U18HS028738

Bridging Community-Based Continence Promotion and Primary Care - 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 analysis 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.

The Medical College Of Wisconsin

TO SUPPORT RESEARCH AND EVALUATIONS, DEMONSTRATION PROJECTS, RESEARCH NETWORKS, AND MULTIDISCIPLINARY CENTERS AND TO DISSEMINATE INFORMATION ON HEALTH CARE AND ON SYSTEMS FOR THE DELIVERY OF SUCH CARE INVOLVING: (1) THE QUALITY, EFFECTIVENESS, EFFICIENCY, APPROPRIATENESS AND VALUE OF HEALTH CARE SERVICES, (2) QUALITY MEASUREMENT AND IMPROVEMENT, (3) THE OUTCOMES, COST, COST-EFFECTIVENESS, AND USE OF HEALTH CARE SERVICES AND ACCESS TO SUCH SERVICES, (4) CLINICAL PRACTICE, INCLUDING PRIMARY CARE AND PRACTICE-ORIENTED RESEARCH, (5) HEALTH CARE TECHNOLOGIES, FACILITIES AND EQUIPMENT, (6) HEALTH CARE COSTS, PRODUCTIVITY, ORGANIZATION, AND MARKET FORCES, (7) HEALTH PROMOTION AND DISEASE PREVENTION, INCLUDING CLINICAL PREVENTIVE SERVICES, (8) HEALTH STATISTICS, SURVEYS, DATABASE DEVELOPMENT, AND EPIDEMIOLOGY, (9) DIGITAL HEALTHCARE RESEARCH, AND (10) PATIENT SAFETY RESEARCH, INCLUDING HEALTHCARE-ASSOCIATED INFECTIONS. IN SUPPORT OF THIS RESEARCH, THE AGENCY HAS A SPECIAL INTEREST IN HEALTH CARE AND ITS DELIVERY IN THE INNER CITY, IN RURAL AREAS, AND FOR PRIORITY POPULATIONS (LOW-INCOME GROUPS, MINORITY GROUPS, WOMEN, CHILDREN, THE ELDERLY, AND INDIVIDUALS WITH SPECIAL HEALTH CARE NEEDS).

93.226 - Research on Healthcare Costs, Quality and Outcomes

Division of Grants Management [HHS - AHRQ]

Center for Evidence and Practice Improvement (CEPI) [HHS - AHRQ]

Milwaukee, Wisconsin 53226 United States

Single Zip Code

INTUIT-PC: Improving Nonsurgical Treatment of Urinary Incontinence among women in Primary Care: Dissemination and Implementation of PCOR Evidence (U18) (RFA-HS-21-001)

Amendment Since initial award the End Date has been extended from 01/31/25 to 01/31/26 and the total obligations have increased 159% from $1,095,915 to $2,840,351.