Patient-Centered Medical Home Model: Do School-Based Health Centers Fit the Model?

Abstract

School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.

Differences in Access to Care Among Students Using School-Based Health Centers

“…There is variation among SBHCs in terms of specific breadth of services, staffing structures, and operational characteristics, yet all SBHCs strive to offer a broad spectrum of services that are grounded within a primary care model and placed in a convenient location for students. Others have suggested that some SBHCs have the capacity to serve as a medical home, or an important supplement to existing systems of care, for many adolescents (American Academy of Pediatrics, 2012; Larson & Chapman, 2014). In fact, the literature on SBHCs contains many examples that demonstrate the value of SBHCs for school-aged youth.…”

Completion of the Human Papillomavirus Vaccination Series Among Adolescent Users and Nonusers of School-Based Health Centers

“…23,24 SBHCs provide convenient and immediate access to the health care system and are intended to supplement, not replace, an adolescent's primary care provider. 25 A recent study found that providers and parents accepted and supported the provision of HPV vaccine in a school setting. 26 Twenty-six SBHCs are located on elementary school, middle school, and high school campuses in Seattle, Washington; they are sponsored and staffed by 7 local health care organizations.…”

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

“…19 It is important to keep in mind that whereas the power of our study is such that the reported differences in ED visits pre-SBHC versus post-SBHC are statistically significant, the differences are not likely to translate to clinically meaningful differences in ED usage before and after the opening of SBHCs. Previous studies that found a decrease in ED visits associated with SBHCs cited an increase in preventive care, improved care of chronic conditions, and education about what to do for follow-up or acute care as potential reasons for decreased ED utilization.…”

“…SBHCs may function as parts of a Patient-Centered Medical Home, which would increase utilization of the whole system. 19 It is important to keep in mind that whereas the power of our study is such that the reported differences in ED visits pre-SBHC versus post-SBHC are statistically significant, the differences are not likely to translate to clinically meaningful differences in ED usage before and after the opening of SBHCs. The increase in ED visits in all 12 school districts amounts to an increase of only 1.2 visits per 100 person years.…”