Bridging Community-based Continence Promotion and Primary Care

项目摘要/摘要 尿失禁影响了1800多万美国女性，并与 每年超过180亿美元，随着我们人口老龄化，流行率不断上升。大小便失禁限制了质量 并增加抑郁、跌倒和住院的风险。有效的非手术解决方案是存在的，但 只有一半的大小便失禁女性与医疗保健提供者讨论她们的症状。初级保健 提供者认识到诊断和治疗大小便失禁的重要性，但仍不堪重负 不断增加和压倒一切的相互竞争的优先事项，因此大小便失禁仍然被低估和 没有得到充分的对待。我们将测试两个实施策略，以帮助初级保健诊所将筛查和 尿失禁的治疗：询问(筛查)；建议(教育失禁是常见的和可以治疗的)； 和辅助(提供循证治疗)，称为UI-辅助。认识到两国之间的有效伙伴关系 初级保健和公共卫生机构在成功实施时改善健康和减轻负担， 我们假设，作为简化实践便利化的补充的实施战略 伙伴关系建设(利用社区资源，建立联盟，提供持续咨询，以及 创建在线学习社区)将克服实施干预措施的已知障碍，从而 覆盖范围更广，最终产生更大的影响。我们已经与地方、州和国家各级的合作伙伴接洽 其使命与拟议的工作相一致，并支持初级保健，以改善尿路疾病的治疗 大小便失禁，增加了可持续性和后续规模的可能性。我们将比较 简化实践便利化与通过建立伙伴关系简化实践便利化。指导原则 格拉斯哥的覆盖范围、有效性、采用、实施和维护(RE-AIM)框架，我们将 通过对50个初级保健实践进行的3型混合整群随机试验来检验我们的假设。我们将使用 差异差异分析，比较(A)筛查和(B)筛查患者的比例 由研究组在实施(目标1)前后提供大小便失禁的治疗。使用混合 方法，我们将研究实施策略和上下文因素对UI-Assisted覆盖范围的影响， 采用、实施和维护(目标2)和患者报告的结果(目标3)，包括 症状改善、身体和社会功能、心理症状、生活质量、应对 战略、经济关切和不良事件)。随着尿失禁的流行继续 增加，随着初级保健实践面临越来越大的压力，需要用更少的时间和 迫切需要改善护理的资源、可扩展的干预措施和实施战略。

PROJECT SUMMARY/ABSTRACT Urinary incontinence affects more than 18 million U.S. women and is associated with healthcare costs in excess of $18 billion annually, with increasing prevalence as our population ages. Incontinence limits quality of life and increases the risk of depression, falls, and institutionalization. Effective non-surgical solutions exist, but only half of women with incontinence discuss their symptoms with a healthcare provider. Primary care providers recognize the importance of diagnosing and treating incontinence but remain overburdened by increasing and overwhelming competing priorities, and thus incontinence remains underdiagnosed and undertreated. We will test two implementation strategies to help primary care clinics incorporate screening and treatment of urinary incontinence: Ask (screen); Advise (educate that incontinence is common and treatable); and Assist (offer evidence-based treatment), called UI-Assist. Recognizing that effective partnerships between primary care and public health agencies improve health and decrease burden when implemented successfully, we hypothesize that an implementation strategy that supplements streamlined practice facilitation with partnership building (engaging community resources, building coalitions, providing ongoing consultation, and creating an online learning community) will overcome known barriers to intervention implementation, resulting in broader reach and ultimately larger impact. We have engaged partners at the local, state, and national levels whose missions align with the proposed work and supporting primary care to improve treatment of urinary incontinence, increasing likelihood of sustainability and subsequent scale. We will compare the impact of streamlined practice facilitation versus streamlined practice facilitation with partnership building. Guided by Glasgow’s Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will test our hypothesis through a type 3 hybrid cluster randomized trial of 50 primary care practices. We will use a difference-in-differences analyses that compares the proportion of patients who are (a) screened and (b) offered treatment for incontinence before and after implementation (Aim 1) by study arm. Using mixed methods, we will examine the impact of implementation strategy and contextual factors on UI-Assist’s Reach, Adoption, Implementation, and Maintenance (Aim 2) and on patient-reported outcomes (Aim 3), including symptom improvement, physical and social functioning, psychological symptoms, quality of life, coping strategies, economic concerns, and adverse events). As the prevalence of urinary incontinence continues to increase, and as primary care practices face increasing pressure to address more with less time and resources, scalable interventions and implementation strategies to improve care are urgently needed.