Bridging Community-based Continence Promotion and Primary Care

连接基于社区的失禁促进和初级保健

• 批准号: 10377670
• 负责人: Heidi Wendell Brown
• 金额: $ 105.66万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10377670
• 关键词: Bridging; Community; based; Continence; Promotion

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.

项目摘要/摘要 尿失禁会影响超过1800万的美国妇女，并且与医疗保健成本有关 每年超过180亿美元，随着人口年龄的增长，患病率的增加。尿失禁限制 生活并增加抑郁，跌倒和制度化的风险。存在有效的非手术解决方案，但 只有一半的尿失禁妇女与医疗保健提供者讨论症状。初级保健 提供者认识到诊断和治疗尿失禁的重要性，但仍然沉重 增加和压倒性的竞争优先级，因此尿失禁仍未诊断，并且 被忽视。我们将测试两种实施策略，以帮助初级保健诊所进行筛查和 尿失禁的治疗：询问（屏幕）；建议（教育尿失禁是常见的）； 并协助（提供基于证据的治疗），称为UI辅助。认识到之间有效的伙伴关系 成功实施后，初级保健和公共卫生机构可以改善健康，并降低伯宁 我们假设一种实施策略，该策略可以用 伙伴关系建设（吸引社区资源，建立联盟，提供持续的咨询以及 创建一个在线学习社区）将克服已知的干预实施障碍，从而 在更广泛的范围内，最终影响更大。我们已经与地方，州和国家一级的合作伙伴订婚 其任务与拟议的工作保持一致并支持初级保健以改善尿的治疗 尿失禁，可持续性的可能性增加和随后的规模。我们将比较 通过合作伙伴关系建立的简化实践设施与简化的实践设施。指导 格拉斯哥的影响力，有效性，采用，实施和维护（RE-AIM）框架，我们将 通过50种初级保健实践的3型混合簇随机试验来检验我们的假设。我们将使用一个 比较（a）筛查和（b）的患者比例的差异分析分析 通过研究部门提供了实施前后的治疗方法（目标1）。使用混合 方法，我们将研究实施策略和上下文因素对UI辅助范围的影响， 采用，实施和维护（AIM 2）和患者报告的结果（AIM 3），包括 症状改善，身体和社会功能，心理症状，生活质量，应对 策略，经济问题和不利事件）。随着尿失禁的患病率继续 随着初级保健惯例的增加，随着时间的越来越多的压力，以更少的时间来解决更多问题， 迫切需要资源，可扩展的干预措施和改善护理的实施策略。