Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use

ABSTRACT BACKGROUND Previous studies of urban school‐based health centers (SBHCs) have shown that SBHCs decrease emergency department (ED) utilization. This study seeks to evaluate the effect of SBHCs on ED utilization in a rural setting. METHODS This retrospective, controlled, quasi‐experimental study used an ED patient data set from the Bassett Healthcare Network in rural New York to compare ED visits between school‐aged children from 12 SBHC schools before and after the SBHC opening. Time series analysis was used to determine trends in SBHC schools and 2 control schools without SBHCs over the 18‐year study period. RESULTS ED visit incidence densities for all 12 school districts combined showed a significant increase in ED visits post‐SBHC (Rate ratio (RR) = 1.15; p < .0001). This increase may, in part, be explained by the upward trend of ED visits in the region, as seen in the small, but significant, positive slope (RR = 0.0033, p < .0001) for control schools. There was variation in the change in incidence density post‐SBHC among school districts, with increases in 78% of schools. CONCLUSIONS The opening of SBHCs in rural settings results in a slight, but significant, increase in ED use, which is contrary to previous cross‐sectional studies in urban settings.