Investigator Spotlight

5 Questions for Researchers

1. Why is your area of science important?
One of my interests is in methods for analyzing data that is not “well collected”, which can mean anything from outcomes that are only partially measured to data that is only available in summarized or aggregated format. A big part of this is a secondary use of data, or analyses of data sets that were originally collected for another purpose. As a biostatistician, I often need to get creative statistically to be able to answer researchers’ clinical questions with this kind of data, but also to be aware of its limitations.

2. What was important in your Health Services Research training?
As a biostatistician, my path to health services research was on the non-traditional side. My undergraduate degree is in English Literature, but I began college planning on pursuing pre-med. I took courses in chemistry, linear algebra, and advanced mathematics, but the courses I found to be most interesting were an intro statistics course and a course in computer modeling and simulation of ecology and evolution. This led me to apply to master’s programs in epidemiology, but on enrolling in the program I discovered that all the courses I was most interested in were in the biostatistics department. Switching degree tracks allowed me to obtain training in the theory and methods of statistical science, which I have been applying to health services research since joining ACCORDS.

3. What are the major take-home messages your current research provides?
My research has shown me that is almost always possible to answer a researcher’s questions with the data they have, even if that data is not perfect. One of the ways I try to think about addressing these issues is to conceptualize what would be the “ideal” design to answer that same question, and then try to bridge the gap between that approach and the data we have. 

4. What are your goals or areas for future research?
I currently have a CCTSI pilot grant to investigate methods for time-to-event analysis of aggregated data in the presence of a non-susceptible fraction (i.e., individuals who will never experience the event). This was motivated by vaccine hesitancy research with Drs. Allison Kempe and Sean O’Leary of ACCORDS, who are interested in ways to improve HPV vaccination rates. The event of interest is HPV vaccine series initiation or completion. There is interest in particular in how to reach highly hesitant parents, who may fall into such a “non-susceptible” group, so I want to understand what factors may be associated with membership in this group. The aggregated data part of the project is relevant because data sharing can be challenging when working with entities that may prefer not to share individual patient data. My hope is that this research will foster even more productive collaborations with these groups, either by allowing us to do the same research with aggregated data, or by informing discussions on how much individual patient data may be needed to answer given research questions.

5. What advice do you have for researchers who want to work in this area? OR What is the most important advice you have received from your mentors?
New collaborations can often drive interesting methods of research, even in areas you weren’t familiar with previously, so always keep an open mind and don’t be afraid to propose novel statistical approaches when they might be helpful.

Dr. Vijaya Vemulakonda is an Associate Professor of Pediatric Urology, Director of Research, and Residency Program Director for the Division of Urology at the University of Colorado. She earned her law degree cum laude from Harvard Law School and her medical degree from the University of Mississippi School of Medicine. She completed her urology residency at Baylor College of Medicine and her pediatric fellowship at Seattle Children's Hospital, University of Washington School of Medicine. Her clinical interests include the management of antenatally detected congenital urologic anomalies, including UPJ obstruction, vesicoureteral reflux, posterior urethral valves, and bladder exstrophy variants. These interests have led to her development of multidisciplinary clinical teams focused on the prenatal and postnatal care of infants and children with congenital anomalies of the kidney and urinary tract (CAKUT). Her research utilizes qualitative and mixed methods as well as electronic health record (EHR)-based data collection tools to study surgical outcomes and reduce disparities of care for infants and children with CAKUT. Current funding includes an AHRQ K08 Career Development Award and the AUA Rising Star in Urologic Research Award, which have led to the development of the Pediatric Urologists Researching Surgical outcomes Using Information Technology (PURSUIT) Network, an EHR-based  multi-center collaborative surgical research network currently focused on demographic variations in the care for infants with suspected UPJ obstruction.

1. Why is your area of science important?
Pediatric urology focuses on the diagnosis and treatment of relatively rare congenital kidney, urinary tract, and genital anomalies. Due to the low numbers of patients with these diagnoses at any single center, there is a lack of well-designed studies to identify best practices for the surgical treatment of these patients. Additionally, surgeons often lack the time and resources needed to meaningfully participate in prospective collaborative research. By developing tools that leverage existing clinical workflow, such as clinical charting during routine clinical practice, we have been able to prospectively collect standardized data across multiple pediatric urologic practices, thereby allowing us to overcome the barriers to meaningful study of who gets surgery and what the effects of surgery are on renal outcomes. This work has allowed us to identify and develop strategies to address demographic variations in care, thereby providing the infrastructure needed to develop evidence-based best practice guidelines for infants and children with these rare conditions.

2. What was important in your Health Services Research training?
I think that both my law background and my HSR training have given me a unique perspective on the current barriers to research in pediatric urology and have fueled my interest in building multi-center collaborations to address underlying demographic inequities in care and to develop clinical guidelines that meaningfully improve the overall care of infants and children with congenital urologic anomalies. My training in the CCTSI Clinical Faculty Scholars Program also afforded me the opportunity to identify the benefits of multidisciplinary teams to answer research questions that I alone do not have the expertise to address. Finally, my affiliation with ACCORDS has allowed me to find mentors and collaborators across the spectrum of qualitative and mixed methods research, decision aid development and evaluation, and implementation science, needed for me to meaningfully address the current gaps in my field of research.

3. What are the major take-home messages your current research provides?
My qualitative work has helped me to recognize that the uncertainty inherent in a prenatal diagnosis adversely impacts parents’ ability to understand their child’s diagnosis and meaningfully participate in surgical decision-making. Additionally, the lack of clear standards for the evaluation and treatment of prenatal hydronephrosis leads surgeons to rely on their own experience rather than objective standards when providing treatment recommendations, thereby leading to differences in surgical counseling based on perceived parental characteristics. My K award also allowed me to develop the Pediatric Urologists Researching Surgical outcomes Using Information Technology (PURSUIT) Network, a 5-site research collaboration that uses EHR-based data collection tools integrated into the clinical note to prospectively collect data on infants and children with congenital urologic anomalies. Our multi-center collaborative research has found that practices widely vary in the studies obtained to diagnose hydronephrosis, the rates of surgical intervention, and the timing and extent of follow-up evaluation, limiting the ability to meaningfully study the effect of surgery on renal outcomes or identify best practices in these infants without interventions to standardize the ways in which these patients are evaluated.

4. What are your goals or areas for future research?

My long-term goal is to conduct a pragmatic trial that more definitively establishes the role of surgery in preserving renal function in infants with CAKUT (congenital anomalies of the kidney and urinary tract) and utilize implementation methods to effectively integrate best practice guidelines into clinical practice. As a first step, we are currently pursuing R01 funding to (1) use implementation science methods to develop and implement the evaluative infrastructure needed to study short-term and long-term renal outcomes; and (2) to develop and test the effect of parent-centered decision aids on the ability of parents to meaningfully participate in treatment discussions and on the quality of the decision for surgical or non-surgical treatment of infants with prenatal hydronephrosis. Additionally, the PURSUIT network continues to collect clinical data on the evaluation and treatment of infants with CAKUT, thereby allowing us to expand the scope of our current research to multiple congenital urologic anomalies.

5. What advice do you have for researchers who want to work in this area? 

My advice is: (1) find an area of research that you find meaningful and impactful. For me, knowing that the work I am doing has the potential to empower parents to meaningfully participate in the care of their children and develop the evidence needed to improve pediatric urologic helps me to face the hurdles (and there are many) that I have faced in developing a successful career as a surgeon-scientist; (2) look for mentors and collaborators outside of your field of expertise. I have found that being able to work with people outside of surgery has allowed me to gain new perspectives on issues in pediatric urology, allowing me to develop a unique clinical and research niche both locally and nationally; and (3) remember to find time for the things that keep you grounded. Being the parent of a 5-year old helps me to stay humble and to keep my research ups and downs in perspective!