Advertisement

The Inflection Point Model: A Model to Explore the Hidden Burdens of Non–Cancerous Genitourinary Conditions

      OBJECTIVE

      To propose a conceptual model to identify points along the condition course where actions or inaction affect downstream burdens of non–cancerous genitourinary conditions (NCGUC).

      MATERIALS AND METHODS

      The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened an interdisciplinary meeting to comprehensively consider the burdens of NCGUCs. Subsequently, the authors met monthly to conceptualize the model.

      RESULTS

      Inflection points (IP) describe time points during a condition course that are sensitive to change. Our proposed Inflection Point Model (IPM) helps conceptualize burden/benefit trade-offs in any related decision and provides a platform to identify the downstream aggregate burden of a NCGUC across multiple socio-ecological levels at a single time point, which may be summed across the condition course to measure cumulative burden. Two personae demonstrate the utility of this model to better understand impacts of 2 common NCGUCs.

      CONCLUSION

      The IPM may be applied in multiple contexts: narrowly to explore burden of a single NCGUC at a single IP; or more broadly, to address multiple conditions, multiple IPs, or multiple domains/levels of social ecology. Applying the IPM may entail combining population data describing prevalence of NCGUCs, associated behaviors, and resulting outcome patterns that can be combined with suitable mathematical models to quantify aggregate and cumulative burden. The IPM challenges stakeholders to expand from the individual to include broader levels of social ecology. Application of the IPM will undoubtedly identify data gaps and research needs that must be fulfilled to delineate and address the burden of NCGUCs.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gorina Y
        • Schappert S
        • Bercovitz A
        • Elgaddal N
        • Kramarow E
        Prevalence of incontinence among older Americans.
        Vital Health Statistics. 2014; 3: 1-33
        • Markland AD
        • Richter HE
        • Fwu C-W
        • Eggers P
        • Kusek JW
        Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008.
        J Urol. 2011; 186: 589-593
        • Miller DC
        • Saigal CS
        • Litwin MS
        The demographic burden of urologic diseases in America.
        Urol Clin North Am. 2009; 36: 11-15
        • Curhan GC
        Epidemiology of stone disease.
        Urol Clin North Am. 2007; 34: 287-293
        • Grases F
        • Costa-Bauzá A
        • Ramis M
        • Montesinos V
        • Conte A
        Recurrence of renal lithiasis.
        Scand J Urol Nephrol. 2003; 37: 482-486
        • Coyne KS
        • Sexton CC
        • Clemens JQ
        • et al.
        The impact of OAB on physical activity in the United States: results from OAB-POLL.
        Urology. 2013; 82: 799-806
        • Maserejian NN
        • Minassian VA
        • Chen S
        • Hall SA
        • McKinlay JB
        • Tennstedt SL
        Treatment status and risk factors for incidence and persistence of urinary incontinence in women.
        Int Urogynecol J. 2014; 25: 775-782
        • Yip SO
        • Dick MA
        • McPencow AM
        • Martin DK
        • Ciarleglio MM
        • Erekson EA
        The association between urinary and fecal incontinence and social isolation in older women.
        Am J Obstet Gynecol. 2013; 208: 146.e141-146.e147
        • Parker-Autry C
        • Houston DK
        • Rushing J
        • et al.
        Characterizing the functional decline of older women with incident urinary incontinence.
        Obstet Gynecol. 2017; 130: 1025-1032
        • Noguchi N
        • Chan L
        • Cumming RG
        • Blyth FM
        • Naganathan V
        A systematic review of the association between lower urinary tract symptoms and falls, injuries, and fractures in community-dwelling older men.
        Aging Male. 2016; 19: 168-174
        • Irwin DE
        • Milsom I
        • Kopp Z
        • Abrams P
        Symptom bother and health care–seeking behavior among individuals with overactive bladder.
        Eur Urol. 2008; 53: 1029-1039
        • Hägglund D
        • Wadensten B
        Fear of humiliation inhibits women's care-seeking behaviour for long-term urinary incontinence.
        Scand J Caring Sci. 2007; 21: 305-312
        • National Institute of Diabetes and Digestive and Kidney Diseases
        Meeting Summary.
        in: Uncovering the Hidden Burden of Benign Genitourinary Conditions, Bethesda2021 (MD2019)
        • Boon H
        • Verhoef M
        • O'Hara D
        • Findlay B
        • Majid N
        Integrative healthcare: arriving at a working definition.
        Altern Ther Health Med. 2004; 10: 48-56
        • Struckmann V
        • Leijten FRM
        • van Ginneken E
        • et al.
        Relevant models and elements of integrated care for multi-morbidity: results of a scoping review.
        Health Policy. 2018; 122: 23-35
        • Daneshgari F
        • Hijaz A
        • Mahajan S
        • Liu J
        • Demetriou AA
        History and development of an integrated model of care for female pelvic medicine and surgery.
        Urology. 2014; 83: 965-968
        • Willke RJ
        • Neumann PJ
        • Garrison Jr., LP
        • Ramsey SD
        Review of recent US value frameworks—a health economics approach: an ISPOR special task force report [6].
        Value Health. 2018; 21: 155-160
        • Willskytt S
        • Tillman AM
        Resource efficiency of consumables – life cycle assessment of incontinence products.
        Resources Conserv Recycl. 2019; 144: 13-23
        • Diaby V
        • Goeree R
        How to use multi-criteria decision analysis methods for reimbursement decision-making in healthcare: a step-by-step guide.
        Expert Rev Pharmacoecon Outcomes Res. 2014; 14: 81-99
        • Frazão TDC
        • Camilo DGG
        • Cabral ELS
        • Souza RP
        Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps.
        BMC Med Informat Decision Making. 2018; 18: 90
        • Chapple CR
        • Mironska E
        • Wagg A
        • et al.
        Multicriteria decision analysis applied to the clinical use of pharmacotherapy for overactive bladder symptom complex.
        Eur Urol Focus. 2020; 6: 522-530
        • Youngkong S
        • Baltussen R
        • Tantivess S
        • Mohara A
        • Teerawattananon Y
        Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand.
        Value in Health. 2012; 15: 961-970
        • Phillips F
        • Hwang GG
        • Limprayoon P
        Inflection points and industry change: was Andy Grove right after all?.
        J Technol Manage Growing Econom. 2016; 7
        • Ellis BJ
        • Del Giudice M
        • Dishion TJ
        • et al.
        The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice.
        Dev Psychol. 2012; 48: 598-623
        • LeRouge C
        • Ma J
        • Sneha S
        • Tolle K
        User profiles and personas in the design and development of consumer health technologies.
        Int J Med Inform. 2013; 82: e251-e268
        • Ouslander JG
        • Zarit SH
        • Orr NK
        • Muira SA
        Incontinence among elderly community-dwelling dementia patients.
        J Am Geriatr Soc. 1990; 38: 440-445
        • Williams BR
        • Vargo K
        • Newman DK
        • et al.
        It's about time: the temporal burden of lower urinary tract symptoms among women.
        Urol Nurs. 2020; : 40
        • Vickers AJ
        • Elkin EB
        Decision curve analysis: a novel method for evaluating prediction models.
        Med Decis Making. 2006; 26: 565-574
        • Kaminsky J
        • Keegan LT
        • Metcalf CJE
        • Lessler J
        Perfect counterfactuals for epidemic simulations.
        Philos Trans R Soc Lond B Biol Sci. 2019; 37420180279
        • Eldred-Evans D
        • Sahai A
        Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder.
        Ther Adv Urol. 2017; 9: 3-10