Identify, Teach and Treat (IT2): Automating clinical decision pathways for the care of women

识别、教导和治疗 (IT2)：自动化临床决策路径以护理女性

• 批准号: 10559508
• 负责人: KIMBERLY Sue KENTON
• 金额: $ 63.67万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 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/10559508
• 关键词: Identify; Teach; Treat; IT2; Automating

Project Summary: In this application, we describe a multi-level implementation strategy to systematically improve the identification of urinary incontinence (UI) among women seen in primary care, support patient-centered decision making for UI, and accelerate the uptake of evidence-based nonsurgical treatment modalities for UI. We expect to demonstrate how system-level changes aimed at improving UI care, when implemented in conjunction with a mature quality improvement and information technology infrastructure and combined with innovative patient- centered supports, can lead to transformative improvement. With 65 primary care practices and 327 primary care physicians, who provide care to over 279,000 individual women, Northwestern Medicine is the largest health system in Illinois and well suited to implement the latest patient-centered outcomes research evidence regarding nonsurgical treatment for UI in women. Meanwhile our trans-regional, integrated pelvic health program is already providing the full breadth of approved non-surgical treatments for UI. The linchpin of our proposal is our unique existing partnership with Wisercare© – a company with whom we have developed an evidence-based, shared decision-making module for UI that we will fully integrate into the primary care provider (PCP) workflow. Our approach begins with a set of strategies to equitably and systematically implement screening for UI on an annual basis in primary care practices in a way that is designed to reduce the burden on PCPs. Patients who screen positive will to learn more about UI through an online shared decision-making tool available in multiple languages. Patients who complete the Wisercare© shared decision-making module will be able to share their results directly with their PCP, prompting further counseling and treatment. Meanwhile, we will provide PCPs throughout the health system with education and clinical decision support on non-surgical options for treating UI and will use practice facilitation to onboard new workflows. The processes will be periodically audited and screening for UI will be added to physician performance metrics. We aim to study program impact by studying the historical under-identification of UI prior to implementing these changes; reporting on patient treatment preferences and satisfaction with the shared decision-making process; tracking changes in UI diagnosis, and utilization of non-surgical treatment for UI; and studying changes in PCP comfort and support around the identification and treatment of UI. Our reliance on implementing durable changes in care delivery should be sustainable and a model for other systems.

项目概要： 在此应用中，我们描述了一种多层次的实施策略，以系统地改进识别 初级保健中女性尿失禁 (UI) 的发生率，支持以患者为中心的决策 UI，并加速采用基于证据的 UI 非手术治疗方式。 演示系统级更改如何旨在改善 UI 护理，与 成熟的质量改进和信息技术基础设施以及创新的患者 集中支持可以带来变革性的改进。 拥有 65 个初级保健诊所和 327 名初级保健医生，为超过 279,000 人提供护理 西北医学是伊利诺伊州最大的卫生系统，非常适合实施最新的 关于女性 UI 非手术治疗的以患者为中心的结果研究证据。 跨区域综合盆腔健康计划已经提供了经批准的非手术治疗的全部范围 我们提案的关键是我们与 Wisercare© 公司现有的独特合作关系。 我们与他们一起开发了一个基于证据的、共享的 UI 决策模块，我们将充分利用该模块 融入初级保健提供者 (PCP) 工作流程。 我们的方法始于一套策略，以公平、系统地实施 UI 筛选 以旨在减轻 PCP 患者负担的方式每年进行初级保健实践。 屏幕积极愿意通过多个可用的在线共享决策工具了解有关 UI 的更多信息 完成 Wisercare© 共享决策模块的患者将能够分享他们的信息。 直接向他们的 PCP 提供结果，促使进一步咨询和治疗。同时，我们将提供 PCP。 整个卫生系统提供有关非手术治疗选择的教育和临床决策支持 UI 并将使用实践促进来加入新的工作流程。这些流程将定期进行审核和审核。 UI 筛查将被添加到医生绩效指标中。 我们的目标是在实施这些计划之前，通过研究 UI 的历史识别不足来研究计划的影响 变更；报告患者治疗偏好和对共同决策过程的满意度； 跟踪 UI 诊断的变化、UI 非手术治疗的使用以及研究 PCP 的变化； 围绕 UI 的识别和处理提供舒适度和支持。 护理服务的变化应该是可持续的，并为其他系统树立榜样。