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， 名为“提高基层医疗对资源的认识和筛查泌尿系统疾病”的建议 强化治疗（PURSUIT）作为改善泌尿系疾病非手术治疗的一部分 初级保健中的妇女感染率（INTUIT-PC）。我们的首要目标是改善获得 使用最有效的远程分娩对女性退伍军人进行循证非手术UI治疗 在我们的第一个目标中，我们将比较两种模式：我们的mHealth UI 我们的mHealth UI模型结合了通过临床视频提供的临床专业知识 远程医疗（CVT），以改善患者层面的UI症状。利用我们目前的临床试验 基础设施，利用这两个模型，我们提出的研究将纳入一个连续的，多个 分配，随机试验（SMART）设计，以确定远程交付的最佳模式， 非手术UI治疗以改善UI症状。在我们的第二个目标中，我们提出了一种实现方式， 促进实践战略，以提高对循证准则的认识和遵守， 非手术UI治疗的实践水平。我们将采用类型1混合容错实现 设计用于评估我们的移动健康干预措施的有效性，同时使用范围，功效/有效性， 采用、实施和维护（RE-AIM）框架，用于指导我们的实践级实施 approach.对于我们的第三个混合方法论的目标，我们寻求探索女性退伍军人和供应商， 对可能影响未来本地、区域和 全国传播。PURSUIT的目标是针对62个初级保健实践，治疗超过50，000名妇女 老兵实践将随机分组，以接收交互式mHealth UI应用程序， 外科UI治疗模式，具有或不具有通过远程医疗提供的额外临床UI专业知识。所有 初级保健实践将通过PURSUIT工具包获得实践便利，该工具包包括（1）1-2次访视， 实践主持人通过虚拟小组会议和一次现场访问（如果允许）参与实践;（2） 移动医疗或移动医疗应用培训（MAT）培训：MAT培训将通过面对面的方式提供， 学术细节，在线资源，并通过电子邮件或办公时间与项目工作人员持续支持， 在线资源中心：在线资源中心将在整个项目实施过程中提供， 和电子学习模块将作为虚拟实践促进会议的结构基础;以及（4）健康 信息技术（HIT）援助：项目工作人员将为开发UI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 应用程序.我们未来的目标是传播最有效的方式提供非手术UI治疗 为退伍军人医疗保健管理局的全国女性退伍军人提供服务。

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.