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

描述(申请人提供)：960万美国儿童(13%)没有医疗保险，在缺乏保险的情况下存在显著的种族/民族差异。相比之下，只有7%的白人儿童没有保险，20%的拉美裔儿童和12%的非裔美国儿童没有保险，拉美裔和非洲裔儿童占没有保险儿童的57%，尽管只占所有美国儿童的37%。大量研究表明，没有保险对儿童的健康、医疗保健和死亡率有深远的负面影响。然而，有证据表明，为没有保险的儿童提供保险会显著改善健康和医疗保健。但大约70%的未参保美国儿童(600万)有资格参加医疗补助或儿童健康保险计划(CHIP)，但没有参加，因此需要创新策略来为更多儿童投保，消除差距。这项拟议的研究将是第一个随机对照试验，比较父母导师(PM)与传统的医疗补助/芯片外展和登记在为未参保的少数族裔儿童提供保险方面的有效性。这项主要研究的目的是评估在为符合条件的、未参保的拉丁裔和非裔美国儿童提供保险方面，PM是否比传统的医疗补助/芯片外展和登记更有效和更具成本效益。第二个目标是确定获得医疗保险的未参保儿童在医疗保健机会、健康状况、服务使用和其他健康结果方面是否有所改善。研究对象将是300名有资格但没有参加医疗补助/CHIP的未参保的拉丁裔和非裔美国儿童，他们居住在达拉斯县，那里90%的未参保儿童(166,013人)是拉丁裔或非裔美国人。受试者将被随机分到PM组或接受传统医疗补助/芯片外展的对照组。经前综合症是有经验的父母，他们至少有一个孩子目前在医疗补助/芯片覆盖范围内。经前综合征将接受为期两天的强化培训，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，帮助家庭完成并提交保险申请，充当医疗补助/芯片联络人，并协助维持保险范围。除了标准的医疗补助/芯片外展，控制组将不会接受任何干预。主要结果将包括获得医疗保险、承保连续性、获得保险的时间间隔、父母对获得保险过程的满意度以及费用；次要结果将包括获得护理的机会、健康状况、服务使用、生活质量、护理质量、父母满意度、经济负担、旷课和父母工作日。受试者将由一名盲人评估员每月联系一年，以监测结果。这项研究目标的实现有可能对缩小种族/民族差距、增强少数群体社区的能力、通过雇用少数群体父母提供经济振兴以及促进知识、实践和儿童健康政策作出重大贡献。如果成功，这一干预措施可以成为为没有保险的儿童提供保险和减少保险覆盖范围中的种族/族裔差距的国家模式。 与公共健康相关：没有医疗保险对儿童的健康、医疗保健和死亡率产生了深远的负面影响，但近1000万美国儿童(13%)没有保险，保险覆盖范围存在显著的种族/民族差异。这项研究的目的是评估父母导师(已经有一个孩子得到医疗补助或儿童健康保险计划[CHIP]覆盖的父母)在为符合条件的、未参保的拉丁裔和非裔美国儿童提供保险方面是否比传统的医疗补助/CHIP方法更有效、更具成本效益，并确定获得医疗保险的少数族裔未参保儿童在医疗保健机会、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，这一创新干预措施有可能对缩小种族/族裔差距、增强少数群体社区的能力、通过雇用少数群体父母提供经济振兴以及促进知识、实践和儿童健康政策产生重大影响；这一干预措施还可成为为未参保儿童提供保险和减少儿童保险覆盖范围中的种族/族裔差距的国家模式。

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.