A Randomized Trial of Effects of Parent Mentors on Insuring Minority Children

家长导师对少数民族儿童保险影响的随机试验

• 批准号: 8142037
• 负责人: GLENN FLORES
• 金额: $ 56.47万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-09 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8142037
• 关键词: Accident and Emergency department; Accounting; Achievement; African American; Blinded; Caring; Child; Child health care; Childhood; Communities; Control Groups; County; Economics; Eligibility Determination; Employment; Enrollment; Family; Health; Health Insurance; Health Policy; Health Services; Health Services Accessibility; Health Status; Healthcare; Hospitalization; Insurance; Insurance Coverage; Intervention; Knowledge; Latino; Medicaid; Mentors; Methods; Minority; Modeling; Monitor; Outcome; Parents; Process; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Schools; Services; Training; Uninsured; Visit; Work; compare effectiveness; cost; cost effective; empowered; experience; improved; innovation; mortality; outreach program; primary outcome; programs; public health relevance; racial and ethnic disparities; randomized trial; satisfaction; secondary outcome; successful intervention; time interval; trial comparing

DESCRIPTION (provided by applicant): 9.6 million US children (13%) have no health insurance, and dramatic racial/ethnic disparities exist in lacking coverage. In contrast to only 7% of white children being uninsured, 20% of Latino and 12% of African- American children are uninsured, and Latino and African-American children account for 57% of uninsured children, although comprising only 37% of all US children. Numerous studies show that being uninsured has a profound negative impact on children's health, healthcare, and mortality. Evidence suggests, however, that insuring uninsured children results in significantly improved health and healthcare. But about 70% of uninsured US children (6 million) are eligible for but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), so innovative strategies are needed to insure more children and eliminate disparities. The proposed study would be the first randomized controlled trial comparing the effectiveness of parent mentors (PMs) to traditional Medicaid/CHIP outreach and enrollment in insuring uninsured minority children. The primary study aims are to evaluate whether PMs are more effective and more cost-effective than traditional Medicaid/CHIP outreach and enrollment in insuring eligible, uninsured Latino and African-American children. The secondary aim is to determine whether uninsured children who obtain health insurance experience improvements in healthcare access, health status, use of services, and other health outcomes. Subjects will be 300 uninsured Latino and African-American children eligible for but not enrolled in Medicaid/CHIP and residing in Dallas County, where 90% of uninsured children (166,013) are Latino or African-American. Subjects will be randomized to PMs or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents who have at least 1 child currently covered by Medicaid/CHIP. PMs will undergo a 2-day intensive training session, and will be paired with intervention subjects and their families, for whom they will provide information on program eligibility, help families complete and submit insurance applications, act as a Medicaid/CHIP liaison, and assist in maintaining coverage. Controls will receive no intervention other than standard Medicaid/CHIP outreach. Primary outcomes will include obtaining health insurance, coverage continuity, the time interval to obtain coverage, parental satisfaction with the process of obtaining insurance, and costs; secondary outcomes will include access to care, health status, use of services, quality of life, quality of care, parental satisfaction, financial burden, and missed school and parental work days. Subjects will be contacted monthly for 1 year to monitor outcomes by a blinded assessor. Achievement of the study aims has the potential to be a significant contribution to reducing racial/ethnic disparities, empowering minority communities, providing economic revitalization through employment of minority parents, and advancing knowledge, practice, and child health policy. If successful, this intervention could serve as a national model for insuring uninsured children and reducing racial/ethnic disparities in insurance coverage. PUBLIC HEALTH RELEVANCE: Having no health insurance coverage has a profoundly negative impact on children's health, healthcare, and mortality, but almost 10 million US children (13%) are uninsured, and dramatic racial/ethnic disparities exist in insurance coverage. The study aims are to evaluate whether Parent Mentors (parents who already have a child covered by Medicaid or the Children's Health Insurance Program [CHIP]) are more effective and more cost-effective than traditional Medicaid/CHIP approaches to insuring eligible, uninsured Latino and African- American children, and to determine whether minority uninsured children who obtain health insurance experience improvements in healthcare access, health status, use of services, and other health outcomes. If successful, this innovative intervention has the potential to have a major impact on reducing racial/ethnic disparities, empowering minority communities, providing economic revitalization through employment of minority parents, and advancing knowledge, practice, and child health policy; this intervention also could serve as a national model for insuring uninsured children and reducing racial/ethnic disparities in childhood insurance coverage.

描述（由申请人提供）：960万美国儿童（13％）没有健康保险，并且缺乏承保范围存在戏剧性的种族/族裔差异。与只有7％的白人儿童没有保险相反，拉丁美洲裔和12％的非裔美国儿童没有保险，而拉丁裔和非裔美国人儿童则占未保险儿童的57％，尽管只有37％的美国儿童占37％。大量研究表明，没有保险对儿童的健康，医疗保健和死亡率产生深远的负面影响。但是，有证据表明，确保未保险的儿童确保健康和医疗保健可显着改善。但是，约有70％的未保险的美国儿童（600万）有资格，但没有参加医疗补助或儿童健康保险计划（CHIP），因此需要创新的策略来确保更多的儿童并消除差异。拟议的研究将是第一个随机对照试验，将父母导师（PMS）与传统的医疗补助/CHIP外展和入学率进行比较，以确保未投保的少数族裔儿童。主要研究目的是评估PM是否比传统的医疗补助/CHIP外展和入学率更有效，更具成本效益，以确保合格的，没有保险的拉丁裔和非裔美国人儿童。第二个目的是确定未保险的儿童是否可以在医疗保健访问，健康状况，服务和其他健康成果方面改善健康保险经验。 受试者将是300名未保险的拉丁裔和非裔美国人儿童，有资格，但不参加医疗补助/筹码，并居住在达拉斯县，那里有90％的无保险儿童（166,013）是拉丁裔或非裔美国人。受试者将被随机分配给PMS或接收传统医疗补助/CHIP外展的对照组。 PM是经验丰富的父母，他们目前至少有1个由医疗补助/筹码覆盖的孩子。 PMS将参加为期2天的密集培训课程，并将与干预对象及其家人配对，他们将为他们提供有关计划资格的信息，帮助家庭完成和提交保险申请，充当医疗补助/筹码联络，并协助维护承保范围。除了标准的医疗补助/CHIP外展外，控件将不接受干预。主要结果将包括获得健康保险，覆盖范围的连续性，获得覆盖范围的时间间隔，对获得保险过程的父母满意度以及费用；次要结果将包括获得护理，健康状况，服务的使用，生活质量，护理质量，父母满意度，经济负担以及错过的学校和父母的工作日。将每月与受试者联系1年，以监视盲人评估员的结果。这项研究的实现目标有可能为减少种族/种族差异，赋予少数民族社区权力，通过少数群体的就业以及推进知识，实践和儿童健康政策提供经济振兴。如果成功，这种干预措施可以作为确保未保险儿童并减少种族/种族差异的国家模式。 公共卫生相关性：没有健康保险对儿童的健康，医疗保健和死亡率产生深远的负面影响，但是近1000万美国儿童（13％）没有保险，并且在保险范围内存在巨大的种族/种族差异。该研究的目的是评估父母导师（父母已经被医疗补助覆盖的孩子或孩子的健康保险计划[CHIP]）是否比传统的医疗补助/芯片方法更有效，更具成本效益如果成功的话，这种创新的干预措施有可能对减少种族/种族差异，赋予少数民族社区权力，通过少数群体的就业以及推进知识，实践和儿童健康政策的经济振兴产生重大影响；这种干预还可以作为确保未保险儿童并减少儿童保险范围的种族/种族差异的国家模式。