Improving Lower Urinary Tract Symptoms through Interdisciplinary Research and Collaboration between Primary and Specialty Care

通过跨学科研究以及初级和专科护理之间的合作改善下尿路症状

• 批准号: 10260603
• 负责人: JOAN Marie NEUNER
• 金额: $ 19.09万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10260603
• 关键词: Address; Adherence; Adrenergic Agents; Adult; Affect; Agonist; Anti-Cholinergics; Benign; Blood Pressure; Botulinum Toxins; California; Caring; Categories; Characteristics; Chronic; Chronic Care; Clinic; Cluster randomized trial; Collaborations; Communities; Community Health Systems; Data; Development; Disease; Eligibility Determination; Estrogens; Exercise; Extravasation; FDA approved; Female; Fostering; Future; Goals; Guidelines; Health; Health Services; Health Services Research; Health system; Hospitals; Hypertension; Incontinence; Individual; Interdisciplinary Study; Intervention; Link; Measurement; Medicare; Mental Depression; Modeling; Nurses; Office Visits; Operative Surgical Procedures; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patients; Pattern; Pelvic floor structure; Physicians; Population; Population Heterogeneity; Prevalence; Preventive care; Primary Health Care; Provider; Registries; Reporting; Research Personnel; Research Project Grants; Research Project Summaries; Research Proposals; Sampling; Specialist; Stress; Stress Urinary Incontinence; Surveys; Symptoms; Testing; Urethra; Urge Incontinence; Urinary Incontinence; Urine; Urology; Vagina; Visit; Wisconsin; Woman; Work; aged; base; clinical data warehouse; cohort; design; digital health; effective intervention; effective therapy; evidence base; experience; health care delivery; health care service utilization; health practice; improved; innovation; interdisciplinary collaboration; lower urinary tract symptoms; medical specialties; micturition urgency; patient portal; primary care setting; programs; racial diversity; tool

RESEARCH PROJECT SUMMARY Nearly 50% of adult women, including as many as 37% of women aged 30-50, report at least one episode of urinary incontinence. There are several effective nonpharmacologic interventions for mild or early symptoms, including pelvic floor exercises, which may resolve incontinence for up to 50% of patients with early disease. For more severe cases or those who fail nonpharmacologic interventions, seven antimuscarinics (also called anticholinergics) and one B-3 agonist (B-adrenergic) are FDA-approved, and vaginal estrogen, botulinum toxin, urethropexy, urethral bulking, sling surgeries, and neurostimulation all show substantial benefits in some populations of women. However, symptom burden remains high, and the field needs innovative strategies to target effective treatments to the appropriate patients. Urinary incontinence could be better managed using these available treatments though improved collaboration between primary and specialty care. Promising approaches to improve chronic care should be studied in urinary incontinence, which could help with recognition and initial treatment of stress and urgency urinary incontinence across large populations in primary care, as well as foster the link with specialty care and improve referral patterns. Our team has built innovative tools to allow routine electronic measurement of patient-reported outcomes using patient portals. We also have expertise utilizing digital health and other nontraditional delivery of health interventions, with a focus on improving equity as well. Given this background, we propose interdisciplinary team development, pilot and feasibility work with the following aims. Aim 1) To routinely measure patient-reported urinary incontinence in a racially diverse population of adult women in primary care. Aim 2) To pilot test a guideline-based incontinence care pathway that integrates primary and specialty care. Aim 3) To utilize the health system's clinical data warehouse to establish a registry in which to estimate the prevalence and equity of current incontinence health care utilization. This will provide data about the potential eligibility for future studies among female primary care patients and help identify the highest priority points for future intervention. We will pursue these aims in an academic health system with over 2.8 million patient visits yearly.

研究项目摘要 近50％的成年妇女，包括37％的30-50岁妇女，至少报告了一集 尿失禁。有几种有效的非药物干预措施用于轻度或早期症状， 包括骨盆底运动，这可能会解决多达50％的早期疾病患者的尿失禁。 对于更严重的病例或未通过非药物干预措施的患者，七种抗毒作疗法（也称为 抗胆碱能力）和一种B-3激动剂（B-肾上腺素能）是FDA批准的，阴道雌激素，肉毒杆菌毒素， 尿道肌，尿道繁殖，吊带手术和神经刺激在某些人中都显示出很大的好处 妇女人群。但是，症状负担仍然很高，该领域需要创新的策略才能 针对适当患者的有效治疗。尿失禁可以更好地管理 这些可用的治疗方法改善了初级和专业护理之间的协作。有希望的 应在尿失禁中研究改善慢性护理的方法，这可能有助于 识别和初步治疗主要人群中压力和紧急尿失禁 护理以及通过专业护理促进链接并改善推荐模式。我们的团队已经建立了创新 使用患者门户网站对患者报告的结果进行常规电子测量的工具。我们也有 利用数字健康和其他非传统交付健康干预措施的专业知识，重点是 也提高了权益。鉴于此背景，我们建议跨学科团队发展，飞行员和 可行性可实现以下目的。目标1）常规测量患者报告的尿失禁 种族多样化的成年妇女在初级保健中。目标2）试行测试基于指南的尿失禁 整合初级和专业护理的护理途径。目标3）利用卫生系统的临床数据 仓库建立一个注册表，以估算当前失禁健康的患病率和公平性 护理利用。这将提供有关女性初级保健中未来研究的潜在资格的数据 患者并帮助确定未来干预的最高优先级。我们将追求这些目标 每年有超过280万名患者就诊的学术卫生系统。