Ronda Kotelchuck serves on the board of the New York School-Based Health Foundation. She was the founding CEO of the Primary Care Development Corporation (PCDC), a partnership with a mission to expand access to primary and preventive care in underserved communities.
The Ascent: How do school-based health centers extend the vision for patient-centered primary care and the medical home concept?
Kotelchuck: School-based health centers can become, in and of themselves, a patient-centered medical home for students, but they’re usually partners in care. They are a wonderful element on a continuum of patient-centered care, and they possess the features I see as key to the medical home concept.
The first feature is access. There’s nothing like being in the school for immediate access to children. They don’t have to go anywhere, it’s free of charge, their parents don’t have to take time off work to bring them to you. Second, it offers a continuing relationship with a provider, one that’s attuned to the community it serves. Also, most school-based health centers offer comprehensive services, which include oral and mental health, comprehensive primary care and, often, preventive vision health. The school-based health center manages referrals to specialists and tries to ensure the students get other services, like mental health and social services. And students are followed up to ensure they receive what they need.
The Ascent: Where do school-based health centers fit on the continuum of care with other primary care providers?
Kotelchuck: School-based health centers are a great augmentation to other primary care providers for managing chronic care needs. There is growing evidence that the availability of chronic care services in the school, especially for asthma and diabetes, reduces ER use, reduces episodes of acute illnesses and lowers costs.
School based health centers also function as partners with primary care physicians in the managed care context--that is, to the designated person to whom the patient is assigned or attached in a payment arrangement. They act as partners in care with those primary care physicians.
The Ascent: How do they accomplish quality improvement, especially when they are usually small practices?
Kotelchuck: It’s a huge challenge, because you need to have data to do quality improvement. The National Association of School-Based Health Centers is beginning to create some infrastructure through its Quality Counts initiative to use combined data for quality improvement. Tracking and reporting can be a challenge simply because each school-based health center serves such a small population. Quality Counts allows school-based health centers to upload data directly from an electronic health record. That will give us quality data for well-child visits and preventive health screenings at an aggregate level, against which individual centers can compare their own data. In miniature, it’s the same kind of quality improvement effort you first saw happen with hospital care, and then later with primary care.