Managing urinary incontinence: evaluating the role of practice facilitators in enhancing quality improvement and digital integration in primary care

Abstract Background Practice facilitation is an established strategy for advancing quality improvement in primary care, particularly in chronic disease management. However, knowledge gaps remain regarding its long-term impact, integration of digital tools (e.g., telehealth), and barriers encountered during implementation. This study aimed to address these gaps by evaluating the Agency for Healthcare Research and Quality (AHRQ)-funded Managing Urinary Incontinence (MUI) Initiative, which supported five US institutions in implementing evidence-based, nonsurgical treatments for urinary incontinence (UI) in women. Methods Over a two-year period, we conducted virtual semi-structured interviews and focus groups with 15 practice facilitators from each grantee institution, all of whom worked with a total of 270 practices. Discussions explored their evolving roles, implementation processes, challenges encountered, and strategies for supporting UI care. Data were audio-recorded, transcribed, and subjected to thematic analysis in Dedoose, using a team-developed codebook with dual independent coders. Results Five major themes emerged: (1) practice facilitator role conceptualization varied across settings and evolved over time; (2) facilitators were central to supporting process improvements with tailored resources; (3) technology integration, such as telehealth and electronic health records (EHRs), was increasingly leveraged but unevenly adopted; (4) substantial barriers included navigating institutional bureaucracy and securing physician champions amidst competing demands; and (5) facilitators implemented strategies for sustaining practice change beyond the funded intervention. Despite successes, facilitators struggled with limitations of time, resources, and systemic constraints. Conclusions The findings provide actionable insights into the facilitation process for implementing evidence-based UI care, highlighting the importance of adaptive facilitator roles, technology use, and strategies for overcoming barriers and sustaining improvements. This research contributes to practical approaches for implementation in primary care settings.