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Real World Examples of Use
The first urinary incontinence guideline sponsored by the Agency
for Health Care Policy and Research (AHCPR) was released in March
1992. In the four years since then, AHCPR has disseminated over
1.2 million copies of the guideline and quick reference guide for
clinicians—an abbreviated form of the guideline—and an
equal number of patient guides.
The biggest users are nursing homes, home health agencies,
hospitals, and other providers, including managed care
organizations. But nursing schools, specialized health
services, government agencies, businesses, and consumer groups
also are using them.
The guideline has wide application and is being used to reduce
the number of incontinent patients, save health care dollars by
avoiding tests and surgery, and improve quality.
Health Facilities and Services
- Use of the urinary incontinence guideline helped the Heritage
Manor Nursing Home in Chattanooga, TN, cut the number of
incontinent residents by 65 percent in just 14 months. During the
same period (September 1992 to November 1993), the facility was
able to more than double its number of normally dry patients
(those fully dry or continent with assistance). This included
six individuals previously considered untreatable.
- AHCPR's urinary incontinence guideline has saved hundreds of
people from surgery, according to Michael I. Williams, chief
executive officer of Advantage Medical Services, a Bradenton, FL
health provider that uses behavior-based treatment built on the
AHCPR guideline. Ninety percent of its patients, which it
receives on referral from local primary care doctors, improve
within three weeks. The treatment method has also reduced costs
by eliminating unnecessary testing. Advantage Medical Services
can begin treating patients after completing tests that cost no
more than $100, according to Mr. Williams, who said that the test
costs of incontinent patients referred to urologists typically
run between $400 and $2,000.
- Noble Horizons, a nursing home in Salisbury, CT, used AHCPR's
urinary incontinence guideline to develop a continence management
program. By March 1995—six months after initiating the
program—half the residents who underwent prompted voiding
training, which is recommended by the guideline, had improved
their continence status.
- Using the AHCPR guideline as the basis for its behavior-based
treatment program, New Beginnings Continence Clinic in Sioux
Falls, SD, has helped many patients regain continence without
surgery. In a random study of patient outcomes at the clinic, 72
percent of the patients improved their continence status, and 26
percent of these became fully continent.
- The Kansas Foundation for Medical Care, Inc., the Medicare
peer review organization for Kansas, relies heavily on the
urinary incontinence guideline and AHCPR guidelines
for other conditions as sources for identifying quality
indicators to measure quality of care and help providers improve
- At the Visiting Nurses Association of Health Midwest, a home
health services organization in Kansas City, MO, employing more
than 2,000 nurses, therapists and other allied health workers,
nurses have increased their competency in handling incontinent
homebound patients thanks to the guideline. According to Shirley
Harland, RN, CETN, a certified enterostomal therapist, the nurses
have found the guideline extremely helpful in standardizing
- Nurses at Central Mississippi Health Care At Home—a home
health service agency in Jackson—no longer consider urinary
incontinence a normal part of aging because of the
AHCPR guideline, according to Bonnie Carminati, RNC, CETN, CDE.
Ms. Carminati said the guideline has improved the ability of
staff nurses and home health aides to identify and assess
- By using behavioral methods recommended in the guideline,
Marilyn-Lu Webb, RN, CNP, CRRN, PhD, director of incontinence
management at the Linder Quann Medical Group in Fresno, CA, has
been able to cure or improve the incontinence problems of 98
percent of her patients. Ms. Webb said she is able to spare most
patients the necessity of referral to urologists and the expense
and discomfort of unnecessary surgery.
- The guideline has also helped reduce costs at Ralston-Penn
Center, a nurse-managed treatment facility in Philadelphia.
According to Christine Bradway, RN, MSN, director of its
continence program, AHCPR's guideline influenced a change in
their clinical practices, and helped reduce initial patient
- In Texas, state long-term care facility surveyors use
AHCPR's urinary incontinence and pressure ulcer guidelines to
help identify and correct problems in 2,378 Medicare/Medicaid
nursing homes, personal care homes, and facilities serving
persons with mental retardation.
- Maryland State policy has designated AHCPR's urinary
incontinence guideline as a standard for state and private-sector
health care organizations to follow. This policy of Maryland's
Health Resources Planning Commission, in effect since 1992, is
designed to promote use of the guideline as a model for
facilities to develop their own protocols, as a standard for
licensing nursing homes, and as a potential basis for nursing
- Urinary incontinence and other AHCPR guidelines serve as
models of care for nurses with Delaware's Division of Services
for Aging and Adults with Physical Disabilities when handling
Medicaid waiver cases to assess whether the State should allow
Medicaid funds to support home care as an alternative to nursing
home care. In these cases, the nurses often use the AHCPR
guidelines as guides for setting up and monitoring nursing
home plans for patients. Division staff also use AHCPR
guidelines as models of care when investigating allegations of
abuse, neglect or exploitation of elderly persons by family
members or others. The Division is a part of Delaware's
Department of Health and Human Services.
- The State of Florida has required that the AHCPR urinary
incontinence guideline be made available to all hospitals and
health professionals throughout the state, with the
state's formal endorsement, in order to reduce unwarranted
variation in the delivery of medical equipment, improve the
quality of medical care, and promote the appropriate utilization
of health care services.
- AHCPR's urinary incontinence guideline is now the standard
resource for nursing students of Petersburg Junior College in
Pinellas Park, FL. According to Dr. Jodi Parks,
director of nursing, students previously relied on various
textbooks—which she said were usually outdated—to learn
how to treat bladder problems. Dr. Parks said nursing
instructors can now offer their students a more consistent
approach to treating patients by using AHCPR's guideline as a
standard of care.
- At the Ohio State University College of Nursing, the urinary
incontinence and three other AHCPR guidelines are required
reading for graduate students of Dr. Linda Bernhard.
She uses the guidelines to teach her students how to make
clinical diagnoses preparatory to their undergoing clinical
Current as of March 1996