Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is putting in place a virtual screening and care program to increase access to nonsurgical treatments for urinary incontinence, or UI, in women ages 60 and older.

Nearly half of women have UI, or the accidental leaking of urine. UI can negatively affect their quality of life and keep people from enjoying life. UI becomes more common with age, but it’s not an inevitable part of aging. Several nonsurgical treatment options are available. Most women, however, do not receive treatment. Many women are embarrassed to talk about their symptoms, and clinicians, including doctors and nurses, may not screen for UI.

What is the goal of this implementation project?

A PCORI-funded systematic review update, completed in 2018, confirmed that nonsurgical treatments such as Kegel exercises or bladder training can improve UI. But fewer than 25% of women receive care for UI. Virtual care may be a way to screen and offer care to more women for UI.

This project is putting a virtual screening and care program in place at a large health system. The goal is to increase access to UI treatment for women ages 60 and older who are from diverse racial and ethnic backgrounds.

What will this project do?

The project team is putting the program in place in 15 medical service areas within Kaiser Permanente Southern California. The virtual program sends a personal message about UI via secure email or text to all women ages 60 and older. This message asks women about their symptoms. Women with symptoms then receive a handout and educational video with information about treatment methods they can use on their own for 12 weeks. The program also sends reminders and encouragement. After 12 weeks, women who continue to have UI symptoms receive a referral for further treatment.

The project team is working with sites to:

  • Refine UI screening questions and information about UI treatments
  • Add screening questions and information about the process for patients to enter the self-care program to the patient portal
  • Conduct outreach to and educate clinicians and staff on UI care, the program, and how it relates to other services
  • Conduct outreach to women ages 60 and older to increase awareness and use of the program
  • Provide ongoing consultation and guidance in using the program

The project team is providing sites with materials for clinicians, like Q&A sheets, communication scripts, and patient handouts. The team is also developing a guide to help other health systems adopt this program.

What is the expected impact of this project?

During this project, 26,000 women will receive the virtual screening and care program. The project will demonstrate what’s required to put the program in place in areas with diverse patient populations. The project evaluation will confirm that the program is working as intended to increase access to UI screening and treatment for women ages 60 and older.

More about this implementation project:

Stakeholders Involved in This Project

  • American Urogynecologic Society
  • National Association for Continence
  • Kaiser Permanente Southern California
  • Health system and clinical leaders from additional Kaiser Permanente regions and from other integrated delivery systems and hospitals
  • Research liaisons from electronic health record (EHR) vendors
  • Large stakeholder panel with representatives from other organizations, including academic health systems, federally qualified health centers, county and public health systems

Implementation Strategies

  • Adapt the program to work with sites’ existing resources and workflows, including local tailoring of specific implementation strategies.
  • Integrate virtual screening and conservative treatment delivery for UI into standard practice.
  • Modify sites’ existing IT systems to improve patient screening for UI symptoms and to trigger referrals to a virtual self-care treatment program.
  • Provide sites with tools to support implementation, including Q&A sheets and communication scripts for clinicians and EHR-based tools to support patient outreach and delivery of virtual care.
  • Provide educational materials to patients, through an online portal, such as an instructional handout and video explaining UI types and treatments.
  • Educate clinicians and staff on UI treatment, the virtual program, and follow up options for patients who require further treatment, through webinars, seminars, newsletters, and email messages
  • Use a phased implementation approach.
  • Identify and prepare local physician champions.
  • Provide technical assistance to sites, including consultation and guidance.
  • Develop an implementation manual that future sites can use to implement the program.

Evaluation Outcomes

To document implementation:

  • Proportion of women screened, identified, referred, and treated through virtual program
  • Patient completion of the program

To assess healthcare and health outcomes:

  • Symptom resolution
  • Patient satisfaction with care
  • Patient knowledge and attitudes
  • Healthcare utilization (number, types of encounters)

Project Information

Brian Mittman, PhD, MA
Shawn Menefee, MD
Kaiser Foundation Research Institute, a Division of Kaiser Foundation Hospitals
Implementation Strategies to Enhance Use of Conservative Management of Urinary Incontinence in Women

Key Dates

March 2022
June 2025

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded Systematic Review Update: Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update


Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
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Last updated: March 15, 2024