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

增强患者和提供者的能力以改善对尿失禁的护理：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，但对此的认识和循证护理 情况仍然不是最好的。初级保健的一线治疗，有系统支持和专业支持， 具有巨大的潜力，但患者、提供者和系统级别的各种障碍导致诊断不足和 次优管理。 因此，使用已建立的以患者为中心的结果研究证据用于非手术治疗 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。实施 战略包括大规模筛查，授权患者与他们的提供者、提供者 教育和培训，通过护士导航促进执业，以及一个新的移动平台“聊天机器人”，以 让患者参与他们的UI的自我管理。基于系统的战略，用于简化推荐和 治疗也将实施。实施计划与AHRQ的EvidenceNow完全一致 框架：实践便利化、专家咨询、共享学习协作、数据反馈和 基准和健康信息技术支持。 在3年的时间里，我们的目标是：1)在 初级保健实践的大型网络。该计划将涉及对用户界面的系统筛选和识别， 患者授权、提供者培训和授权、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 在所有已招募的做法中，这些要素与当地的量身定做相适应。2)创建以证据为基础、以患者为中心的护理 在优化卫生信息系统的同时将初级保健负担降至最低的途径，包括 嵌入式电子筛查工具，可持续改善护理质量。3)评估 改善尿毒症干预的授权对患者和提供者重要结果的影响 实践提供者和员工之间的知识和信心、实践工作流程和满意度。通过一个 多层次、以病人为本、支持初级保健实践的系统性干预，以及严格的 混合方法分析，拟议的研究在改善实践和患者结局方面具有巨大的潜力 并产生可传输的新知识，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.