This study will test the effectiveness of a new model of care to translate the AHCPR Urinary Incontinence (UI) Guideline into practice in nursing homes. The model will utilize nurse practitioners in nursing homes to implement a carefully designed and focused effort to identify, work up, treat and follow up new cases of urinary incontinence on an ongoing basis -- in collaboration with medical and nursing staff. The model will be tested utilizing existing nurse practitioners in nursing homes, but has potential application for all nursing homes -- regardless of whether they have nurse practitioners on staff -- since the nurse practitioners' work could be effectively accomplished by consulting nurse practitioners and could likely be reimbursed under existing HCFA mechanisms. A quasi-experimental design will be used to evaluate the practice performance of five experimental nurse practitioners at experimental nursing home sites and five control nurse practitioners at control nursing home sites who will be followed prospectively for 15 months prior to the intervention and 15 months during the intervention using detailed chart review by blind nurse reviewers. A total of 200 cases of new UI prior to the intervention and 200 cases of new UI during the intervention will allow comparison of changes or lack of changes in key practice performance areas. The study will determine the feasibility of this focused approach by nurse practitioners for improving specifically targeted areas of UI care in nursing homes (i.e., case identification, treatment of reversible causes of UI, basic physical examination, rectal examination, post-void residual testing, bladder training, use of recommended UI medications) as well as the effectiveness of the model in,reducing UI in nursing homes, preventing the complications associated with UI and improving the quality of life of nursing home residents and families. The cost of the model will also be determined and compared to usual care.
