Stephen Kraus: Good morning. My name is Stephen Kraus, and I'd like to take this opportunity to thank you for providing me an opportunity to update you on the SUFU OAB Clinical Care Pathway.

These are my disclosures. The AUA/SUFU Overactive Bladder Guidelines offers a very comprehensive and evidence-based approach to the management of overactive bladder. However, the guidelines are not perfect. There are areas where evidence is lacking. The guidelines focus mainly on the healthcare provider, and not really offer any implementation strategies, nor is there really a role for patient buy-in. We know that in other chronic disease states, that patient engagement is a key for success.

This led to the development of many other OAB Clinical Care Pathways from various entities, including different practices. But many of these were not standardized and were even imperfect. For example, some did not offer all aspects of OAB treatments, especially if that provider did not offer that particular therapy. Some were not evidence-based and did not really follow the guidelines very well. Some even seemed to push more advanced or third-line therapies, while some seem to over-utilize testing, such as urodynamics and cystoscopy. Almost none of them offered any means for patient engagement. Thus, patient compliance was still poor.

Indeed, some of these practices actually show that the number of third-line therapies did increase, which, let's be clear, it's not necessarily bad. In fact, it could be a good sign that the clinical care pathway that they were using was actually moving patients along instead of keeping them stuck in earlier therapies.

However, it would be ideal if we could confirm that patient satisfaction and quality of care and efficacy was really optimized with a clinical care pathway. A good clinical care pathway should be able to police itself and do that for us.

So in 2015, SUFU established the SUFU OAB Clinical Care Pathway Project, with the goals of establishing a SUFU branded OAB Clinical Care Pathway based on evidence and expert consensus. This CCCP would be an easy to-use-companion to the AUA SUFU guidelines, which would basically simplify the guidelines, offering providers enhanced ability to offer all additional lines of therapy, provide educational components for patients, and offer a way for patient engagement, as well as measure patient outcomes.

You can see the committee here and the members, and this committee was comprised of OAB experts in all aspects of OAB therapies, including pelvic floor therapy and behavioral modification. The Clinical Care Pathway Project was supported by unrestricted grants from Medtronic, Allergan, and Astellas.

The components of the OAB Clinical Care Pathway are as follows. There's a flow diagram, which again, basically mirrors and follows the guidelines, again, in a more simplified, easy-to-use manner for the provider and also unbiased. A patient roadmap, which is what really sets us apart our clinical care pathway from others. This is how we are able to improve patient engagement. The roadmap provides patient education, it establishes tangible timelines and expectations, and provides a trigger for patients to seek further care when they're not satisfied.

We also developed a SUFU OAB Clinical Care Pathway website as part of the SUFU website. If you navigate to the SUFU website, you can find it there. But it's easier actually, to just Google SUFU OAB CCP, and it should pop right up.

We have first-line therapy modules, which are basically patient education materials on conservative therapies, dietary modifications, pelvic floor exercises, medication tool, and other helpful hints to improve their compliance. It's especially nice for providers who may not have all the resources as part of their practice. Now they have the ability to offer some of these other therapies.

We also had planned to implement a smartphone app, which is just coming online as we speak. And we'll speak more about this later, but basically it's meant to serve as a digital roadmap or digital navigator. Again, the bulk of our efforts have been here and we'll go over this shortly.

In addition, we're now at the point where we're enacting dissemination efforts to broadcast the CCP, and this'll be our next key focus. This will be aimed at all stakeholders, including urologic specialists, urogynecologists, general urology, general gynecology, primary care, and patients themselves. We've partnered with UroToday to help with this. In the process, we'll be creating an OAB Center of Excellence center at the UroToday website. Ultimately, we'd like to create a voluntary patient registry using the functionality of the app. And again, we can talk about that later.

Here, you can see the CCP website as part of the SUFU website, and you can download pretty much everything you need here. And we have it in English, Spanish, and even some components are in French.

Here you can see the flow diagram, and again, this is meant for the providers and it mirrors the guidelines, and it should be easier to follow.

Here you can see the patient roadmap, and this was really designed with the patient in mind. It was really meant to mimic the Chutes and Ladder type game in hopes of making it easy for the patient to follow and navigate it.

Here's the OAB Clinical Care Pathway app. I'm showing my phone's screen so that you can see what it looks like. You can see it here circled in red. It will be available at the App Store and the equivalent for Android users soon. You can see the images that will show up on the home screen and the diary entry page. Other pages you'll see, the New Entry page for the diary, as well as the Self Assessment. And the self assessment tool that comes up on the app is actually the PGI-I questionnaire. Then there's the personalized My Treatment center.

I'm going to run for you now the video of using the app. You can see here that I've clicked it and we're initiating the onboarding process. This would be the home screen and here's the onboard screen. It offers the option to indicate what type of treatments, behavioral therapy, different medications, the doses, and such. These are, again, allowing you to personalize what the patient would be doing. Once these are set up, it will also offer reminders. You have the opportunity for offering two medications on the app. So a patient, if they're on dual medications, can be reminded about both. Then there's the section for entering personal demographics, which is optional.

Next, we'll go into the Diary and you can see the diary auto-stamps based on the time, but you can override it if you need to. It also has urge severity rating and whether or not an accident actually occurred.

Next, we'll be going into the Patient Resources. The patient resources tab is linked to those modules that we just discussed. You can see here, we have modules on urge suppression, pelvic floor exercises and muscle training, healthy bladder habits, and then helpful hints, such as five changes that one can make. And these are all, again, the various modules and what the patient would see. You can download these on the website as well.

The last one, the Healthy Bladder Habits. And also realized that these were written with the patients in mind, at their reading level.

Next you'll see the My Treatment section again, another way to get to it on the homepage. You can personalize their treatment. Then there's the Self Assessments. The self assessments is, again, the PGI-I. You can see the various responses, and it triggers also the response, it's time. It'll go off every four weeks, but you can also do it when you prefer to do it. It's also tied to a response. In this case, it says, you're doing great. Keep it up. For a poor response, it says you are not doing as well as you were expecting. Perhaps you should consider seeking your primary care provider or other specialist.

The app also has the opportunity for limiting fluids for those who might be having excessive nocturnal fluids, as well as timed voiding. And this last but not least, you'll get summary pages going over the diary, the averages of her time period, including the urge scales. You can even download a PDF version of the diary.

So at this point, I'd like to thank you for your attention. Please feel free to access and use the clinical care pathway and the app, which should be available shortly. Thank you again for your attention. I hope you enjoy the rest of the meeting.