Improving Primary Care Understanding of Resources and Screening for Urinary Incontinence to Enhance Treatment (PURSUIT)

退伍军人事务部综合服务网络(VISN-7)是我们的目标区域 题为《提高对初级保健资源的了解和对尿路疾病筛查的建议》 加强尿失禁治疗(追求)“作为改进非手术治疗尿路疾病的一部分 初级保健中的妇女大小便失禁(Intuit-PC)。我们的首要目标是改善获取 使用最有效远程分娩的退伍军人女性非手术尿失禁循证治疗 在我们的第一个目标中，我们将比较两个模型：我们的mHealth用户界面 医疗设备和我们的mHealth用户界面模型与通过临床视频提供的临床医生专业知识相结合 远程医疗(CVT)可改善患者层面的尿失禁症状。利用我们目前的临床试验的优势 基础设施使用这两种模式，我们提议的研究将结合顺序的、多个 分配、随机试验(SMART)设计，以确定远程交付的最佳模型 非手术治疗改善尿失禁症状。在我们的第二个目标中，我们提出一个实现 实践便利化战略，以提高认识和遵守循证指导方针 实践层面的非手术尿失禁治疗。我们将采用第1类混合效率-实施 旨在评估我们的移动健康干预的有效性，同时使用REACH、功效/有效性、 采用、实施和维护(RE-AIM)框架来指导我们的实践级实施 接近。对于我们的第三个混合方法目标，我们试图探索女性退伍军人和提供者的 对可能影响未来远程用户界面处理的本地、地区和 全国传播。追求的目标是62家初级保健诊所，为50,000多名妇女提供治疗 退伍军人。实践将在集群中随机进行，以接收交互式mHealth UI应用程序 具有或不具有通过远程医疗提供的额外临床UI专业知识的外科UI治疗方式。全 初级保健实践将通过Purchage工具包获得实践便利，该工具包包括(1)1-2次访问 通过虚拟小组会议和一次现场访问(如果允许)练习辅导员参与实践；(2) 移动医疗或移动医疗应用培训(MAT)培训：MAT培训将通过面对面提供 学术细节、在线资源，以及通过电子邮件或办公时间与项目人员和 专家；3)在线资源中心：在线资源中心将在整个项目实施过程中可用， 电子学习模块将作为虚拟实践促进会议的结构基础；和(4)健康 信息技术(HIT)援助：项目工作人员将为以下项目开发用户界面注册表提供支持 通过mHealth非手术用户界面进行人口管理、质量改进和数据报告 申请。我们未来的目标是传播提供非手术尿失禁治疗的最有效的方式 为退伍军人医疗管理局内的全国退伍军人提供服务。

The Department of Veterans Affairs Integrated Service Network (VISN-7) is our targeted region for this proposal, named “Improving Primary Care Understanding of Resources and Screening for Urinary Incontinence to Enhance Treatment (PURSUIT)” as part of the Improving Nonsurgical Treatment of Urinary Incontinence among women in Primary Care (INTUIT-PC). Our overarching goal is to improve access to evidence-based nonsurgical UI treatment for women Veterans using the most effective remote delivery modality in the Southeast region of the U.S. In our first aim, we will compare two models: our mHealth UI modality alone and our mHealth UI model combined with clinician expertise delivered via clinical video telehealth (CVT) to improve UI symptoms at the patient level. With leverage from our current clinical trial infrastructure that utilizes these two models, our proposed study will incorporate a sequential, multiple assignment, randomized trial (SMART) design to determine the optimal model for remote delivery of nonsurgical UI treatment for UI symptom improvement. In our second aim, we propose an implementation strategy of practice facilitation, to improve awareness and adherence to evidence-based guidelines on nonsurgical UI treatments at the practice level. We will employ a Type 1 Hybrid Effectiveness-Implementation design to assess the effectiveness of our mHealth intervention, while using the Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide our practice level implementation approach. For our third mixed-methodology aim, we seek to explore women Veterans’ and providers’ perceptions of key factors that may influence future remote UI treatment scalability for local, regional, and national dissemination. PURSUIT aims to target 62 primary care practices that treat over 50,000 women Veterans. Practices will be randomized in clusters to receive the interactive mHealth UI application non- surgical UI treatment modality with or without additional clinical UI expertise delivered via telehealth. All primary care practices will receive practice facilitation with a PURSUIT toolkit that includes (1) 1-2 visits with a practice facilitator engaging practices through virtual group sessions and one on-site visit (if allowed); (2) Mobile-health or mHealth Application Training (MAT) training: MAT training will be offered through in-person academic detailing, online resources, and ongoing support via email or office hours with project staff and experts; 3) Online Resource Hub: The online resource hub will be available throughout project implementation, and e-learning modules will serve as the structural base for virtual practice facilitation sessions; and (4) Health information technology (HIT) assistance: Project staff will offer support in developing UI registries for population management, quality improvement, and data reporting through the mHealth nonsurgical UI application. Our future goal is to disseminate the most effective modality for delivering nonsurgical UI treatment for women Veterans nationally within the Veterans Healthcare Administration.