Immunopathology of chronic sinusitis

Faculty Mentor’s Name: Dr. Jennifer Mulligan
Email: jennifer.mulligan@medicine.ufl.edu
Phone Number: (352) 273-8638
Project Category: Translational
International Component or Travel: No

Research Project Description:
The laboratory of Jennifer Mulligan, PhD, Division of Pulmonary Medicine, in collaboration with Jeb Justice, MD and Brian Lobo, MD, Department of Otolaryngology, welcome medical students interested in conducting translational research related to the immunopathology of chronic sinusitis (CRS). CRS affects up to 16% of the US population with direct costs of nearly $22 billion per year. Its negative impact on quality of life exceeds other chronic conditions, such as heart failure and chronic obstructive pulmonary disease.

In conjunction with senior members of the research team, students will be given the opportunity to develop and execute their own unique project as a part of several ongoing NIH-funded studies. At the completion of the rotation, students will be strongly encouraged to prepare a first author manuscript and present their findings at an upcoming meeting of the American Rhinologic Society (virtual or in person). Potential research topics may include, but are not limited to, airway delivery of vitamin D to improve epithelial cell dysfunction related to CRS, role of epithelial cell complement production in CRS and identification of novel mediators of olfactory dysfunction. Additional information about these projects can be found on NIH Reporter (https://projectreporter.nih.gov/reporter.cfm).

Sarcoidosis Patient’s Perceptions of Access to Care

Faculty Mentor’s Name: Dr. Divya Patel
Phone Number: (352) 273-8738
Project Category: Clinical
International Component or Travel: No

Research Project Description:
1. Background: Access to care can be defined as the opportunity or ease with which consumers or communities are able to use appropriate services in proportion to their needs (1). Although the concept of access to care in our healthcare system is complex and open to a variety of interpretations, it can be summarized as the interface between potential users and healthcare resources. It is thus heavily influenced by the characteristics of those who supply as well as those who utilize the services (2). In addition, access to care must be considered appropriate for the varying health needs of different groups in society and the availability of such services to those particular populations. The barriers to access of care must then be examined in the context of the social determinants of health, defined as the forces beyond biology which impact health outcomes (3). These variables include a host of political, socioeconomic, structural, as well as cultural factors that shape an individual’s ability to utilize services available to benefit his or her health. The aim of our study is to identify these social determinants of health that impact access to care for patients with sarcoidosis.
Sarcoidosis is a systemic granulomatous disease of unclear etiology that leads to multisystem organ dysfunction. It is a unique disease entity that disproportionately affects U.S. blacks more frequently as well as with higher severity. Medical literature cites social determinants as an influential factor in predicting disease severity and health inequity for this particular disease (4, 5, 6). Rabin et al evaluated patient with biopsy proven sarcoidosis and found that lower income patients were more likely to be black, female, with a less than high school education, and uninsured or with public insurance. These social determinants subsequently correlated with worse physical functioning and dyspnea scores, more trouble obtaining medications, increased missed appointments, and higher severity of sarcoidosis defined as more extensive organ involvement, higher radiographic staging, and worse pulmonary function tests. The goal of our study is to further examine these barriers to care for sarcoidosis patients that lead to disparities in health outcomes. We plan to do this by conducting an anonymous survey of sarcoidosis patients consisting of questions tailored to identify their perceived obstacles to their access to care. We aim to measure equity of access to care in terms of availability, utilization, outcomes of services provided, and self-perceived quality of care delivered.
2. Specific Aims:
1) What are social determinants of health in relation to the presentation and management of sarcoidosis? Key social determinants we plan to survey include: race, age, gender, location, income level, education level, insurance and how they correlate with diagnosis, severity, specialist care, etc.
2) What are the specific barriers to access of appropriate and quality care for sarcoidosis patients? Barriers including but not limited to: cost, transportation, availability of specialist care/centers, stigma, etc.
3) How do these social determinants influence sarcoidosis care and outcomes? Examine for correlation of above factors with disease severity, ECOG scores, staging, and treatments.
4) How do we proceed with mitigating these barriers to eliminate sarcoid-related disparities? Hypothesize possible solutions to any disparities identified.
3. Research Plan / Study Description:
• We have developed a survey to investigate access to care in the sarcoidosis population modeled after on prior validated surveys in other disease populations. This survey includes questions about individuals’ experiences of access to healthcare, continuity of care, burdens of care, and related functional status
• Recruitment Method: An email will be sent out the Foundation for Sarcoidosis Research (FSR) Patient Registry and online support community. Patients in this registry are located throughout the United States and have varying socioeconomic backgrounds
• We will distribute this anonymous survey through Qualtrics
• Data will be tabulated and analyzed using routine parametric and standard descriptive statistics (e.g. Chi-squared tests for categorical variable, ANOVA for normally-distributed variables, Kruskal-Wallis tests for non-normally distributed data). Depending on the size and diversity of the responding population, subgroup analyses will be conducted regarding income, gender, race, and geography in regards to access to healthcare, functional status and treatment.
• This is a cross-sectional study design
• Exclusion criteria are those who do not wish to take the survey, subjects under 18 years of age.
• Pregnant women may be included in the study
• No identifiers will be obtained. Data will only be analyzed in aggregate to ensure to protect PHI