Identify, Teach and Treat (IT2): Automating clinical decision pathways for the care of women

项目概要： 在这个应用中，我们描述了一个多层次的实施策略，以系统地提高识别 在初级保健中看到的女性尿失禁（UI），支持以患者为中心的决策， UI，并加速采用循证非手术治疗UI的方式。我们期望 演示如何在与 成熟的质量改进和信息技术基础设施，并结合创新的病人- 集中的支持，可以带来变革性的改进。 拥有65个初级保健诊所和327名初级保健医生，为279，000多人提供护理 妇女，西北医学是伊利诺伊州最大的卫生系统，非常适合实施最新的 关于女性UI非手术治疗的以患者为中心的结局研究证据。同时我们 跨区域、综合的盆腔健康计划已经提供了全面的批准的非手术治疗 治疗UI。我们的建议的关键是我们与Wisercare©的独特现有合作伙伴关系-一家公司 我们与他们一起开发了一个基于证据的共享决策模块，我们将充分利用 整合到初级保健提供者（PCP）的工作流程中。 我们的方法从一套策略开始，以公平和系统地实施筛选UI上， 在初级保健实践中，以一种旨在减轻PCP负担的方式，的患者 屏幕积极的意愿，以了解更多关于用户界面通过在线共享决策工具，可在多个 语言完成Wisercare©共享决策模块的患者将能够分享他们的 结果直接与他们的PCP，促使进一步的咨询和治疗。同时，我们将提供PCP 在整个卫生系统中，提供关于非手术治疗选择的教育和临床决策支持， 用户界面，并将使用实践促进板载新的工作流程。这些过程将定期接受审计， UI筛选将添加到医生绩效指标中。 我们的目标是通过在实施这些之前研究UI的历史识别不足来研究计划影响。 报告患者的治疗偏好和对共享决策过程的满意度; 跟踪UI诊断的变化，以及UI的非手术治疗的利用;并研究PCP的变化 在识别和治疗UI方面提供舒适和支持。我们依靠实施持久的 提供护理方面的变化应是可持续的，并应成为其他系统的典范。

Project Summary: In this application, we describe a multi-level implementation strategy to systematically improve the identification of urinary incontinence (UI) among women seen in primary care, support patient-centered decision making for UI, and accelerate the uptake of evidence-based nonsurgical treatment modalities for UI. We expect to demonstrate how system-level changes aimed at improving UI care, when implemented in conjunction with a mature quality improvement and information technology infrastructure and combined with innovative patient- centered supports, can lead to transformative improvement. With 65 primary care practices and 327 primary care physicians, who provide care to over 279,000 individual women, Northwestern Medicine is the largest health system in Illinois and well suited to implement the latest patient-centered outcomes research evidence regarding nonsurgical treatment for UI in women. Meanwhile our trans-regional, integrated pelvic health program is already providing the full breadth of approved non-surgical treatments for UI. The linchpin of our proposal is our unique existing partnership with Wisercare© – a company with whom we have developed an evidence-based, shared decision-making module for UI that we will fully integrate into the primary care provider (PCP) workflow. Our approach begins with a set of strategies to equitably and systematically implement screening for UI on an annual basis in primary care practices in a way that is designed to reduce the burden on PCPs. Patients who screen positive will to learn more about UI through an online shared decision-making tool available in multiple languages. Patients who complete the Wisercare© shared decision-making module will be able to share their results directly with their PCP, prompting further counseling and treatment. Meanwhile, we will provide PCPs throughout the health system with education and clinical decision support on non-surgical options for treating UI and will use practice facilitation to onboard new workflows. The processes will be periodically audited and screening for UI will be added to physician performance metrics. We aim to study program impact by studying the historical under-identification of UI prior to implementing these changes; reporting on patient treatment preferences and satisfaction with the shared decision-making process; tracking changes in UI diagnosis, and utilization of non-surgical treatment for UI; and studying changes in PCP comfort and support around the identification and treatment of UI. Our reliance on implementing durable changes in care delivery should be sustainable and a model for other systems.