Examining the Effectiveness of School-based Health Centers (SBHCs) to Improve Pediatric Asthma Care

About This Grant

PROJECT SUMMARY More than 20 million children in the US lack sufficient access to essential healthcare. School-based health centers (SBHCs) have been broadly implemented to address this unmet need, particularly for low-income and minoritized children, by providing primary healthcare at school. Despite proven feasibility with over 3000 SBHCs now in operation in the US, the effectiveness of SBHCs to improve health outcomes has yet to be established. It is critical to determine the effectiveness of SBHCs to inform future investment and policy focused on SBHC expansion or modification, as well as best practices. Our multidisciplinary team propose asthma as an ideal pediatric disease to examine SBHC effectiveness. Asthma is the most common chronic disease in childhood, affecting more than 6 million children in the US. It has detrimental consequences, particularly for low-income, Black and Latinx children who experience more missed schooldays, poor school performance, parental lost workdays, and urgent visits than their higher income and white counterparts from asthma. This disproportionate morbidity borne by marginalized children is largely due to poor access to guideline-based asthma care and adverse social determinants of health (SDOH). Many low-income, Black and Latinx children with asthma now receive care in SBHCs and have the potential to receive guideline-based asthma care at school. While prior cross-sectional and small cohort studies suggest that SBHCs improve pediatric asthma outcomes, there has yet to be a large-scale examination of the effectiveness of SBHCs to improve asthma care and outcomes for marginalized children. With traditional community health centers (CHCs) as a comparator condition, we propose to conduct an unprecedented, multi-state and longitudinal study examining the effectiveness of SBHCs to advance health equity in asthma care. We will examine electronic health record (EHR) data from 2015-2025 in the OCHIN, inc. data network, the largest data network of SBHCs and CHCs in the US serving >6 million low-income and vulnerable patients nationwide, including 395 SBHCs and 1280 CHCs in 16 states. Our data network includes longitudinal measures of asthma care and outcomes with novel linkages to geographically coded SDOH data on community-level economic, environmental, and structural factors. In Aim 1 we will determine whether SBHCs are more (or less) effective than CHCs at providing high quality asthma care and reducing asthma exacerbations among low-income children; and evaluate the potential synergy of these two settings for optimal asthma care. In Aim 2 we will examine whether SBHCs are more (or less) effective than CHCs at improving asthma outcomes given specific adverse SDOH. In Aim 3 we will conduct qualitative work with multi-level SBHC partners, including children/caregivers, SBHC staff and policymakers to explain quantitative findings in Aims 1 and 2. Leveraging this unique network of SBHCs, this study provides a landmark opportunity to examine the effectiveness of SBHCs to improve pediatric asthma care for marginalized children and will inform national SBHC policy.