U18HS028742

Empowering Women and Providers for Improved Care of Urinary Incontinence: EMPOWER Study - 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 non-surgical treatments for urinary incontinence in women, we propose an integrated, multilevel (patient, provider, 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.

University Hospitals Cleveland Medical Center

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]

Ohio United States

State-Wide

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 207% from $1,027,026 to $3,154,883.