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.

项目摘要 儿童和青少年在健康结果和获得护理方面的差距很大且持续存在， 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， 住在低收入家庭，住在农村。以学校为基础的健康中心(SBHC)可能有助于 通过使学龄儿童更容易获得和负担得起医疗保健来促进卫生公平，这意味着 私营医疗中心处于有利地位，可以减少卫生保健使用和健康结果方面的差距。前期研究 通常建议从SBHC中获益。然而，大多数研究只检查了几个SBHC并报告了 相关关联而不是因果证据。这项拟议中的加州SBHC研究和 俄勒冈州将通过使用大样本和严格的因果推理来克服先前研究的局限性 方法：研究方法。由于这两个州最近都经历了SBHC的增长，我们将利用 随时间推移和跨学校提供校舍，以比较校舍对学生的影响 在治疗学校(有护理学校)和对照学校(没有护理学校)开设儿童健康中心之后。vbl.使用 多年的医疗保险索赔数据、调查数据和教育数据，我们将：(1)描述 SBHC，包括他们提供的服务，在SBHC接受护理的患者，以及自开始以来的变化 评估获得SBHC对卫生保健利用、成本、健康的影响 结果，以及总体和健康差距人口成员的教育结果(定义如下 种族/民族、家庭收入和乡村)；和(3)检查SBHC在哪些方面 特征各不相同，包括地点、提供的服务、规模和大流行，以告知操作 当前的SBHC和未来SBHC的设计。拟议的研究是及时和重要的，因为 长期存在的和新的卫生保健障碍以及人们日益认识到学校在 促进儿童青少年健康发展。