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: 8281372
• 负责人: GLENN FLORES
• 金额: $ 55.32万
• 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/8281372
• 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%) 没有医疗保险，并且在缺乏保险方面存在巨大的种族/民族差异。相比之下，只有 7% 的白人儿童没有保险，而 20% 的拉丁裔儿童和 12% 的非裔美国儿童没有保险，拉丁裔和非裔美国儿童占未参保儿童的 57%，尽管他们只占美国儿童总数的 37%。孩子们。大量研究表明，没有保险会对儿童的健康、医疗保健和死亡率产生深远的负面影响。然而，有证据表明，为未投保的儿童提供保险可以显着改善健康和医疗保健。但约 70% 的未参保美国儿童（600 万）有资格享受医疗补助或儿童健康保险计划 (CHIP)，但尚未加入，因此需要创新策略来为更多儿童提供保险并消除差距。拟议的研究将是第一个随机对照试验，比较家长导师 (PM) 与传统医疗补助/CHIP 推广和登记在为未参保少数族裔儿童提供保险方面的有效性。主要研究目的是评估 PM 在为符合条件的未参保拉丁裔和非裔美国儿童提供保险方面是否比传统医疗补助/CHIP 推广和登记更有效且更具成本效益。第二个目标是确定获得健康保险的未参保儿童在医疗保健获取、健康状况、服务使用和其他健康结果方面是否有所改善。 受试者将是居住在达拉斯县的 300 名未参保的拉丁裔和非裔美国儿童，他们有资格但未参加 Medicaid/CHIP，其中 90% 的未参保儿童 (166,013) 是拉丁裔或非裔美国人。受试者将被随机分为接受传统医疗补助/CHIP 外展服务的 PM 或对照组。 PM 是经验丰富的家长，目前至少有 1 个孩子享受 Medicaid/CHIP。 PM 将接受为期 2 天的强化培训课程，并将与干预对象及其家人配对，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/CHIP 联络人，并协助他们在维持覆盖范围方面。除了标准医疗补助/CHIP 外展服务之外，对照者不会接受任何干预。主要结果将包括获得健康保险、承保连续性、获得承保的时间间隔、父母对获得保险过程的满意度以及费用；次要成果将包括获得护理的机会、健康状况、服务的使用、生活质量、护理质量、家长满意度、经济负担以及缺课和家长工作日。将在一年内每月联系受试者，以由盲态评估员监测结果。研究目标的实现有可能对减少种族/民族差异、赋予少数群体社区权力、通过少数群体父母就业实现经济振兴以及推进知识、实践和儿童健康政策做出重大贡献。如果成功，这种干预措施可以成为为未参保儿童提供保险并减少保险覆盖范围的种族/民族差异的全国模式。 公共健康相关性：没有健康保险会对儿童的健康、医疗保健和死亡率产生深远的负面影响，但近 1000 万美国儿童 (13%) 没有保险，而且保险范围存在巨大的种族/民族差异。该研究的目的是评估家长导师（已经有孩子受 Medicaid 或儿童健康保险计划 [CHIP] 覆盖的父母）是否比传统 Medicaid/CHIP 方法更有效且更具成本效益，为符合条件的、未参保的拉丁裔和拉丁裔提供保险。非裔美国儿童，并确定获得健康保险的少数族裔未参保儿童在医疗保健获取、健康状况、服务使用和其他健康结果方面是否有所改善。如果成功，这种创新干预措施有可能对减少种族/民族差异、增强少数群体社区权能、通过雇用少数群体父母实现经济振兴以及推进知识、实践和儿童健康政策产生重大影响；这一干预措施还可以作为为未参保儿童提供保险和减少儿童保险覆盖方面的种族/族裔差异的国家模式。