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

项目摘要 儿童和青少年在健康结果和获得保健方面的差距很大，而且持续存在， 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的结果更差， 生活在低收入家庭和农村地区。学校健康中心（SBHC）可能有助于 通过使学龄儿童更容易获得和负担得起保健，促进保健公平， SBHC处于有利地位，以减少医疗保健使用和健康结果的差距。先前的研究 通常表明SBHC的好处。然而，大多数研究只检查了少数SBHC， 相关关联而非因果证据。这项对加州SBHC的研究， 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.由于这两个州最近都经历了SBHC的增长，我们将利用 不同时间和不同学校的SBHC的可用性，以比较SBHC对学生的影响， 在治疗学校（有SBHC）和对照学校（没有SBHC）开设SBHC之后。使用 多年的健康保险索赔数据，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，以及自开始以来的变化 COVD-19大流行的影响;（2）估计SBHC访问对卫生保健利用，成本，健康 结果，以及总体和健康差异人口成员的教育结果（定义为 种族/民族，家庭收入和农村）;（3）检查SBHC的维度 特征各不相同，包括位置、提供的服务、规模和流行病，以告知 当前SBHCS和未来SBHC的设计。这项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 促进儿童和青少年的健康发展。

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.