摘要：Objectives. We evaluated emergency department (ED)–based outreach for the State Children’s Health Insurance Program (SCHIP). Methods. We conducted a multicenter trial among uninsured children (≤ 18 years) who presented to 5 EDs in 2001 and 2002. On-site staff enrolled consecutive subjects for a control period followed by an intervention period during which staff handed out SCHIP applications to the uninsured. The primary outcome was state-level confirmation of insured status at 90 days. Results. We followed 223 subjects (108 control, 115 intervention) by both phone interview and state records. Compared to control subjects, those receiving a SCHIP application were more likely to have state health insurance at 90 days (42% vs 28%; P <.05; odds ratio [OR]=3.8; 95% confidence interval [CI]=1.7, 8.6). Although the intervention effect was prominent among 118 African Americans (50% insured after intervention vs 31% of controls, P <.05), lack of family enrollment in other public assistance programs was the primary predictor of intervention success (OR=3.7; 95% CI=1.6, 8.4). Conclusions. Handing out insurance applications in the ED can be an effective SCHIP enrollment strategy, particularly among minority children without connections to the social welfare system. Adopted nationwide, this simple strategy could initiate insurance coverage for more than a quarter million additional children each year. In 1997, the US government initiated the multibillion dollar State Children’s Health Insurance Program (SCHIP) in hopes of improving the health status of nearly 10 million uninsured children. The program not only expanded insurance coverage for poor children under Medicaid but also subsidized low-cost state insurance alternatives for working families living above the poverty line. However, despite significant efforts within each state, over 7 million children remain uninsured, 1 and many eligible families are still unaware of SCHIP enrollment opportunities. 2, 3 Although streamlined outreach and enrollment efforts have seen modest results, there is limited evidence for the efficacy of specific intervention strategies. We identified 1 of the simplest outreach strategies—handing out SCHIP applications at locations frequented by uninsured children—and sought to quantify its impact. With approximately 3 million visits by uninsured children to US emergency departments (EDs) each year, 4, 5 we chose to study the effect of handing out SCHIP applications in an ED setting. We hypothesized that such an approach might represent a low-cost, high-impact enrollment strategy, particularly among those families who lack routine contact with the health and welfare system outside the ED. 6, 7
