Insuring Uninsured Children

候选人Glenn Flores博士的长期职业目标是通过作为研究者、临床医生、导师和倡导者的杰出贡献，成为儿童健康服务研究领域公认的领导者。他一直致力于开展有可能对儿童健康产生直接影响的研究，特别是那些少数民族、贫困和医疗保健系统服务不足的儿童。Flores博士认为他的出版物，研究经费，作为导师的记录，以及作为演讲者和顾问的国家认可，都是他作为研究者成功的有力证据，并有可能在未来为该领域做出贡献。候选人的职业发展计划包括：1)提高开展焦点小组和随机试验的研究技能；2)定期与高级顾问团队开会；3)完成负责任的研究行为课程；4)指导少数民族卫生服务研究人员；5)开发和使用协同政策链接。机构环境提供了优秀的资源，包括部门承诺保护弗洛雷斯博士80%的研究成果，一个由知名儿科健康服务研究人员组成的高级咨询团队，以及所需的支持人员和设备。拟议研究的目的是：1)利用焦点小组确定父母无法为未投保的子女获得医疗保险的原因，重点是拉丁美洲人；2)进行随机试验，评估案例管理是否比传统方法更有效地为未参保儿童提供保险。美国有1100万儿童没有保险，尽管有儿童健康保险计划（CHIP），但这一数字仍在逐年增长。各州难以识别和登记未投保的儿童，未使用的CHIP朋友有丢失的危险。我们将针对试点工作确定的儿童未参保比例特别高的社区中儿童参保的障碍开展6个焦点小组。焦点小组的数据将用于培训病例管理人员，以帮助家庭获得保险资格、申请和维持保险。未参保儿童（N = 300）将被招募并随机分配到训练有素的病例管理人员中，或只使用传统保险登记方法的对照组。检查的结果将包括：获得健康保险的儿童比例，从研究登记到获得保险的时间，获得偶发保险的儿童比例，以及父母对获得保险过程的满意度。两组受试者均将获得参与奖励，并在1-2年内每月联系监测结果（取决于入组时间）；干预对象也将每月联系，由病例管理人员提供持续的帮助。试点工作确定了几个没有保险的儿童比例很高的社区愿意参与研究。拟议的项目是及时的，因为它严格评估了一种特定的、可重复的方法在高风险人群中的有效性。如果成功的话，这一干预措施将成为为未参保儿童提供保险的全国模式。

The long-term career goal of the candidate, Glenn Flores, MD, is to become a recognized leader in child health services research through outstanding contributions as an investigator, clinician, mentor, and advocate. He has endeavored to conduct research that has the potential to have an immediate impact on children's health, particularly those who are minority, poor, and under- served by the health care system. Dr. Flores considers his publications, research funding, track record as a mentor, and national recognition as a speaker and consultant to be strong evidence of his success as an investigator and potential to make future contributions to the field. The candidate's career development plan includes: 1) refining research skills in conducting focus groups and randomized trials; 2) regular meetings with a senior advisory team; 3) completing a course on the responsible conduct of research; 4) mentoring minority health services researchers; and 5) developing and using collaborative policy links. The institutional environment provides excellent resources, including departmental commitment to protect 80 percent of Dr. Flores's effort for the proposed research, a senior advisory team of renown pediatric health services researchers, and needed support staff and equipment. The aims of the proposed research are to 1) use focus groups to identify the reasons why parents are unable to obtain health insurance for their uninsured children, with an emphasis on Latinos; and 2) conduct a randomized trial to evaluate whether case managers are more effective than traditional methods in insuring uninsured children. Eleven million children are uninsured in the US, and the number grows yearly, despite the Children's Health Insurance Programs (CHIP). States are having difficulty identifying and enrolling uninsured children, and unused CHIP fiends are in danger of being lost. We will conduct 6 focus groups on obstacles to insuring children in the communities identified by pilot work to have particularly high proportions of uninsured children. Focus group data will be used to train case managers to assist families with insurance eligibility, applications, and maintaining coverage. Uninsured children (N = 300) will be recruited and randomized to trained case managers, or a control group with access only to traditional methods of insurance enrollment. Outcomes examined will include: the proportion of children obtaining health insurance coverage, the time from study enrollment to obtaining coverage, the proportion of children with episodic coverage, and parental satisfaction with the process of obtaining coverage. Subjects in both groups will receive participation incentives and be contacted monthly to monitor outcomes for 1-2 years (depending on time of enrollment); intervention subjects also will be contacted monthly for ongoing assistance by case managers. Pilot work has identified several communities with high proportions of uninsured children that are willing to participate in research. The proposed project is timely because it rigorously evaluates the effectiveness of a specific, reproducible approach in a high-risk population. If successful, the intervention could serve as a national model for insuring uninsured children.