Background: Research suggests large changes to healthcare utilization with the changing health needs of students and families during the COVID-19 pandemic. This may be especially true in communities hardest hit by COVID-19, such as those serving low-income, Black, and Latine students. School-Based Health Centers (SBHCs) may be ideally positioned to address the needs of underserved communities (both students and non-students) due to their co-location on school campuses, provision of culturally relevant and teen-friendly services, and health equity lens. However, it remains unknown how students, families, and communities utilize SBHCs during prolonged school closures, such as those that occurred during the COVID-19 pandemic.  

Objectives: We sought to compare SBHC utilization before and after pandemic-related school closures across a network of SBHCs affiliated with the Los Angeles Unified School District, the second-largest school district in the nation.

Methods: We conducted a secondary analysis of encounter data extracted from electronic health records from 12 SBHCs in LAUSD that remained open during the COVID-19 Pandemic, including patient demographics and ICD diagnosis 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.

Diagnoses included: hypertension, overweight or obesity, diabetes mellitus, hyperlipidemia, sexually transmitted infections, mental health conditions, and preventative health exams.

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), female patients (57.1% vs. 61.7%, p=0.02) Latine patients (71.5% vs. 73.0%, p<0.001) and Black patients (16.5% vs. 14.9%, p<0.001for race/ethnicity differences). The frequency of encounters for annual preventative health exams increased for school-aged patients (32.5% vs. 25.7%, p=0.04) but decreased for other age groups (17.9% vs. 24.6%, p=0.01), while the frequency of encounters for mental health problems increased 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). the relationship between lipid diagnosis and period was statistically significant (p=0.001). For students, lipid related diagnoses was larger compared to the pre-pandemic percentage (3.2% vs 1.6% p=0.001). There were no other significant changes in the frequency of diagnoses or services. 

Conclusions: Despite pandemic-related school closures, SBHCs appeared play a critical role in providing primary care to a large number of students and their families. Findings suggest SBHCs hold value beyond their co-location with academic instruction.