About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome.
Objective
To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs.
Setting
Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs).
Participants
Nine hundred forty-nine inner-city schoolchildren with asthma.
Design
To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information.
Results
Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high—during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively;P= .02).
Conclusion
Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.
ABSTRACT: School‐based health centers (SBHCs) are increasingly charged with providing primary care services including asthma care. This study assessed SBHC provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) asthma care guidelines and the association among provider adherence, patient characteristics, and asthma outcomes. A cross‐sectional study design was used to assess SBHC chart data from 415 children with asthma attending four inner‐city elementary schools (K‐5) in the Bronx, NY. Asthma symptoms, peak flow use, follow‐up visits, and referrals to asthma specialists were documented in the charts of 60%, 51%, 22%, and 3% of subjects, respectively. Thirty‐three percent of charts had SBHC clinician‐documented severity classifications, of which 70% had appropriate medications prescribed. Asthma education and an asthma plan were documented in 18% and 10% of charts, respectively. Environmental triggers and tobacco exposures were documented in 71% and 49% of charts, respectively. Older children (> 8 years) were more likely to have documentation of peak flow use for asthma management, asthma education, follow‐up visits, and written asthma plans, whereas younger children (< 8 years) were more likely to miss more days of school (all p < .05). Overall, provider adherence to NHLBI guidelines was inadequate, with adherence somewhat better for older children.
This study examines healthcare utilization over time in Bronx, New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools. Four of the schools have on-site school-based health centers (SBHCs), and two do not have on-site health services (control schools). At baseline, we reported an asthma prevalence of 20%, and high rates of emergency department (ED) use (46%) in the previous year. To determine if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with SBHCs, we prospectively followed children for up to 3 years. Parents were scheduled for interviews every 6 months, and were queried about their children's use of health services for asthma in the prior 6 months. In multivariate models, children in the two intervention SBHC schools were less likely to have visited a community provider for asthma (relative rate ratio, 0.52; 95% confidence interval (CI), 0.30-0.88) or an emergency department for asthma (odds ratio, 0.44; 95% CI, 0.14-1.38; P = 0.059) in the prior 6 months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. However, school type did not affect asthma hospitalization rates, which declined in all groups. Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services.
