Effect of School-Based Health Centers on Reducing Students Health Disparities

校本健康中心对减少学生健康差异的影响

基本信息

批准号：
9343288
负责人：
CAROL J. HOGUE
金额：
$ 3.43万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-03 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9343288
关键词：
Absenteeism Accident and Emergency department Address Admission activity Affordable Care Act African American Age Asthma Behavioral Benchmarking Caring Case Study Child Child health care Cities Code Communities Cost Analysis Cost Savings Costs and Benefits County Data Diagnosis Effectiveness Emergency department visit Enrollment Environment Ethnic Origin Evaluation Family Federally Qualified Health Center Funding Funding Mechanisms General Population Goals Health Health Care Costs Health Insurance Health Services Accessibility Health Status Healthcare Hispanics Hospital Costs Hospitalization Hospitals Household Housing Improve Access Life Link Longitudinal Studies Low income Measures Medicaid Minority Modeling Monitor Natural experiment Not Hispanic or Latino Obesity Outcome Parents Persons Policies Population Poverty Prevalence Primary Health Care Process Race Records Research Role Rural Schools Sentinel Services Site Students Surveys Testing Time Translations Underserved Population base cost disparity reduction elementary school evidence base health care service health disparity hospital utilization improved meetings minority student novel strategies programs public health relevance satisfaction scale up socioeconomic disadvantage statistics suburb success trend

项目摘要

DESCRIPTION (provided by applicant): One in 5 persons in poverty is a child <18 years, and this number is growing, especially in the South. Further, 40% of African American and 34% of Hispanic children <18 years live in low-income households, and 55% of poor rural African-American children have less access to health services. Since a majority of public school students are from low-income families in both the South and West, public schools present an opportunity to reach underserved populations on-site with quality healthcare services. For > 2 decades model School-based Health Centers (SBHCs) have been tested to meet health needs of disparity population, but less than 1% of public elementary schools house SBHCs. Four issues must be addressed in taking SBHCs to scale: sustainability, evidence of community need and support, evidence of health and health cost impact, and fidelity to exemplar models. The ongoing Georgia SBHC Project provides operational solutions to the first two issues. The goal of the proposed study, EPOCH (Evaluating Processes and Outcomes for Children), will take advantage of an opportunity to conduct a "natural experiment" that will assess the ability of this approach to solve the other two issues. We will examine the effects of expanding SBHCs across three public elementary school sites in Georgia that differ by environment (rural, small city, and suburban) and race / ethnicity (one each being predominantly African American, Hispanic, and non-Hispanic white children). A specific focus will be the effects of SBHCs on improved access to primary care and, in turn, on the level of health outcomes including obesity, uncontrolled asthma, and Emergency Department and hospital utilization and costs to the Medicaid program. We will conduct a year-by-year comparison of health indicators and health care costs for children with and without access to SBHCs. In a novel approach to evaluating SBHCs, we will conduct a full-scale process and outcome evaluation, following the Implementation Fidelity model proposed by Carroll, et al., and modified by Hasson. This will include active monitoring to measure program adaptations, secondary analysis of SBHCs' benchmarking, schools' routine FitnessGrams and absenteeism statistics, and by linking children enrolled in an SBHC to their Medicaid claims records. This quasi-experimental, longitudinal study will include 7 years' data (3 pre-, 1 during, and 3 post-SBHC implementation) for the 3 SBHC schools and 3 similar, non-SBHC schools. Additionally, Medicaid data will be extracted for children living in the 6 schools' zip codes to conduct utilization and cost analyses on improving specific health outcomes (e.g., asthma and obesity) and reducing health disparities in rural and minority populations. The EPOCH study offers an opportunity to create a new evidence base for the role of SBHCs in states without the Medicaid expansion. Comprehensive SBHCs may have greater importance there because of the lack of alternatives for children to access free or subsidized health care. These findings will also inform the nation as it considers reauthorization of the Children's Health Insurance Program (CHIP) in 2015.

描述（由申请人提供）：贫困中的五分之一的儿童<18岁，这一数字正在增长，尤其是在南方。此外，在低收入家庭中，有40％的非裔美国人和34％的西班牙裔儿童居住在18岁以下，而55％的非裔美国人儿童获得了卫生服务的机会。由于大多数公立学生来自南部和西部的低收入家庭，因此公立学校提供了一个机会，可以在现场与优质的医疗服务接触服务不足的人群。在过去的20年中，基于学校的模型医疗中心（SBHC）已经进行了测试，以满足差异人口的健康需求，但不到1％的公立小学SBHC。在将SBHC进行扩展时，必须解决四个问题：可持续性，社区需求和支持的证据，健康和健康成本影响的证据以及对示例模型的忠诚。正在进行的佐治亚州SBHC项目为前两个问题提供了运营解决方案。拟议的研究时代（评估儿童的过程和结果）的目标将利用机会进行“自然实验”，以评估这种方法解决其他两个问题的能力。我们将研究在佐治亚州的三个公立小学网站上扩大SBHC的影响，而佐治亚州的三个公立小学网站（农村，小城市和郊区）和种族 /族裔（每个人都主要是非裔美国人，西班牙裔和非西班牙裔白人儿童）。具体的重点将是SBHC对改善获得初级保健的影响，进而对肥胖症，不受控制的哮喘以及急诊科和医院利用以及医疗补助计划的成本等健康结果水平的影响。我们将对有或没有获得SBHC的儿童的健康指标和医疗保健费用进行逐年比较。在评估SBHCS的新方法中，我们将按照Carroll等人提出的实施保真度模型并由Hasson修改，进行全面的过程和结果评估。这将包括积极的监控，以衡量计划的适应，对SBHCS的“基准测试”，“常规健身”和“缺勤统计”的次要分析，以及通过将入学SBHC的儿童与其医疗补助索赔记录联系起来。这项准实验性的纵向研究将包括3个SBHC学校的7年数据（3个前，1例SBHC实施）和3所类似的非SBHC学校。此外，将为生活在6所学校的邮政编码中的儿童中提取医疗补助数据，以进行利用和成本分析，以改善特定的健康结果（例如哮喘和肥胖症），并降低农村和少数民族人口的健康差异。 Epoch研究提供了一个机会，可以为没有医疗补助扩张的州在州中SBHC的作用创建新的证据基础。由于缺乏儿童免费或补贴医疗保健的替代方案，因此全面的SBHC可能具有更大的重视。这些发现也将为国家提供信息，因为它考虑了儿童健康的重新授权保险计划（芯片）2015年。