Empowering Women and Providers for Improved Care of Urinary Incontinence : EMPOWER Study

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Empowering patients and providers to improve care for urinary incontinence: EMPOWER Study Urinary incontinence (UI) affects over 50% of women. Non-surgical treatment, including behavioral interventions or pharmacotherapy, is usually effective, but recognition and evidence-based care for this condition remains suboptimal. Frontline treatment in primary care, with system support and specialty backup, has great potential, but a variety of patient-, provider-, and system-level barriers result in under-diagnosis and suboptimal management. Therefore, using established patient-centered outcomes research evidence for nonsurgical treatments for urinary incontinence in women, we propose an integrated, multilevel (patient, provide, and system) approach that addresses key barriers to diagnosing and managing UI in the primary care setting. Implementation strategies include large-scale screening, empowering patients to discuss UI with their providers, provider education and training, practice facilitation through nurse navigation, and a novel mobile platform “chatbot” to engage patients in self-management of their UI. A system-based strategy for streamlined referral and treatment will also be implemented. The implementation plan is fully aligned with AHRQ's EvidenceNow framework: practice facilitation, expert consultation, shared learning collaborative, data feedback and benchmarking, and health-information technology support. Over the course of 3 years, we aim to 1) Implement the “Empowerment for Improving UI” program across a large network of primary care practices. The program will involve systematic screening and identification of UI, patient empowerment, provider training and empowerment, nurse navigation, and simple and practical evidence-based technology. We hypothesize that the program will be implemented with fidelity to all planned elements and with local tailoring in all recruited practices. 2) Create an evidence-based patient-centered care pathway that minimizes burden on primary care while optimizing health-information systems, including an embedded electronic screening tool, that lead to sustainable improvement in quality of care. 3) Assess the impact of the Empowering for Improving UI intervention on outcomes important to patients and on provider knowledge and confidence, practice workflow and satisfaction among practice providers and staff. Through a systemic intervention that is multilevel, patient-oriented and supportive of primary care practice, and a rigorous mixed methods analysis, the proposed research has great potential to improve practice and patient outcomes and to generate transportable new knowledge to improve care for women with urinary incontinence.