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

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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.