O2122: Rural School-Based Health Centers and Asthma Management

Background: School-Based Health Centers (SBHCs) are clinics situated within schools. By providing convenient access to health care, SBHCs have an important role to play in asthma management, particularly in rural communities. The purpose of this analysis was to compare health care utilization patterns among students with asthma who attended a school with an SBHC versus those with asthma who did not have access to an SBHC.

Methods: We analyzed outpatient encounters for all patients ages 4-19 living in four counties covered by a healthcare system in rural upstate NY. In 2017, the system operated 19 SBHCs in 15 of 38 school districts in these counties. Patient addresses were geocoded to school districts allowing us to determine whether a student attended a school in a district with or without a SBHC. Students were also classified as SBHC users if they had at least one encounter with an SBHC for any reason during a calendar year. ICD-9-CM/ICD-10-CM codes were used to identify students with asthma in 2015-2016. Rates of asthma-related office visits, well-child visits, and respiratory-related convenient care visits and emergency department (ED) visits were compared by SBHC status and age group in 2017.

Results: There were 16,604 students in the four-county region with at least one encounter with the healthcare system in 2017. Of the 52.8% of students living in districts with a SBHC, 68.5% were classified as SBHC users. Among students with access to an SBHC, 17.4% were identified as having asthma while 15.4% were identified among students without access to SBHCs. A greater proportion of students with asthma who had access to a SBHC versus those without access had one (20.2% vs 17.0%, p=0.03) or two or more asthma-related office visits (16.5% vs 8.7%, p< 0.0001) in the past year. They were also more likely to have had a well-child visit (70.0% vs 63.4%, p=0.0004). Students with asthma who did not have access to an SBHC were more likely to have had at least one respiratory-related convenient care or ED visit (9.8% vs 5.0%, p< 0.0001). SBHC users had the highest median number of office visits for any cause. A sub-analysis limited to the county where the healthcare system is the predominant provider of healthcare showed no difference in the proportion of students with asthma with SBHC access versus no SBHC access who had one asthma-related office visit in the past year (20.8% vs 20.0%, p=0.74). Otherwise, the patterns were consistent with that for the entire region.

Conclusion: SBHCs are associated with increased preventive care and decreased acute care among rural students with asthma.