A Practice-based Intervention to Improve Care for a Diverse Population of Women with Urinary Incontinence

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。这个 干预措施涉及执行变革和组织振兴方案的措施。南加州的三个医疗集团将 参与一项整群随机对照试验，其中60个办公室(每个站点20个)将随机接受 由初级保健提供者组成的临床冠军二人组领导的基于实践的大小便失禁干预 和泌尿科医生/泌尿外科医生，这两人都是该特定医疗小组的成员。这项干预将 包括医生教育、个人表现反馈、电子决策支持、患者教育 使用专门的高级实践提供者(APP)，并实施电子转介服务。 病人护理的质量，如遵守质量指标所证明的，将在 干预实施后的两个随机组。这项提议的调查人员最近 开发并试点测试了一套针对尿失禁的护理质量指标(QI)，包括 对尿失禁的初级护理。遵守这些质量指标将是执行变革和组织振兴方案证据的关键手段， 同时，衡量质量。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 疾病的特定结果、症状严重程度、生活质量和患者知识将在基线上进行测量 使用经过验证的问卷。实施干预后，将向这些问卷发放一份 六个月后第二次，结果将在对照组和干预组之间进行比较。我们 预计这一干预还将减少在照顾代表性不足的少数群体方面的差距。

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. The intervention involved the implementation of PCOR measures. Three Southern California medical groups will participate in a cluster randomized controlled trial in which 60 offices (20 per site) will be randomized to undergo a practice-based incontinence intervention led by a ”clinical champion dyad” comprised of a primary care provider and urologist/urogynecologist, both of whom are members of that specific medical group. The intervention will include physician education, individual performance feedback, electronic decision support, patient education using dedicated advanced practice providers (APPs), and the implementation of an electronic referral service. 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 primary care for UI. Compliance with these quality indicators will be the key means to implement PCOR evidence, while, at the same time, 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, quality of life, and patient knowledge will be measured at baseline using validated questionnaires. After implementation of the intervention, these questionnaires will be given a second time six months later and outcomes will be compared between control and intervention groups. We expect that this intervention will also reduce disparities in care for underrepresented minorities.