Impact of Rural School-Based Health Centers on Asthma Management

To assess whether rural students with asthma who have access to school-based health centers (SBHCs) receive more preventive care and use less emergency care compared with students without access to SBHCs.The study included 4- to 19-year-old students with asthma from 4 rural counties covered by a health care system that sponsors a network of SBHCs in upstate New York. Fifteen of the school districts had SBHCs (“exposed” group), compared with 23 that did not (“comparison” group). The students within school districts with and without SBHCs were similar, in that they were predominantly white and had high rates of economic disadvantage. A diagnosis of asthma was defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 493 and ICD-10-CM code J45. Of the 16 649 students analyzed in 2016 and the 16 405 in 2017, 51.9% and 52.8%, respectively, resided in districts with school-based health centers. Among the students living in SBHC districts, 66.2% in 2016 and 68.5% in 2017 were identified as SBHC users; 15% to 17% of students were identified as having asthma.The study was cross-sectional in design. Data were collected using the health care system’s electronic health record. The study period of 2016–2017 included data obtained 2 years prior to each analysis year. Students were categorized as to whether they lived in an SBHC district and then further delineated as an SBHC user if the student had 1 or more visits to the SBHC during the year. The measured outcomes included numbers of asthma-related office visits, well-child visits, and respiratory-related emergency department (ED) or convenient care (CC) visits.Students in SBHC districts (odds ratio [OR] = 2.23; 95% CI: 1.66–2.99) and those who were SBHC users (OR = 2.91; 95% CI: 2.21–3.83) had greater odds of 2 or more asthma-related office visits than patients with asthma in non-SBHC districts. Those in SBHC districts also had greater odds of having a well-visit (OR = 1.24; 95% CI: 1.03–1.50) than those in non-SBHC districts. Students in SBHCs districts (OR = 0.45; 95% CI: 0.30–0.67) and SBHC users (OR = 0.41; 95% CI: 0.28–0.60) had lower odds of a respiratory-related CC or ED visit.Rural students who use SBHCs had more frequent opportunities for preventive care and used EDs and CC less than those without access to SBHCs.As per the National Heart, Lung, and Blood Institute, the standard of asthma care includes addressing asthma at a minimum of every 6 months. This study reinforces the role of SBHCs in delivering guideline-concordant preventive care in a convenient, school-based setting. Given these benefits, pediatricians and community stakeholders should actively advocate for the expansion of school-based health centers as a key strategy to improve asthma management and reduce acute care utilization among children.