UH Clinicians Awarded $3 million for Improved Care of Urinary Incontinence

CLEVELAND – Urinary incontinence affects a staggering 50 – 70 percent of all women, yet very few seek help with the condition. When women do seek help, many of them are asked to manage their problems independently, or in some cases, the patient’s complaints are not addressed due to barriers in communication between patients and physicians. Fortunately, significant, impactful, non-surgical, and affordable behavioral and physical therapies can successfully help patients.

University Hospitals’ Adonis Hijaz, MD, Chief, Division of Female Pelvic Surgery and Vice Chairman, Department of Urology, and Goutham Rao, MD, Chairman, Department of Family Medicine & Community Health, have been awarded a near $3 million grant through the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, to empower women and providers for improved care of urinary incontinence.

Grants from the AHRQ support research to improve the quality, effectiveness, accessibility and cost-effectiveness of healthcare, and Drs. Hijaz and Rao’s new study is set to do just that. Known simply as the EMPOWER study, this project aims to reach over 5,000 women in Northeast Ohio and evaluate various treatment methods within a primary care setting for women with urinary incontinence.

Drs. Hijaz and Rao, and their collaborators have developed a team-science approach to identify the patient-centered and practice-centered barriers, and designed a multi-level intervention to address them.

“We aim to empower both patients and physicians by removing the barriers to incontinence care; hence this is named the EMPOWER Study,” said Dr. Hijaz.

In the study, patients will be screened in primary care offices for symptoms of urinary incontinence. Women with positive screening results will be asked if they are interested in participating in an implementation study where women will be assigned to one of the three following therapy groups:

• Usual Care – The patient’s urinary incontinence will be managed using standard of care treatment by her primary care provider.

• Nurse Navigation – Along with the treatment described for “Usual Care,” a nurse navigator will work with the patients to implement behavioral changes and provide education and physical therapy options. In addition, the navigator will be available to answer the patient's questions in a timely fashion and help the patient move through the care pathway.

•  Nurse Navigation and ChatBot – Along with the treatment described for “Usual Care” and “Nurse Navigation,” this option will include a ChatBot feature (mobile app) which will allow patients to directly and privately communicate with an artificial intelligence-driven ChatBot, also known as a “conversational agent,” that will provide education and help them navigate the care pathway.

The ChatBot and nurse navigator approach have been chosen deliberately to be feasible to implement during packaged primary care encounters. The study team will analyze the data at six and 12 months after the original appointment, assess adherence to therapy, and, more importantly, how the therapy impacted the outcomes the team hopes to improve – such as improvement in symptoms. If successful, the EMPOWER approach can be easily disseminated to other institutions.

In addition to an outstanding team of clinician investigators, Drs. Hijaz and Rao have support from the UH Primary Care Institute and excellent infrastructure, including collaborators throughout UH and Case Western Reserve University. This includes the University’s School of Medicine, where both clinicians are endowed professors (Dr. Hijaz, Lester Persky Professor, Urology; Dr. Rao, Jack Medalle Professor, Family Medicine & Community Health).

“I’m excited about EMPOWER because if we can move the needle just a little, we can make a huge impact, and whatever we can find, we can most likely replicate in another system to improve on the delivery of care for women with incontinence. The goal for this three-year study is to reach more women who experience the condition, provide them with treatment and positively impact their quality of life,” said Dr. Hijaz, who is passionate about improving the quality of life for affected women.

Enrollment for the study at UH will start soon. For more information on EMPOWER, contact Dr. Hijaz at EMPOWER.Study@UHhospitals.org, or by phone at 216-844-3009.