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

识别、教导和治疗 (IT2)：自动化临床决策路径以护理女性

• 批准号: 10377834
• 负责人: KIMBERLY Sue KENTON
• 金额: $ 69.96万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10377834
• 关键词: Identify; Teach; Treat; IT2; Automating

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.

项目总结： 在这个应用中，我们描述了一个多层次的实施策略，以系统地提高识别能力 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 促进以循证为基础的非手术治疗手段治疗尿崩症。我们希望 演示系统级更改如何与 成熟的质量改进和信息技术基础设施，并结合创新的患者- 以支持为中心，可以带来变革性的改进。 拥有65家初级保健诊所和327名初级保健医生，他们为超过27.9万人提供护理 女性，西北医学是伊利诺伊州最大的医疗系统，非常适合实施最新的 关于女性尿失禁非手术治疗的以患者为中心的结果研究证据。与此同时，我们的 跨区域的综合骨盆健康计划已经提供了所有批准的非手术治疗 治疗尿失禁。我们提议的关键是我们与WiserCare-一家公司-独特的现有合作伙伴关系 我们已经与他一起开发了一个基于证据的、共享的用户界面决策模块，我们将完全 整合到初级保健提供者(PCP)工作流程中。 我们的方法从一系列策略开始，以公平和系统地实现对 在初级保健做法的年度基础上，旨在减轻初级保健医生的负担。患者 Screen积极希望通过在线共享决策工具了解更多关于用户界面的信息 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，我们将提供初级保健医生 在整个卫生系统中，为非手术治疗方案提供教育和临床决策支持 用户界面，并将使用实践促进加入新的工作流程。这些流程将定期进行审计，并 对UI的筛查将被添加到医生绩效指标中。 我们的目标是在实施这些项目之前，通过研究用户界面的历史识别不足来研究项目的影响 变化；报告患者的治疗偏好和对共同决策过程的满意度； 跟踪尿失禁诊断的变化，以及对尿失禁非手术治疗的利用；并研究PCP的变化 舒适性和支持性围绕着UI的识别和治疗。我们对实施可持续发展的依赖 护理提供方面的变化应该是可持续的，并应成为其他系统的榜样。