PROJECT ABSTRACT
The burden of urinary incontinence (UI) on American women is immense in human and financial terms, and
continues to rise with the growing population of older adults. The goal of this proposal is to improve the care for
UI provided to women and, in doing so, decrease the utilization of specialty care while improving patient
outcomes. Specific Aim 1 seeks to improve the quality of incontinence care provided to an ethnically diverse
population of women through a controlled practice-based intervention involving primary care providers. The
intervention involved the implementation of PCOR measures. Three Southern California medical groups will
participate in a cluster randomized controlled trial in which 60 offices (20 per site) will be randomized to undergo
a practice-based incontinence intervention led by a ”clinical champion dyad” comprised of a primary care provider
and urologist/urogynecologist, both of whom are members of that specific medical group. The intervention will
include physician education, individual performance feedback, electronic decision support, patient education
using dedicated advanced practice providers (APPs), and the implementation of an electronic referral service.
The quality of patient care, as evidenced by compliance with the quality indicators, will be measured across the
two randomized arms after implementation of the intervention. The investigators for this proposal recently
developed and pilot-tested a set of quality-of-care indicators (QIs) for urinary incontinence that encompass
primary care for UI. Compliance with these quality indicators will be the key means to implement PCOR evidence,
while, at the same time, measure quality. In addition, in Specific Aim 2, utilization of specialists will be compared
before and after the intervention. The investigators hypothesize that improved care at the level of the primary
care physician will reduce the number of specialty referrals. Lastly, Specific Aim 3 will seek to measure the effect
of the intervention on patient outcomes. Under the hypothesis that a practice-based intervention will improve
disease-specific outcomes, symptom severity, quality of life, and patient knowledge will be measured at baseline
using validated questionnaires. After implementation of the intervention, these questionnaires will be given a
second time six months later and outcomes will be compared between control and intervention groups. We
expect that this intervention will also reduce disparities in care for underrepresented minorities.
