EMPOWER Study Shows Patient Engagement Improves Urinary Incontinence Care for Women

UH Research & Education Institute

Women are twice as likely as men to experience urinary incontinence (UI), yet many delay or avoid seeking care due to embarrassment or the mistaken belief that symptoms are a normal part of aging. To address this gap, University Hospitals launched the EMPOWER study in 2022, a large randomized clinical trial designed to improve the identification, diagnosis and non-surgical management of UI for women in primary care settings across the UH health system. Funded by the Agency for Healthcare Research and Quality (AHRQ), EMPOWER aimed to show women that UI is common, treatable and not something they have to live with.

Adonis Hijaz, MD

Goutham Rao, MD

Results from EMPOWER demonstrate that a nurse-led navigation approach significantly improves symptom management for women with urinary incontinence in primary care by helping patients initiate conversations with physicians and access effective treatment earlier, providing a scalable model for improving outcomes.

“Results of the EMPOWER study demonstrate that incorporating increased screening and guidance in primary care settings can help patients address their symptoms much earlier, leading to better long-term clinical outcomes,"  says Adonis Hijaz, MD, Vice Chairman of the Department of Urology and Director of Female Pelvic Surgery at University Hospitals Cleveland Medical Center, and Lester Persky Professor of Urology at Case Western Reserve University School of Medicine.

“It was a great privilege to be part of the EMPOWER study, and to apply my experience and expertise in primary care, implementation science, and improving diagnosis to a problem that affects hundreds of my own patients,” said Goutham Rao, MD, Division Chief, Family Medicine, and Chief Clinician Experience Officer, University Hospitals Cleveland Medical Center; the Professor and Chair, Department of Family Medicine and Community Health, and the Jack H. Professor of Home-Centered Health Care, Case Western Reserve University School of Medicine and co-PI with Dr. Hijaz of EMPOWER.

A Multi-Pronged Approach to Engaging Patients in UI Prevention and Care

Led by the University Hospitals Urology Institute in collaboration with UH Primary Care Institute (PCI), UH Population Health and Case Western Reserve University, the EMPOWER study, was supported by the national AHRQ EvidenceNOW: Managing Urinary Incontinence or MUI program. MUI aims to reduce gaps between what research indicates works for UI versus what often happens in primary care settings. The Urology Institute at UH is one of five institutions participating in the EvidenceNow initiative. Industry partners for the project included Renalis Health and ECHO Chicago.

The EMPOWER multimodal program used in the study was developed to better diagnose women with UI, shorten the time between diagnosis and treatment and promote non-surgical treatments at the primary care physician or specialist level, says Dr. Hijaz.

During the study, which concluded in early 2026, more than 15,000 women ages 18 and older were screened across 76 UH primary care centers in Northeast Ohio using the International Consultation on Incontinence (ICIQ) questionnaire addressing urine leakage. Women who screened positive for UI were invited to participate in an 8-week trial, of which 400 enrolled. Overall, 58 percent of the 15,000 screened reported experiencing UI, many with moderate to severe symptoms, according to study results.

The EMPOWER approach to care was used to evaluate the effectiveness of first-level therapy to improve UI symptom outcomes. It guided women toward behavioral and therapeutic resources, comparing the efficacy of routine care, nurse navigation, and nurse navigation augmented with a chatbot for the management of UI symptoms.

As part of the study, patients were screened for incontinence during routine primary care visits. Women who reported being bothered by symptoms were then assigned to one of three groups. Nurse navigators worked directly with patients, checking in at key points to guide them through treatment. Women whose symptoms improved were discharged from the program, while those who did not improve were referred to a urogynecologist or female urology. A second group used the mobile ChatBot developed by Renalis to self-manage symptoms. Patients who did not see improvement using the app were also referred to a specialist.

“The overall goal of these approaches was to both increase the identification of patients with urinary incontinence and shorten the time between diagnosis and appropriate treatment, either at the primary care level or at the specialist level,” says Dr. Hijaz. Currently, the average amount of time it takes is around four years from diagnosis to treatment, he says.

Outcomes

Preliminary results indicate that the presence and support of a nurse navigator reduced the severity of UI symptoms over six months compared to standard care, although the addition of the ChatBot made little difference.

“Our goal was to remove barriers to diagnosing and managing UI in the primary care setting and to build capacity in physician offices for the management of UI,” Dr. Hijaz says. “As the name suggests, we strived to empower patients to talk to their providers about UI and engage them in self-management. We also trained providers in the diagnosis and management of UI. This is a viable approach to an important – and undertreated – problem that affects millions of women.”

Key features of this study were a patient education component and direct interaction with a real person, the Patient Navigator. The multipronged approach of patient, provider and systemwide involvement provided a sustainable approach to improving outcomes for women with urinary incontinence.

“I think we’ve done a great job in raising awareness of UI, including how common it is and the availability of effective treatments, not only among patients but also among primary care physicians,” said, Dr. Rao.

Results from this study have led to more routine screening for urinary incontinence. Women seen by UH providers during primary care, Medicare Wellness, and OB‑GYN visits will now be regularly screened for UI through Epic/MyChart. Earlier detection allows providers to intervene sooner, expand treatment options, and improve outcomes for women with urinary incontinence.