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

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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.