Wade Terrance J, Mansour Mona E, Line Kristin, Huentelman Tracy, Keller Kathryn N
Department of Community Health Sciences and Child and Youth Studies, Brock University, St Catharines, Ontario, Canada.
Ambul Pediatr. 2008 Jul-Aug;8(4):241-9. doi: 10.1016/j.ambp.2008.02.004. Epub 2008 Apr 8.
To examine the role of school-based health centers (SBHCs) on changes in student health-related quality of life (HRQOL) over a 3-year period among elementary and middle school students.
Three-year longitudinal prospective study.
Four elementary schools with newly implemented SBHCs and 4 elementary comparison schools matched for rural/urban and state, percentage of nonwhite students, and percentage of free or reduced-price lunch-eligible students.
Randomly selected student-parent dyads (n = 579) who responded in all 3 years from 4 intervention schools and 4 comparison schools randomly selected from school enrollment lists. Students in intervention schools were further divided into SBHC users and nonusers.
SBHC.
The outcome, HRQOL, was measured annually by student self-reported and parent proxy-reported scores using the PedsQL 4.0. School covariates included region and state; individual covariates included child age, gender, race, health insurance, chronic health conditions, family income, and parental marital status.
Adjusting for school- and individual-level covariates, there was a significant improvement in student-reported HRQOL over the 3 years for the SBHC user group compared with the comparison school group. Other significant predictors of student-reported HRQOL included student age, gender, health insurance, and household income. There were no differences across groups by using parent proxy reports of HRQOL.
The SBHC model of health care delivery improves student-reported HRQOL among younger, elementary, and middle school children. Moreover, it appears to have more influence on those children that generally have impeded access to care and who can most benefit from it, specifically those without private health insurance and with lower income levels.
探讨校本健康中心（SBHCs）在3年期间对中小学生健康相关生活质量（HRQOL）变化的作用。
为期3年的纵向前瞻性研究。
4所新设立了SBHCs的小学以及4所与之匹配的小学作为对照，匹配因素包括城乡和所在州、非白人学生比例以及符合免费或低价午餐条件的学生比例。
从4所干预学校和4所对照学校的入学名单中随机抽取的学生-家长二元组（n = 579），这些二元组在3年中均有回应。干预学校的学生进一步分为SBHC使用者和非使用者。
SBHC。
使用儿童生活质量量表4.0（PedsQL 4.0），通过学生自我报告和家长代理报告的分数每年测量一次HRQOL这一结果。学校层面的协变量包括地区和州；个体层面的协变量包括儿童年龄、性别、种族、健康保险、慢性健康状况、家庭收入和父母婚姻状况。
在调整了学校和个体层面的协变量后，与对照学校组相比，SBHC使用者组的学生报告的HRQOL在3年中显著改善。学生报告的HRQOL的其他显著预测因素包括学生年龄、性别、健康保险和家庭收入。使用家长代理报告的HRQOL时，各组之间没有差异。
SBHC医疗服务模式改善了小学和初中低年级学生报告的HRQOL。此外，它似乎对那些通常难以获得医疗服务且最能从中受益的儿童影响更大，特别是那些没有私人健康保险且收入水平较低的儿童。
