The Comparative Effectiveness of Adjuvant Adenoidectomy in Surgical Management of Otitis Media

Kavita Dedhia is an assistant professor in otolaryngology at the University of Pennsylvania (UPENN) and Children’s Hospital of Philadelphia (CHOP). She has clinical expertise in pediatric otolaryngology, specifically chronic ear disease. Dr. Dedhia has recently completed the Master in Health Policy Research program at UPENN through which she gained introductory skills in study design and statistics. Her long-term goal is to become an independent surgeon-scientist and international leader in pediatric otitis media research. This career development award serves as a vehicle to achieve this goal by focusing on gaining and refining the necessary skills to evaluate the effectiveness of surgical otitis media management and patient-centered outcomes. Otitis media is the 3rd most common reason for pediatric primary care visits, yet evidence for type of surgical management has been limited. Most studies lack sociodemographic and regional diversity, have high attrition and cross-over rates, and infrequent assessment of patient-reported outcomes. The aims outlined in this proposal will serve to improve evidence optimizing surgical otitis media management, through using the PEDSnet learning health system. PEDSnet is a clinical network consisting of electronic health record data from 11 of the largest pediatric institutions throughout the United States. Using PEDSnet, a clinical consortium of pediatric otolaryngologists will be formed to assist in carrying out the aims. Aim 1 will evaluate the effectiveness of adjuvant adenoidectomy and heterogeneity of treatment effect based on age and medical conditions at-risk for developmental delay through analyzing the PEDSnet dataset from 11 institutions. Aim 2 will be a prospective cohort study at CHOP that will account for patient and environmental factors not available within the PEDSnet dataset to assess adjuvant adenoidectomy effectiveness. Input for study design and data collection will be obtained from the pediatric otolaryngology consortium. This study will assess patient recruitment, retention, uniform data collection rigor, reproducibility, and estimate effect sizes for a larger scale multi-institutional study at all PEDSnet sites. To carry-out the abovementioned aims, the candidate has formed a strong mentorship team. Her primary mentor, Dr. Christopher Forrest, is the founder of PEDSnet and adept in utilizing the learning health system model in pediatric outcomes research. Her co-mentors are equally impressive: Dr. Gregory Tasian is an expert in pragmatic trials and has formed a pediatric urology clinical network for studying pediatric urological disease, Dr Yong Chen has extensive expertise in medical informatics, causal inference, and comparative effectiveness research; and Dr. Diego Preciado is a pediatric otolaryngology surgeon-scientist who is an expert on otitis media research. The proposed plan will allow the candidate to become proficient in informatics, causal inference, comparative effectiveness, advanced statistical analysis, and pragmatic clinical trials to allow for a successful career as an independent surgeon-scientist.