School-Based Health and Healthcare Utilization Among Rural Youth: Evidence from a School-Based Health Center Opening.

OBJECTIVE: To examine the effects of opening a school-based health center on primary and preventive care utilization among students in a rural setting. STUDY DESIGN: This quasi-experimental study used patient-level electronic health records data from a healthcare network serving a rural region of New York. The sample included patients aged 5-18 residing in 1 school district that opened a school-based health center and those who resided in similar districts without a center, spanning 2.5 years before and 2.5 years after the new center opened. The number of primary care visits and occurrence of any well-child, immunization, and convenient care visits were studied. Difference-in-differences event study models were used to estimate post-intervention changes in utilization trends adjusting for age, sex, treatment district, and half-year fixed effects. RESULTS: Multivariable estimates demonstrated increases in primary care visits and increased odds of receiving an immunization among patients in the treatment group vs those in comparison groups, after the school-based health center opened. CONCLUSIONS: These data provide robust associations consistent with causal evidence that school-based health centers increase utilization of primary care and expand access to a usual source of care in rural settings, highlighting the value of expanding school-based care in these communities.