School-Based Health and Health Care Utilization among Rural Youth: Evidence from a School-Based Health Center Opening.

OBJECTIVE

To examine the effects of opening a school-based health center (SBHC) on primary and preventive care utilization among students in a rural setting.

STUDY

DESIGN

This quasi-experimental study used patient-level electronic health records data from a health care network serving a rural region of New York. The sample included patients aged 5-18 years residing in 1 school district that opened an SBHC and those residing in similar districts without a center, spanning 2.5 years before and 2.5 years after the new center opened. The number of primary care visits and the occurrence of any well-child, immunization, and convenient care visits were studied. Difference-in-differences event study models were used to estimate postintervention changes in utilization trends, adjusting for age, sex, treatment district, and half-year fixed effects.

RESULTS

Multivariable estimates demonstrated an increase in primary care visits and increased odds of receiving an immunization among patients in the treatment group compared with those in the comparison groups, after the SBHC opened.

CONCLUSIONS

These data provide robust associations consistent with causal evidence that SBHCs increase utilization of primary care and expand access to a usual source of care in rural settings, highlighting the value of expanding school-based care in these communities.