Empowering Women and Providers for Improved Care of Urinary Incontinence : EMPOWER Study

授权患者和提供者改善尿失禁护理：EMPOWER研究 尿失禁（UI）影响超过50%的女性。非手术治疗，包括行为治疗 干预或药物治疗，通常是有效的，但认识和循证护理， 情况仍然不理想。初级保健中的一线治疗，有系统支持和专业支持， 具有巨大的潜力，但各种患者，提供者和系统级障碍导致诊断不足， 次优管理 因此，使用以患者为中心的非手术治疗结果研究证据， 针对女性尿失禁，我们提出了一种综合的、多层次（患者、提供者和系统）的方法 这解决了在初级保健环境中诊断和管理UI的关键障碍。执行 策略包括大规模筛查，使患者能够与他们的提供者讨论UI， 教育和培训，通过护士导航促进实践，以及一个新的移动的平台“聊天机器人”， 使患者参与UI的自我管理。一项基于系统的简化转诊战略， 治疗也将实施。实施计划与AHRQ的EvidenceNow完全一致 框架：实践促进、专家咨询、共享学习协作、数据反馈和 制定基准和提供保健信息技术支助。 在3年的时间里，我们的目标是：1）在全球范围内实施“增强用户界面”计划， 初级保健实践的大型网络。该计划将涉及系统的筛选和识别UI， 患者赋权，提供者培训和赋权，护士导航，简单实用 循证技术。我们假设该计划将忠实于所有计划的实施， 在所有招聘实践中，都要考虑当地的具体情况。2)创建以患者为中心的循证护理 最大限度地减少初级保健负担的途径，同时优化卫生信息系统， 嵌入式电子筛查工具，可持续提高护理质量。3)评估 赋权改善UI干预对患者和提供者重要结局的影响 知识和信心、实践工作流程以及实践提供者和工作人员的满意度。通过 多层次、以患者为导向、支持初级保健实践的系统干预，以及严格的 混合方法分析，拟议的研究有很大的潜力，以改善实践和病人的结果 并产生可转移的新知识，以改善对尿失禁妇女的护理。

Empowering patients and providers to improve care for urinary incontinence: EMPOWER Study Urinary incontinence (UI) affects over 50% of women. Non-surgical treatment, including behavioral interventions or pharmacotherapy, is usually effective, but recognition and evidence-based care for this condition remains suboptimal. Frontline treatment in primary care, with system support and specialty backup, has great potential, but a variety of patient-, provider-, and system-level barriers result in under-diagnosis and suboptimal management. Therefore, using established patient-centered outcomes research evidence for nonsurgical treatments for urinary incontinence in women, we propose an integrated, multilevel (patient, provide, and system) approach that addresses key barriers to diagnosing and managing UI in the primary care setting. Implementation strategies include large-scale screening, empowering patients to discuss UI with their providers, provider education and training, practice facilitation through nurse navigation, and a novel mobile platform “chatbot” to engage patients in self-management of their UI. A system-based strategy for streamlined referral and treatment will also be implemented. The implementation plan is fully aligned with AHRQ's EvidenceNow framework: practice facilitation, expert consultation, shared learning collaborative, data feedback and benchmarking, and health-information technology support. Over the course of 3 years, we aim to 1) Implement the “Empowerment for Improving UI” program across a large network of primary care practices. The program will involve systematic screening and identification of UI, patient empowerment, provider training and empowerment, nurse navigation, and simple and practical evidence-based technology. We hypothesize that the program will be implemented with fidelity to all planned elements and with local tailoring in all recruited practices. 2) Create an evidence-based patient-centered care pathway that minimizes burden on primary care while optimizing health-information systems, including an embedded electronic screening tool, that lead to sustainable improvement in quality of care. 3) Assess the impact of the Empowering for Improving UI intervention on outcomes important to patients and on provider knowledge and confidence, practice workflow and satisfaction among practice providers and staff. Through a systemic intervention that is multilevel, patient-oriented and supportive of primary care practice, and a rigorous mixed methods analysis, the proposed research has great potential to improve practice and patient outcomes and to generate transportable new knowledge to improve care for women with urinary incontinence.