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: 8675750
• 负责人: Michael Corbin Lee
• 金额: $ 52.93万
• 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 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8675750
• 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; 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.

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着巨大的种族/民族差异。相比之下，只有7%的白人儿童没有保险，20%的拉丁裔和12%的非洲裔美国儿童没有保险，拉丁裔和非裔美国儿童占未保险儿童的57%，尽管只占美国所有儿童的37%。许多研究表明，没有保险对儿童的健康、保健和死亡率有深远的负面影响。然而，有证据表明，为未投保的儿童提供保险可显著改善健康和医疗保健。但是，大约70%的未投保的美国儿童（600万）有资格但没有参加医疗补助计划或儿童健康保险计划（CHIP），因此需要创新的策略来为更多的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，比较父母导师（pm）与传统的医疗补助/CHIP外展和投保少数族裔儿童的有效性。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，以保险符合条件的，未保险的拉丁裔和非裔美国儿童。第二个目的是确定获得健康保险的未投保儿童在获得医疗保健、健康状况、服务使用和其他健康结果方面是否得到改善。研究对象为300名没有保险的拉丁裔和非裔美国儿童，他们符合医疗补助/CHIP的条件，但没有注册，并且居住在达拉斯县，其中90%的未保险儿童（166,013）是拉丁裔或非裔美国人。受试者将被随机分配到pm组或接受传统医疗补助/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被医疗补助/CHIP覆盖。pm将接受为期两天的强化培训，并将与干预对象及其家庭配对，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，并协助维持覆盖范围。除了标准的医疗补助/CHIP外，对照组将不接受任何干预。主要结果将包括获得健康保险、保险连续性、获得保险的时间间隔、父母对获得保险过程的满意度和费用；次要结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、父母满意度、经济负担、缺课天数和父母工作天数。受试者将每月联系一次，为期1年，由盲法评估员监测结果。研究目标的实现有可能对减少种族/民族差异、赋予少数民族社区权力、通过少数民族父母的就业提供经济振兴以及推进知识、实践和儿童保健政策作出重大贡献。如果成功的话，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方面的种族/民族差异的国家模式。

项目成果

Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial.

• DOI: 10.1542/peds.2015-3519
• 发表时间: 2016-04
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Flores G;Lin H;Walker C;Lee M;Currie JM;Allgeyer R;Fierro M;Henry M;Portillo A;Massey K
• 通讯作者: Massey K

Parent Mentoring Program Increases Coverage Rates For Uninsured Latino Children.

家长指导计划提高了未参保拉丁裔儿童的覆盖率。

• DOI: 10.1377/hlthaff.2017.1272
• 发表时间: 2018
• 期刊: Health affairs (Project Hope)
• 作者: Flores,Glenn;Lin,Hua;Walker,Candy;Lee,Michael;Currie,Janet;Allgeyer,Rick;Fierro,Marco;Henry,Monica;Portillo,Alberto;Massey,Kenneth
• 通讯作者: Massey,Kenneth

Design, methods, and baseline characteristics of the Kids' Health Insurance by Educating Lots of Parents (Kids' HELP) trial: a randomized, controlled trial of the effectiveness of parent mentors in insuring uninsured minority children.

“教育大量家长的儿童健康保险”（Kids HELP）试验的设计、方法和基线特征：一项随机对照试验，旨在评估家长导师为未参保少数族裔儿童提供保险的有效性。

• DOI: 10.1016/j.cct.2014.11.015
• 发表时间: 2015
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Flores,Glenn;Walker,Candy;Lin,Hua;Lee,Michael;Fierro,Marco;Henry,Monica;Massey,Kenneth;Portillo,Alberto
• 通讯作者: Portillo,Alberto