K Award Grantee Interview: Glenn Flores, M.D.
The following is a transcript of grantee responses to the following questions:
- What is the primary focus of your research?
- How has funding from AHRQ helped to advance your research?
- Why did you choose to focus on this topic?
- How has your AHRQ funding helped you help other health services researchers?
Glenn Flores: The K02 Award helped to fund a number of projects, but primarily it was focusing on a randomized trial of a case management intervention to insure uninsured Latino children. So we had community-based case managers that we trained to do outreach and enrollment, and then we randomized uninsured children to the case manager traditional outreach and enrollment, and we found that the intervention was substantially more effective than traditional outreach and enrollment in insuring the uninsured kids at the tune of 95 versus 56 percent—insured them faster, they had higher parental satisfaction with the overall process of obtaining coverage, and their insurance was more continuous. And so we published those findings in Pediatrics, and then that led to a congressional research briefing on Capitol Hill in 2005. We were also honored to have the work prompt a bill that was introduced into the Senate called the Community Health Workers Act. That was not ultimately funded at the time, but I’m told by colleagues that President Obama’s CHIPRA legislation included community health workers as a means of outreach and enrollment to find uninsured children and that in part was based on our study.
We just finished an NIH-funded R01 looking at extending that study to look at parent mentors. So we took parents who already had kids with Medicaid and CHIP coverage, either or, and we trained them to do outreach and enrollment, but we also had them focus on social determinants of health, including getting housing if it was needed; clothing; if there was food insufficiency, where to get resources; and then also once one gets insurance, how you get a medical home and ensure your child has appropriate access to subspecialty services. So we randomized uninsured minority kids in the Dallas area who were eligible for CHIP and Medicaid but not insured through the parent mentor intervention or to traditional outreach and enrollment. And we actually found that, again, it was substantially more effective. It was about 95 versus 68 percent got insured. They did it faster; they had higher parental satisfaction. They had actually better health care and health. They actually had fewer unmet needs, better access to care. They had better quality of care. They had lower out-of-pocket costs and family financial burden. We found that it saved about $6,000 per child insured. So we’re now just writing up those findings. We have several manuscripts under review; several have been published. And so clearly that was a direct outgrowth of the originally funded AHRQ work.
The K02 Award was very timely. When I was early in my career, it gave me a good amount of time to devote to my research. It was protected time that I needed to transition from a young investigator to an independently funded investigator. And it was because of that support I was able to get two essentially R01 equivalents from major foundations for the case management work, and then that led to a subsequent foundation-funded intervention using parent mentors. In that case, it was looking at asthma in minority kids, and it also set the stage for the study that I just mentioned. So it was really critical in helping me to transition from a young investigator to an independent investigator.
My professional career has been devoted to improving the health and the health care of underserved children. And I’m particularly interested in how we achieve equity, how we eliminate disparities in the health and health care of children, whether they be because of race and ethnicity or socioeconomic status or language barriers, immigration status. So that has always been a priority reason not only for my research but for my clinical work and my teaching and my advocacy efforts.
It also allowed me a substantial amount of time to mentor others. And that’s one of the joys of my professional career, is mentoring future investigators. And I’ve had the privilege of mentoring mentees from all different levels. I’ve mentored 68 beginning clinical investigators, including 15 faculty, 9 fellows, 9 residents, 25 medical students, and 10 undergraduates, and they collectively have published 80 articles in major journals, book chapters, made 52 platform presentations and 64 poster presentations at major meetings. They’ve had 29 grants funded, including three career development awards, have received 9 awards for research excellence. And so, by having the support of AHRQ, I was able to both do my research but also mentor future generations of investigators.
And right now, in fact, I’m the director and the PI on an NIDDK-funded initiative called the Research in Academics Pediatric Initiative on Diversity, which we make into the acronym RAPID. And we’re now entering our fourth year, and that’s focused on young investigators from disadvantaged backgrounds, and we provide them not only funding for small projects but also provide them national mentoring from senior distinguished investigators. And that’s been really successful. And again, I think that was an outgrowth of trying to pass on some of the opportunity that I received.
I like to think that the grant, in addition to providing the support to do research and to allow me to do mentoring, also provided me the opportunity to make some contacts at AHRQ and network and through that I think it was instrumental in me being able to be a member of the U.S. Preventive Services Task Force from 2010 to 2013. I also was a member of the Pediatric Quality Measures Program of the CHIPRA initiative that allowed me to provide input on the measures that were developed. And so I think it’s also opened some nice doors and allowed me to give back to AHRQ.