120 - School-based Health Center Utilization during COVID-19 Pandemic-Related School Closures

Poster Number: 120
Publication Number: 120.410

Michelle N. Gallardo, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Alex Zepeda, The Los Angeles Trust for Children's Health, Los Angeles, CA, United States; Patricia Anton, Anton Consulting, Inc., Los Angeles, CA, United States; Christopher Biely, UCLA, Los Angeles, CA, United States; Nicholas Jackson, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Maryjane Puffer, The Los Angeles Trust for Children's Health, Los Angeles, CA, United States; Rebecca Dudovitz, University of California Los Angeles, Los Angeles, CA, United States

Background: Research suggests large changes to healthcare utilization during the COVID-19 pandemic, particularly in low-income, Black, and Latine communities. School-Based Health Centers (SBHCs) may be ideally positioned to address the needs of underserved communities due to their co-location on school campuses and provision of culturally relevant care. However, it remains unknown how communities utilize SBHCs during prolonged school closures like the COVID-19 pandemic.

Objective: We sought to compare SBHC use before and after pandemic-related school closures across SBHCs within the Los Angeles Unified School District (LAUSD), the second-largest school district in the nation.

Design/Methods: We conducted a secondary analysis of electronic health record encounter data from 12 SBHCs operated by Federally Qualified Health Centers and that remained open during the COVID-19 Pandemic. Data included patient demographics, ICD diagnoses, and CPT billing codes. We used the Clinical Classifications Software Refined (CSSR) to identify encounters for common conditions sensitive to primary care or represented in the National School Based Health Alliance National Quality Measures. Chi-square analysis with p-values obtained using cluster-robust estimation to account for clustering within clinics compared demographic characteristics and diagnoses before (July 1, 2015-February 29, 2020) and during (from March 1, 2020-March 31, 2021) pandemic-related school closures.

Results: During the pandemic, study SBHCs conducted 52,530 encounters and maintained ~4,040 encounters/month. Compared to the pre-pandemic period, during the pandemic, smaller percentage of encounters were with student-aged patients, ages 6-19 (13.7% vs. 22.1%, p=0.001 Table 1). The frequency of encounters for annual preventative health exams increased for school-aged patients (32.5% vs. 25.7%, p=0.04 Table 2) but decreased for other age groups (17.9% vs. 24.6%, p=0.01), while the frequency of encounters for mental health problems for both school-aged patients (10.0% vs. 3.7%, p < 0.001) and other age groups (13.6% vs. 8.1%, p < 0.001).Conclusion(s): Despite pandemic-related school closures, SBHCs appeared play a critical role in providing primary care to many students and their families. Findings suggest SBHCs hold value beyond their co-location with academic instruction.
Michelle Gallardo CVMichelle.Gallardo_Resume_11.2021.pdf
Table 2. Differences in Diagnoses for SBHC Encounters before and during the COVID-19 Pandemic