A Practice-based Intervention to Improve Care for Women with Urinary Incontinence

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PROJECT ABSTRACT The burden of urinary incontinence (UI) on American women is immense in human and financial terms, and continues to rise with the growing population of older adults. The goal of this proposal is to improve the care for UI provided to women and, in doing so, decrease the utilization of specialty care while improving patient outcomes. Specific Aim 1 seeks to improve the quality of incontinence care provided to an ethnically diverse population of women through a controlled practice-based intervention involving primary care providers. Three Southern California medical groups will participate in a cluster randomized controlled trial in which 40 offices (12- 14 per site) will be randomized to undergo a practice-based incontinence intervention led by a urologist/urogynecologist ”clinical champion” who is a member of that specific medical group. The intervention will include physician education, individual performance feedback, electronic decision support, and patient education. The quality of patient care, as evidenced by compliance with the quality indicators, will be measured across the two randomized arms after implementation of the intervention. The investigators for this proposal recently developed and pilot-tested a set of quality-of-care indicators (QIs) for urinary incontinence that encompass care provided at both the generalist and specialist level. Compliance with these quality indicators will be the key means to measure quality. In addition, in Specific Aim 2, utilization of specialists will be compared before and after the intervention. The investigators hypothesize that improved care at the level of the primary care physician will reduce the number of specialty referrals. Lastly, Specific Aim 3 will seek to measure the effect of the intervention on patient outcomes. Under the hypothesis that a practice-based intervention will improve disease-specific outcomes, symptom severity and quality of life will be measured at baseline by the urogenital distress inventory-short form (UDI-6) and the incontinence impact questionnaire-short form (IIQ-7). After implementation of the intervention, these questionnaires will be given a second time and outcomes will be compared between control and intervention groups. We expect that this intervention will also reduce disparities in care for underrepresented minorities.