社区做出贡献 为农村卫生政策提供信息。

Project summary abstract Low-income rural youth face negative social determinants of health and challenges in accessing health care. School-Based Health Centers (SBHCs) are an innovative response to increase access, but their impact in rural communities is not well documented. This project proposes a multilevel mixed-methods evaluation of an SBHC network operating in 4 low-income rural counties in New York state. Run by the Bassett Healthcare Network, these SBHCs are permanent, on-site, year-round and attend to the full range of healthcare needs (physical, dental, mental, chronic and acute) at no out-of-pocket cost to patients. The setting permits a quasi-experimental design to assess SBHC impact by comparing 16 school districts with SBHCs and 22 school districts without. The project involves a multi-disciplinary team of Cornell University and Bassett researchers and community partners. The project will use both qualitative data (from semi-structured interviews and focus groups) and quantitative data (administrative data, survey, and patient healthcare visit data) and multilevel analytical methods to address three aims: Aim 1. Assess the impact of SBHCs on healthcare utilization. We will assemble a panel dataset of all patient visits to Bassett healthcare facilities over 12 years (2011-2022) to measure healthcare utilization (frequency, location, services) for preventive care (e.g., well-care, vaccinations) and care for acute and chronic conditions (e.g., asthma, mental health) among children in school districts with and without SBHCs. Aim 2. Assess the impact of SBHCs on cross-agency collaboration. We will assess provision of social services in the 4-county study area through document research, focus groups, interviews with school and community leaders, and a survey of agency leaders. We will identify and measure factors that differentiate the level of cross- agency collaboration among healthcare providers, community agencies, and local governments for each school district. Aim 3. Assess the impact of SBHCs and cross-agency collaboration on school performance and on community healthcare utilization. Combining data from multiple levels (patient, school district, and county) will enable us to assess the different roles SBHCs play in addressing social determinants of health. Community outcome measures include school attendance and broader community healthcare utilization. Study results will enhance understanding of how SBHCs may shape health outcomes and contribute to individual and community wellbeing to inform rural health policy.