title: 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.
authors.affiliation: PGY2, Mount Sinai Hospital, 1 Gustave L. Levy Pl, New York, NY 10029. schwartzkes@gmail.com.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Schwartz
authors.affiliation: Columbia-Bassett Medical School Program, Columbia College of Physicians & Surgeons, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326. daphne.monie@bassett.org.
authors.forename: Daphne
authors.initials: D
authors.lastname: Monie
authors.affiliation: Bassett Research Institute, One Atwell Road, Cooperstown, NY 13326. melissa.scribani@bassett.org.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Scribani
authors.affiliation: Bassett Research Institute, One Atwell Road, Cooperstown, NY 13326. nicole.krupa@bassett.org.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Krupa
authors.affiliation: Bassett Research Institute, One Atwell Road, Cooperstown, NY 13326. paul.jenkins@bassett.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Jenkins
authors.affiliation: Bassett Research Institute, One Atwell Road, Cooperstown, NY 13326. august.leinhart@bassett.org.
authors.forename: August
authors.initials: A
authors.lastname: Leinhart
authors.affiliation: School-Based Health, Bassett Healthcare Network, One Atwell Road, Cooperstown, NY 13326. chris.kjolhede@bassett.org.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Kjolhede
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009518:New York; D012189:Retrospective Studies; D012424:Rural Population; D012572:School Health Services; D012574:Schools
keywords: child and adolescent health; emergency care; emergency department; rural health; school-based health centers