Adams Esther K, Strahan Andrea E, Joski Peter J, Hawley Jonathan N, Johnson Veda C, Hogue Carol J
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Am J Prev Med. 2020 Oct;59(4):504-512. doi: 10.1016/j.amepre.2020.04.026. Epub 2020 Aug 27.
This study measures effects on the receipt of preventive care among children enrolled in Georgia's Medicaid or Children's Health Insurance Program associated with the implementation of new elementary school-based health centers. The study sites differed by geographic environment and predominant race/ethnicity (rural white, non-Hispanic; black, small city; and suburban Hispanic).
A quasi-experimental treatment/control cohort study used Medicaid/Children's Health Insurance Program claims/enrollment data for children in school years before implementation (2011-2012 and 2012-2013) versus after implementation (2013-2014 to 2016-2017) of school-based health centers to estimate effects on preventive care among children with (treatment) and without (control) access to a school-based health center. Data analysis was performed in 2017-2019. There were 1,531 unique children in the treatment group with an average of 4.18 school years observed and 1,737 in the control group with 4.32 school years observed. A total of 1,243 Medicaid/Children's Health Insurance Program-insured children in the treatment group used their school-based health centers.
Significant increases in well-child visits (5.9 percentage points, p<0.01) and influenza vaccination (6.9 percentage points, p<0.01) were found for children with versus without a new school-based health center. This represents a 15% increase from the pre-implementation percentage (38.8%) with a well-child visit and a 25% increase in influenza vaccinations. Increases were found only in the 2 school-based health centers with predominantly minority students. The 18.7 percentage point (p<0.01) increase in diet/counseling among obese/overweight Hispanic children represented a doubling from a 15.3% baseline.
Implementation of elementary school-based health centers increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia, with potential reductions in racial and ethnic disparities.
本研究衡量了佐治亚州医疗补助计划或儿童健康保险计划覆盖的儿童中，新设立的小学健康中心的实施对预防保健服务接受情况的影响。研究地点因地理环境和主要种族/族裔而有所不同（农村白人、非西班牙裔；黑人聚居的小城市；以及郊区西班牙裔）。
一项准实验性治疗/对照队列研究，使用了医疗补助计划/儿童健康保险计划在小学健康中心实施前（2011 - 2012学年和2012 - 2013学年）与实施后（2013 - 2014学年至2016 - 2017学年）的儿童索赔/登记数据，以估计有（治疗组）和没有（对照组）机会使用小学健康中心的儿童在预防保健方面的影响。数据分析于2017 - 2019年进行。治疗组有1531名独特儿童，平均观察了4.18个学年；对照组有1737名儿童，平均观察了4.32个学年。治疗组共有1243名参加医疗补助计划/儿童健康保险计划的儿童使用了他们学校的健康中心。
与没有新小学健康中心的儿童相比，有新小学健康中心的儿童的健康儿童就诊率（增加5.9个百分点，p<0.01）和流感疫苗接种率（增加6.9个百分点，p<0.01）显著提高。这代表健康儿童就诊率比实施前的百分比（38.8%）增加了15%，流感疫苗接种率增加了25%。仅在以少数族裔学生为主的2个学校健康中心发现了增加情况。肥胖/超重西班牙裔儿童的饮食/咨询增加了18.7个百分点（p<0.01），从15.3%的基线水平翻倍。
小学健康中心的实施增加了佐治亚州城市地区年轻的公共保险儿童对关键预防保健服务的接受程度，并有可能减少种族和族裔差异。
