Background Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes. Objective To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes. Design The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes. Setting Primary care practices in 3 U.S. states. Participants Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington. Measurements Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics. Results 110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 826 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors. Limitations Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels. Conclusion Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability.

Objective To estimate prevalence of urinary incontinence (UI) health care utilization in women from the population to specialty care. Method The General Longitudinal Overactive Bladder Evaluation – UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the bladder health survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg. Results A total sample of 7,059 women received the BHS. Of those, 3,316 (47%) responded. Prevalence of UI was 1,366 (41%). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91% vs 87%), significantly more overweight or obese (74% vs 61%), and more likely to have a college education or higher (54% vs 46%), P<0.01. Nine-hundred fifty eight (73%) women with UI reported duration of more than two years and 72% reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25%) sought care, 313 (23%) received some care, and 164 (12%) received subspecialty care. Conclusion UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.

BACKGROUND: Varenicline, a selective α4β2 nicotinic acetylcholine recep-

Aims To determine predictors of health care utilization in women with urinary incontinence (UI) from the population to specialty care. Methods The General Longitudinal Overactive Bladder Evaluation – UI is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the bladder health survey (BHS). Survey data were linked with electronic health records (EHR) to examine factors associated with a clinical UI diagnosis using logistic regression. Risk factors analyzed included: UI symptoms, subtypes, bother, severity, duration and effect on quality of life, and demographic and other health characteristics. All statistical tests were two-sided with a p-value < 0.05 being significant. Results The overall prevalence of any UI based on responses to the BHS was 1,618/4064 (40%). Of the 1,618 women with UI, there were only 398 (25%) women with EHR (clinical) diagnosis of UI. Women with UI versus those without UI were more likely to be have a BMI >25kg/m2 (70% versus 58%), more likely to be parous (91% versus 87%) and college educated (54% versus 46%), P<0.001. After adjusting for confounders in the model, variables significantly associated with clinical UI diagnosis included: older age (OR=1.96), higher parity (> 1 birth) (OR=1.76), higher urgency UI (OR=1.08), adaptive behavior (OR=1.2), and UI bother scores (OR=1.01), as well as more frequent outpatient visits (OR=1.03), P<0.05. Conclusions UI is a highly prevalent condition with only a minority of women seeking care. Factors associated with health care utilization include older age, parity (1+), number of doctor visits, urgency UI subtype, UI bother and impact on behavior.

IRB Administrators and Directors will be reported on as well. Results: Data are in the process of collection, and will be reported on at the March 2011 HMORN Conference in Boston. Conclusions: In order to maintain and improve efficiency and effectiveness, as well as meet the turnaround times of funding agencies, it is imperative that multi-site research review strives to continuously improve quality without sacrificing the imperative to conduct rigorous ethical and regulatory reviews of proposed research. The processes established in the HMORN work toward this goal, and require the cooperation of the Network-wide research enterprise.