Improving the Quality and Frequency of Screening for Urinary Incontinence in the Primary Care Setting

Background: Urinary incontinence (UI) is one of the most underreported and underdiagnosed medical conditions affecting women worldwide. Women who suffer from UI have poorer quality of life, and increased anxiety and depression compared to those without UI. One identified reason for women not seeking treatment for UI is that health care providers never asked about UI at their medical visits. Local Problem: Lack of use of validated tool during UI screening in primary care. Methods: A quality improvement project was developed to increase quality and frequency of screening for urinary incontinence in women ages 35-65 years during annual exams at an ambulatory primary care clinic by integration of the validated Michigan Incontinence Symptom Index (M-ISI) screening tool. Interventions: Specific genitourinary questions were developed and included in the online patient intake forms which flagged affected patients for further evaluation with the M-ISI. Providers were instructed to review M-ISI severity and bothersome scores with patients at time of visit. Pre- and post- implementation data regarding frequency of UI screening and provider referral rates were compared to assess the efficacy of the intervention. A post implementation survey was given to providers to assess satisfaction and gather feedback on the utility and feasibility of using the M-ISI in clinical practice. Results: A total of 53 women were screened with the M-ISI. Provider referral rates to a UI specialist and patient education regarding UI and treatment options increased. Of those screening positive, 34 (64%) were referred to UI specialist, compared to 16% of patients before the intervention. Thirty-three (62%) received education regarding UI that was documented in the EHR, compared to 9 (27%) women pre- implementation. Providers and medical assistants indicated high satisfaction and feasibility when using the M-ISI for UI screening. Conclusions: Measurement of severity and bothersome scores included in M-ISI quantified the problem for affected patients and prompted greater consideration by providers to refer women to specialty care. More women were referred to specialists and received education regarding UI as a consequence of this intervention. Women were able to self-identify UI in the pre-visit intake screening which ensured that patients were asked about UI symptoms by their provider. Further study of M-ISI use in primary care settings is needed to determine if results can be replicated in other settings.