EvidenceNOW: Managing Urinary Incontinence
Urinary Incontinence (UI) affects a large number of women. More than half of women over 20 years of age reported any urinary leakage, while the rates of moderate to severe UI increase from 17% of women at 20 years of age to 38% of women over age 60.
UI is not merely a nuisance condition. It increases depression and work disability. Complications due to UI are more severe in women over 65 years old, and those with moderate to severe UI are at increased risk for unmet care needs, falls, nursing home admissions, and death. Due to UI symptoms, women may not be compliant with recommendations for therapies such as exercise or diuretics that could help them with UI or other chronic conditions. Finally, UI is costly. The economic impact of UI in women was estimated to be $19.5 billion in 2004.
There are also disparities in UI and UI care. For example, the prevalence of daily incontinence is twice as high in Hispanic women compared to Asian women. Sadly, while 70% of white women with UI sought care for UI symptoms, only 16% of Latina, 6% of black, and 5% of Asian women reported seeking any care. Finally, there is a significant gap between evidence-based care and actual practice. Fewer than 30% of women (> age 40) with UI report receiving any care for UI symptoms, despite available safe and effective non-surgical treatments for UI, according to a recent systematic review.
This project will build on AHRQ’s EvidenceNOW model of external support to help primary care practices implement evidence. Several factors align to make implementation of nonsurgical treatment of UI for women successful at this time. Diagnosis and stepped care are supported by guidelines from professional organizations. Effective implementation strategies have been published, and third-party payers, including Medicare and Medicaid, reimburse for UI assessment and treatment.
However, primary care is functioning within a complex and constantly shifting healthcare environment. New models for organizing and paying for primary care have changed its landscape. The movement from volume-based payment to value-based payment, the widespread use of electronic health records, and a large number of often unaligned quality improvement programs have impacted primary care practices and clinicians. In addition, the COVID-19 epidemic has affected the availability of primary care visits. This project provides a unique opportunity to support primary care’s ability to deliver evidence-based interventions for UI in women using lessons learned from implementation efforts in the EvidenceNOW model of external support to primary care practice.
This project aims to use the EvidenceNOW model of external support to primary care practices to help them disseminate and implement patient-centered outcomes research findings to improve nonsurgical treatments for UI among adult women in primary care practices. To achieve this goal, grantees will:
- Use evidence-based implementation strategies to increase the delivery of evidence-based care for UI among women.
- Develop or enhance mechanisms for improving linkages between primary care settings and needed supports, such as community-based resources and specialty care.
- Develop patient-centered care plans.
- Design an implementation plan that is sustainable, so that both UI treatment as well as capacity for practice improvement will be sustained.
- Evaluate the effectiveness of implementation strategies and disseminate findings.
The full announcement requesting grant proposals is found here: