More than a Safety-Net: Establishing an urban school-based health center (SBHC) network as a principal provider of care in the context of a major medical system

Little is known about utilization patterns of school-based health care, particularly in networks embedded in major urban health care systems. [1] 

We analyzed system-wide medical record data, using an innovative data-mining tool, Clinical Looking Glass®, on the 14,553 children aged 4-22 who accessed one of the 22 school-based health centers (SBHCs) in the Montefiore School Health Program (MSHP) during the 2012 school year.

Total ambulatory visits for the cohort was 63,351, of these, 90.9%, took place at an MSHP site. Additionally, 84.8% of users accessed 100% of their outpatient care in the Montefiore system at an MSHP site. To analyze the role of MSHP relative to other Montefiore outpatient services, we identified patients with a Montefiore PCP in EHR and accessed both MSHP and at least one other Montefiore outpatient site in the same period, n=2,083.  These patients generated 14,505 outpatient visits, 62.8% of which occurred at an MSHP site. These patients accessed 86% of diabetes visits, 79% of reproductive health visits, and 58% of asthma visits at their SBHC. Medicaid managed care capitation data will be used to identify health care utilization by this cohort outside the Montefiore system.

This data demonstrates the capacity of an SBHC to serve as the principal provider of care and further supports the role of SBHCs as a critical bridge to accessible, quality, primary care.

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[1] Allison MA, Crane LA, Beaty BL, Davidson AJ, Melinkovich P, Kempe A. School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents. Pediatrics. 2007;120(4):e887-e894.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Discuss the role of school based health centers as a bridge to accessible primary health care Demonstrate the role of school based health as a principal provider of primary care within a large, urban health care system Evaluate the future position of school based health care as a primary care provider and as a medical home for their patients rather than as a 'safety-net' provider of services

Keyword(s): School-Based Health, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have more than 10 years of work experience in child health and reproductive health in both the United States and Latin American. I have more than 5 years experience working on clinical program evaluation and practice-based research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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