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: 10559587
• 负责人: Heidi Wendell Brown
• 金额: $ 38.1万
• 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 2023-07-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10559587
• 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.

项目概要/摘要 尿失禁影响超过 1800 万美国女性，并与医疗费用相关 每年超过 180 亿美元，随着人口老龄化，失禁的患病率不断增加，限制了生活质量。 生活并增加抑郁、跌倒和住院的风险，但存在有效的非手术解决方案。 只有一半的失禁女性与初级保健提供者讨论她们的症状。 提供者认识到诊断和治疗失禁的重要性，但仍然负担过重 不断增加和压倒性的竞争优先事项，因此尿失禁仍然得不到充分诊断和 我们将测试两种实施策略，以帮助初级保健诊所纳入筛查和治疗。 尿失禁的治疗：询问（屏幕）；建议（教育尿失禁是常见且可以治疗的）； 和协助（提供基于证据的治疗），称为 UI-Assist 认识到之间的有效伙伴关系。 初级保健和公共卫生机构如果成功实施，可以改善健康并减轻负担， 我们寻求一项战略，以补充简化的实践促进实施 建立伙伴关系（利用社区资源，建立联盟，提供持续的咨询，以及 创建一个在线学习社区）将克服实施干预措施的已知障碍，从而 我们在地方、州和国家层面都有合作伙伴参与，影响范围更广，影响更大。 其使命与拟议的工作一致，支持初级保健以改善泌尿系统疾病的治疗 我们将比较失禁、持续性增加的可能性以及随后的规模。 简化的实践促进与以伙伴关系建设为指导的简化的实践促进。 格拉斯哥的覆盖范围、有效性、采用、实施和维护 (RE-AIM) 框架，我们将 我们将通过对 50 个初级保健实践进行的 3 类混合整群随机试验来检验我们的假设。 双重差异分析，比较接受 (a) 筛查和 (b) 筛查的患者比例 通过研究组在实施（目标 1）之前和之后提供失禁治疗。 方法，我们将研究实施策略和背景因素对 UI-Assist 覆盖范围的影响， 采用、实施和维护（目标 2）以及患者报告的结果（目标 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、经济问题和不良事件）。 增加，并且随着初级保健实践面临越来越大的压力，需要用更少的时间和精力解决更多问题 迫切需要资源、可扩展的干预措施和实施战略来改善护理。