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

项目总结/摘要 目标：本提案提供了一个在导师和顾问指导下的结构化研究培训计划 在相关领域，以促进莱文博士的发展成为一个独立的临床科学家。她的长期目标 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 改善嗜酸性粘蛋白慢性鼻窦炎预后并减轻差异。 研究：慢性鼻窦炎是一种使人衰弱的副鼻窦疾病， 美国（US）人口，导致顽固性充血，嗅觉丧失和持续性头痛， 导致渗透性和危及生命的疾病。对不同人群的研究表明， 而黑人患者更有可能患有严重的慢性鼻窦炎疾病亚型，如嗜酸性粒细胞增多症， 粘蛋白慢性鼻窦炎（EMRS），一种在美国南部常见的亚型。西班牙裔和黑人EMRS患者 存在更晚期的疾病，治疗后结局更差，并且发病率高 包括面部骨骼畸形和视力变化。EMRS表现差异背后的病因 结果未知。关于如何减少疾病负担的基本问题无法得到回答 直到我们了解影响EMRS治疗结果的因素。该提案的目标是产生 预测EMRS治疗结果并减少健康差异的证据。我们会雇佣一个 纵向队列研究，并使用患者和提供者的半结构化访谈来确定重要的EMRS 治疗结果的决定因素。该建议的中心假设是，EMRS差异导致 从个人和社区一级的健康决定因素和环境暴露的相互作用， 对EMRS临床和生物学结局指标的可量化影响。为了测试这一点，我们将：1）开发一个 计算模型集成多水平因素，以预测EMRS术后结局; 2）确定最佳- 实践，以促进高效和有效的临床医生-患者沟通和EMRS护理; 3）开发试点 采取干预措施，减少护理延误。我们将让利益攸关方参与试点干预措施的制定， 反馈拟议的研究符合NIMHD的使命，即开发新的研究方法，以改善 少数民族健康和减少健康差距。研究结果将有助于指导临床实践和治疗 提高EMRS护理质量和减少差异的建议。 培训：为了实现这些目标，莱文博士将接受指导，重点教学，一对一的辅导， 团队科学和混合方法研究的实践培训，包括以下重要方面： 计算建模和定性研究。她将建立一个强大的生物学研究网络， 为独立开辟道路。NIMHD K23奖将为莱文博士提供受保护的时间， 必要的培训，以实现她的职业目标，改善结果和减少EMRS患者的差异。

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.