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

描述（由申请人提供）：960万美国儿童（13%）没有医疗保险，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%的白色儿童没有保险，20%的拉丁美洲儿童和12%的非洲裔美国儿童没有保险，拉丁美洲和非洲裔美国儿童占57%的没有保险的儿童，虽然只占所有美国儿童的37%。许多研究表明，没有保险对儿童的健康，医疗保健和死亡率有着深远的负面影响。然而，有证据表明，为未投保的儿童投保会显著改善健康和医疗保健。但是，大约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），因此需要创新战略来为更多的儿童提供保险并消除差距。这项拟议的研究将是第一项随机对照试验，比较父母导师（PM）与传统医疗补助/CHIP外展和登记在为未投保的少数民族儿童投保方面的有效性。该研究的主要目的是评估PM是否比传统的医疗补助/CHIP外展和登记更有效，更具成本效益，以确保符合条件，未投保的拉丁美洲和非洲裔美国儿童。第二个目的是确定获得健康保险的未投保儿童是否在医疗保健获得，健康状况，服务使用和其他健康结果方面有所改善。 受试者将是300名未投保的拉丁裔和非洲裔美国儿童，他们符合医疗补助/CHIP的条件但未入组，居住在达拉斯县，那里90%的未投保儿童（166，013）是拉丁裔或非洲裔美国人。受试者将被随机分配至PM组或接受传统Medicaid/CHIP外展的对照组。PM是有经验的父母，他们至少有一个孩子目前由Medicaid/CHIP覆盖。PM将接受为期2天的强化培训课程，并将与干预受试者及其家人配对，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，担任Medicaid/CHIP联络员，并协助维持覆盖范围。对照组将不接受标准Medicaid/CHIP外展以外的干预。主要结果将包括获得医疗保险，覆盖的连续性，获得保险的时间间隔，父母对获得保险的过程的满意度，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，以及错过学校和父母工作日。将每月联系受试者一次，持续1年，由设盲评估员监测结局。研究目标的实现有可能是减少种族/民族差异，赋予少数民族社区，通过少数民族父母的就业提供经济振兴，并推进知识，实践和儿童健康政策的重大贡献。如果成功的话，这种干预措施可以作为一个全国性的模式，为没有保险的儿童提供保险，并减少保险覆盖范围中的种族/民族差异。 公共卫生相关性：没有健康保险对儿童的健康、医疗保健和死亡率有着深远的负面影响，但近1000万美国儿童（13%）没有保险，而且保险覆盖范围存在着巨大的种族/民族差异。本研究的目的是评估家长导师是否（已经有一个孩子被医疗补助或儿童健康保险计划[CHIP]覆盖的父母）比传统的医疗补助/CHIP方法更有效，更具成本效益，可以为符合条件的未投保拉丁裔和非洲裔美国儿童提供保险，并确定获得健康保险的少数未投保儿童是否在医疗保健服务，健康状况，使用服务和其他健康成果。如果成功的话，这种创新的干预措施有可能对减少种族/民族差异产生重大影响，赋予少数民族社区权力，通过少数民族父母的就业提供经济振兴，并推进知识，实践和儿童健康政策;这种干预措施也可以作为一个国家模式，为没有保险的儿童提供保险，并减少儿童保险覆盖范围中的种族/民族差异。

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.