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

以实践为基础的干预措施，以改善对尿失禁女性的护理

• 批准号: 10257342
• 负责人: Teryl Nuckols
• 金额: $ 10.18万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10257342
• 关键词: American; Area; Behavior Therapy; California; Caring; Client satisfaction; Clinical; Computerized Medical Record; Control Groups; County; Disease; Distress; Education; Elderly; Equipment and supply inventories; Ethnic group; Exercise; Feedback; General Practitioners; Genitourinary system; Geographic Locations; Goals; Gynecologist; Health Services; Human; Incontinence; Individual; Intervention; Los Angeles; Measurable; Measures; Medical; Medical center; Older Population; Operative Surgical Procedures; Outcome; Patient Care; Patient Education; Patient-Focused Outcomes; Patients; Pelvic floor structure; Performance; Physicians; Physicians' Offices; Population Heterogeneity; Prevalence; Primary Care Physician; Primary Health Care; Provider; Quality Indicator; Quality of Care; Quality of life; Questionnaires; Race; Randomized; Randomized Controlled Trials; Research Personnel; Severities; Site; Specialist; Symptoms; Testing; Time; Triage; Underrepresented Minority; Urinary Incontinence; Urologist; Woman; arm; base; care providers; clinical decision support; disparity reduction; ethnic diversity; group intervention; health care disparity; improved; intervention effect; lifetime risk; medical specialties; member; patient population; pelvic organ prolapse; prospective; racial and ethnic disparities; secondary analysis

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.

项目摘要 美国女性的尿失禁(UI)负担在人力和经济方面都是巨大的， 随着老年人口的增长，这一数字继续上升。这项提案的目标是改善对 提供给女性的用户界面，并在这样做的同时减少对专业护理的利用，同时改善患者 结果。具体目标1旨在提高为不同种族提供的大小便失禁护理质量 通过初级保健提供者参与的有控制的以实践为基础的干预措施，扩大妇女人口。三 南加州医疗集团将参加一项整群随机对照试验，在试验中，40个办公室(12- 每个站点14个)将随机接受基于练习的大小便失禁干预 泌尿科医生/妇科医生“临床冠军”，是该特定医疗小组的成员。干预措施 将包括医生培训、个人绩效反馈、电子决策支持和患者 教育。病人护理的质量，通过遵守质量指标来证明，将被衡量 在实施干预后，跨越两个随机的手臂。这项提案的调查人员 最近开发并试点测试了一套用于尿失禁的护理质量指标(QI)， 包括在全科医生和专科医生层面提供的护理。遵守这些质量指标 将是衡量质量的关键手段。此外，在具体目标2中，将比较专家的利用情况 干预前后。研究人员假设，改善初级卫生保健水平 护理医生将减少专科转诊的数量。最后，具体目标3将寻求衡量效果 对患者预后的干预。在以实践为基础的干预将改善的假设下 特定疾病的结局、症状严重程度和生活质量将由泌尿生殖系统在基线上进行衡量 痛苦问卷-简表(UDI-6)和失禁影响问卷-简表(IIQ-7)。之后 实施干预后，这些问卷将第二次发放，结果将 对照组与干预组比较。我们预计，这种干预也将缩小差距。 照顾未被充分代表的少数民族。