Insuring Uninsured Children

候选人格伦·弗洛雷斯医学博士的长期职业目标是通过作为研究人员、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。他努力开展有可能对儿童健康产生直接影响的研究，特别是那些少数族裔、贫困和未得到医疗保健系统服务的儿童。弗洛雷斯博士认为，他的出版物、研究资金、作为导师的履历，以及作为演讲者和顾问的全国认可，都是他作为研究人员取得成功的有力证据，并具有未来为该领域做出贡献的潜力。候选人的职业发展计划包括：1)在进行焦点小组和随机试验方面完善研究技能；2)定期与高级顾问团队会面；3)完成关于负责任的研究行为的课程；4)指导少数族裔卫生服务研究人员；5)开发和使用协作政策链接。机构环境提供了极好的资源，包括部门承诺保护弗洛雷斯博士为拟议研究所做的80%工作，一支由知名儿科卫生服务研究人员组成的高级顾问团队，以及所需的支持人员和设备。拟议研究的目的是：1)使用焦点小组来确定父母无法为其未参保的孩子获得医疗保险的原因，重点是拉美裔；以及2)进行随机试验，以评估病例管理人员在为未参保的儿童提供保险方面是否比传统方法更有效。尽管有儿童健康保险计划(CHIP)，但美国仍有1100万儿童没有保险，而且这个数字每年都在增长。各州在识别和招收未参保儿童方面存在困难，未使用的芯片恶魔有丢失的危险。我们将针对试点工作确定的未参保儿童比例特别高的社区儿童投保障碍问题开展6个焦点小组。焦点小组数据将用于培训案例经理，以帮助家庭获得保险资格、申请和维持保险范围。未参保的儿童(N=300)将被招募并随机分配到训练有素的病例管理人员，或只能使用传统保险登记方法的对照组。审查的结果将包括：儿童获得医疗保险的比例，从研究登记到获得保险的时间，有间歇性保险的儿童的比例，以及父母对获得保险的过程的满意度。两组的受试者都将获得参与奖励，并每月被联系以监测1-2年的结果(取决于登记时间)；干预受试者也将每月被联系以获得病例经理的持续援助。试点工作已经确定了几个未参保儿童比例较高的社区，它们愿意参与研究。拟议的项目是及时的，因为它严格评估了一种特定的、可重复使用的方法在高危人群中的有效性。如果成功，这项干预可能会成为为没有保险的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.