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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. Specific Aim 3 will seek to measure the effect of the intervention on patient outcomes. The investigators hypothesize that improved care at the level of the primary care physician will reduce the number of specialty referrals. In Specific Aim 2, utilization of specialists will be compared before and after the intervention. Compliance with these quality indicators will be the key means to implement PCOR evidence, while, at the same time, measure quality. The quality of patient care, as evidenced by compliance with primary care UI quality indicators the investigators developed and pilot-tested, will be measured across the two randomized arms after implementation of the intervention. 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. Four Southern California medical groups will participate in a cluster randomized controlled trial in which 60 offices (15 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 involves the implementation of PCOR measures.
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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 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. 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. Other: Academic Detailing Other: Electronic Clinical Decision Support Other: APP Co-management Other: Electronic Referral Researchers will compare the intervention group to the delayed intervention (control) group to see if the intervention results in increased adherence to evidence-based quality indicators. Patient participants will bring up urinary incontinence with their primary care provider and complete three electronic surveys. The delayed intervention group will provide usual care until the crossover phase of the study, at which point they will receive the same intervention as the intervention group.
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The intervention group will receive an intervention consisting of academic detailing, clinical decision support tools, electronic referral, and the ability to refer to an advanced practice provider for co-management. Provider participants will be randomized at the office level to either an intervention group or a delayed intervention (control) group. Does our intervention reduce disparities in care?.What effect will this intervention have on patient outcomes, including disease-specific outcomes, symptom severity, quality of life, and patient knowledge?.Will this intervention reduce the utilization of specialist care for urinary incontinence?.Can a practice-based intervention involving primary care providers lead to improved quality of incontinence care?.The main questions it aims to answer are:
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The main goal of this clinical trial is to improve the care for urinary incontinence (UI) provided to adult women by primary care providers. Why Should I Register and Submit Results?.