Eosinophilic Mucin Chronic Rhinosinusitis: Determining the multi-level factors that mediate disease and disparities

嗜酸性粘蛋白慢性鼻窦炎：确定介导疾病和差异的多层次因素

基本信息

批准号：
10643496
负责人：
CORINNA GEHRETT LEVINE
金额：
$ 15.44万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-07 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10643496
关键词：
Acculturation Address Affect Aftercare Allergic Analysis of Variance Anosmia Biological Black race Caring Clinical Clinical Treatment Communication Communities Computer Models Data Deformity Development Dimensions Disease Disparity Early treatment Educational Intervention Environmental Exposure Environmental Risk Factor Ethnic Origin Etiology Face Feedback Florida Future Glean Goals Headache Health Services Accessibility Health Status Hispanic Home Humidity IgE Impairment Individual Infection Inflammatory Inflammatory Response Interdisciplinary Study Intervention Interview Knowledge Language Lead Life Longitudinal cohort study Lung Measures Mediating Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Minority Mission Modeling Molds Morbidity - disease rate Mucins Mucous body substance National Institute on Minority Health and Health Disparities Neighborhoods Operative Surgical Procedures Outcome Outcome Measure Paranasal Sinus Diseases Pathway interactions Patients Physical environment Polyps Population Population Heterogeneity Positioning Attribute Predictive Factor Prospective cohort Provider Qualitative Research Race Recommendation Recurrence Reduce health disparities Reporting Research Research Methodology Research Personnel Research Training Sampling Science Scientist Severity of illness Sinus Socioeconomic Status Structure Symptoms Testing Thick Time Training Training Programs Treatment outcome United States Vision advanced disease black patient burden of illness career chronic rhinosinusitis clinical practice cohort community-level factor cytokine disorder subtype disparity reduction education resources face bone structure health care availability health determinants high risk population improve minority health improved improved outcome low socioeconomic status machine learning model microbiome outcome disparities patient oriented patient-clinician communication prevent prospective random forest response social cohesion social culture social stress sociodemographics therapy development tool treatment center

项目摘要

PROJECT SUMMARY/ ABSTRACT Goal: This proposal provides a structured research training program under the guidance of mentors and advisors in related fields to promote Dr. Levine’s development into an independent clinician-scientist. Her long-term goal is leading a multidisciplinary research teams to develop patient-centered treatment pathways and interventions that improve outcomes and mitigate disparities in eosinophilic mucin chronic rhinosinusitis. Research: Chronic rhinosinusitis is a debilitating disease of the paranasal sinuses that affects up to 16% of the United States (US) population, causing intractable congestion, smell loss, and persistent headaches that can lead to permeant and life-threatening morbidities. Research in diverse populations demonstrates that Hispanic and Black patients are more likely to have severe chronic rhinosinusitis disease subtypes such as eosinophilic mucin chronic rhinosinusitis (EMRS), a subtype common in the southern US. Hispanic and Black EMRS patients present with more advanced disease, have worse post-treatment outcomes, and have high rates of morbidity including facial bone deformities and vision changes. The etiology behind the disparities in EMRS presentation and outcomes are unknown. Fundamental questions about how to reduce disease burden cannot be answered until we understand the factors that influence EMRS treatment outcomes. The goal of this proposal is generating evidence to predict EMRS treatment outcomes and reduce health disparities. We will employ a prospective longitudinal cohort study and use semi-structured interviews of patients and providers to identify important EMRS treatment outcome determining factors. The central hypothesis of this proposal is that EMRS disparities result from the interplay of individual- and community-level health determinants and environmental exposures that have quantifiable impacts on EMRS clinical and biological outcome measures. To test this, we will: 1) develop a computation model integrating multi-level factors to predict EMRS post-surgical outcomes; 2) determine best- practices to facilitate efficient and effective clinician-patient communication and EMRS care; 3) develop a pilot intervention to reduce delays in care. We will engage stakeholders in pilot intervention development and feedback. The proposed research aligns with the NIMHD mission to develop new research methods to improve minority health and reduce health disparities. The research results will help inform clinical practice and treatment recommendations to improve the quality of EMRS care and reduce disparities. Training: To accomplish these aims Dr. Levine will receive mentorship, focused didactics, one-on-one tutorials, and hands-on training in team science and mixed methods research, incorporating important aspects of computational modeling and qualitative research. She will establish a robust rhinology research network to facilitate a pathway to independence. A NIMHD K23 award will provide Dr. Levine with the protected time and essential training to achieve her career goals of improving outcomes and reducing disparities for EMRS patients.

项目概要/摘要目标：该提案在导师和顾问的指导下提供结构化的研究培训计划促进莱文博士发展成为一名独立的临床医生科学家的长期目标。正在领导一个多学科研究团队开发以患者为中心的治疗途径和干预措施改善结果并减轻嗜酸性粘蛋白慢性鼻窦炎的差异。研究：慢性鼻窦炎是一种使鼻旁窦衰弱的疾病，影响高达 16% 的鼻窦疾病。美国 (US) 人口，导致顽固性鼻塞、嗅觉丧失和持续性头痛，对不同人群的研究表明，西班牙裔人会导致永久性和危及生命的发病率。黑人患者更有可能患有严重的慢性鼻窦炎疾病亚型，例如嗜酸性粒细胞增多症粘蛋白慢性鼻窦炎 (EMRS)，一种常见于美国南部西班牙裔和黑人 EMRS 患者的亚型。患有更晚期的疾病，治疗后结果更差，并且发病率很高包括面部骨骼畸形和视力变化 EMRS 表现差异背后的病因。关于如何减轻疾病负担的基本问题尚不清楚。直到我们了解影响 EMRS 治疗结果的因素为止。该提案的目标是产生。我们将采用前瞻性证据来预测 EMRS 治疗结果并减少健康差异。纵向队列研究并使用患者和提供者的半结构化访谈来识别重要的 EMRS 该提案的中心假设是 EMRS 差异导致。个人和社区层面的健康决定因素与环境暴露的相互作用对 EMRS 临床和生物学结果测量的可量化影响为了测试这一点，我们将： 1) 开发一个综合多层次因素来预测 EMRS 术后结果的计算模型；2) 确定最佳- 促进高效、有效的临床医患沟通和 EMRS 护理的实践 3) 开展试点；我们将让利益相关者参与试点干预措施的制定和实施。拟议的研究与 NIMHD 的使命相一致，即开发新的研究方法以改进。研究结果将有助于为临床实践和治疗提供信息。提高 EMRS 护理质量并减少差异的建议。培训：为了实现这些目标，莱文博士将接受指导、重点教学、一对一辅导、以及团队科学和混合方法研究的实践培训，纳入了以下重要方面她将建立一个强大的鼻学研究网络，以进行计算建模和定性研究。 NIMHD K23 奖项将为 Levine 博士提供受保护的时间和途径。必要的培训，以实现她改善结果和减少 EMRS 患者差异的职业目标。