A large proportion (15-35%) of women suffer from urinary incontinence (UI), which can cause or exacerbate other physical health problems and significantly reduce individuals' quality of life. Though appropriate outpatient management can reduce the morbidity and cost of UI, it remains a vastly under-diagnosed and under-treated problem in primary care settings. The need to reduce variations in practice, control health care costs, and improve patient care outcomes has spurred the development of clinical practice guidelines. These guidelines, often cumbersome and difficult to navigate, have little impact on practice and outcomes. To successfully implement guidelines, providers must be able to quickly access and analyze key information and provide patient- specific advice at the time of consultation. Innovative, point-of-care tools can help physicians effectively navigate and incorporate clinical guidelines into patient care visits. We aim to develop point-of-care decision support software to help primary care physicians implement practice guidelines for the management of urinary incontinence in women. Phase I goals include translating text-based guidelines into algorithmic statements, developing prototype of decision support software deliverable on hand held computer, and collecting and analyzing observational, survey, and interview data to evaluate the prototype's feasibility and acceptability in a sample of primary care physicians. PROPOSED COMMERCIAL APPLICATIONS: If proven effective in improving guideline compliance, the proposed decision support software would be significantly attractive to managed care organizations, individual practice associations, and insurance companies. Another potentially strong market would be medical schools, whose students and residents routinely use hand-held computers as point-of-care resources.
