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

项目摘要 尿失禁（UI）对美国妇女的负担是巨大的人力和财力， 随着老年人口的不断增长，该提案的目的是改善对 为女性提供UI，并在这样做的过程中，减少了对专科护理的利用，同时改善了患者 结果。具体目标1旨在提高为不同种族提供的失禁护理的质量， 通过涉及初级保健提供者的基于受控实践的干预措施，对妇女人口进行干预。三 南加州医疗团体将参与一项随机对照试验，其中40个办事处（12- 每个研究中心14例）将被随机分配接受基于实践的失禁干预，由 泌尿科医生/妇科泌尿科医生“临床冠军”，他是该特定医疗组的成员。干预 将包括医生教育，个人表现反馈，电子决策支持，和病人 教育将衡量病人护理的质量，以遵守质量指标为依据 在实施干预措施后，两个随机化组之间。这项提案的调查人员 最近开发并试点测试了一套尿失禁护理质量指标（QIs）， 包括在全科医生和专科医生两级提供的护理。符合这些质量指标 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 在干预前后。研究人员假设，改善初级保健水平， 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 of the intervention干预on patient病人outcomes结果.假设基于实践的干预会改善 疾病特异性结局、症状严重程度和生活质量将在基线时由泌尿生殖系统 痛苦量表-简表（UDI-6）和失禁冲击量表-简表（IIQ-7）。后 实施干预措施后，这些问卷将再次发放，结果将 对照组和干预组之间的比较。我们期望这种干预也将减少差距 关注弱势群体。

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.