The New F - Tag 315 Deborah

In this issue, Johnson and Ouslander tackle one of the most costly, enduring, and vexing problems in long-term care: urinary incontinence (UI) management. Since 1988 when a consensus statement on the state of the science was drafted by an interdisciplinary expert panel (National Institutes of Health Consensus Conference on UI) and in 1996, when the Agency for Healthcare Research and Quality (AHRQ, formerly AHCPR) published UI clinical practice guidelines, the dissemination and adoption of UI technologies has lagged well behind other geriatric syndrome initiatives such as fall prevention, restraint reduction, and pain assessment. In their opening comments describing a symposium covering recent changes in the Centers for Medicare and Medicaid Services (CMS) guidelines for management of UI, the authors note with incredulity and alarm that among the 500 attendees, not one was a medical director or physician. Tempering this observation with the suggestion that this might be an isolated incident, they question whether medical directors in long-term care (LTC) have abdicated leadership in this domain of care. In this thoughtful and comprehensive paper, the authors describe the new CMS interpretive guidelines and their evidence base, and suggest how medical directors can fulfill new obligations related to the quality of care of residents with UI or catheters in the current LTC context that amplifies their leadership role in developing and implementing resident care policies and practices. The new CMS guidelines combine former tags F-315 and F-316 into one (revised) tag, F-315, which contains interpretive guidelines, a new investigative protocol, and compliance and noncompliance criteria for residents with UI, urinary tract infection, or a urinary catheter. As a certified continence care specialist, I approached this paper with great interest and expectancy. Johnson and Ouslander provide a succinct summary of the key recommendations in the CMS UI guideline and compare the guideline with other evidencebased guidelines from AHRQ and the American Medical Directors Association (AMDA), and quality indicators from the Assessing Care of Vulnerable Elders Study (ACOVE). They also provide Web links to direct the reader to the CMS site on the new UI guidelines, to view the original text, as well as other Clinical Practice Guideline (CPG) sites, and give directions on how to navigate. The authors provide a cogent summary of the current evidence for practice and concordance with other CPGs, and make recommendations for