Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program
Summary We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses’ actions for 525 fragility fracture patients, showing that their management i...
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| Veröffentlicht in: | Osteoporosis international 2016-04, Vol.27 (4), p.1569-1576 |
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| creator | Senay, A. Delisle, J. Raynauld, J. P. Morin, S. N. Fernandes, J. C. |
| description | Summary
We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses’ actions for 525 fragility fracture patients, showing that their management is efficient and safe.
Introduction
A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians’ and nurses’ clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS.
Methods
Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment.
Results
Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians’ decisions were the same in >96 %, and Gwet AC1
1
coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.
Conclusions
High agreement between nurses’ and physicians’ clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures. |
| doi_str_mv | 10.1007/s00198-015-3413-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4791513</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4217482001</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-f4cb6c5a76861260c54134acd5018fd8967c8d184bd980d85778e47019a7268b3</originalsourceid><addsrcrecordid>eNqNks1u1DAUhS0EosPAA7BBltiURcBOHP-wQCoVBaSRWAASO8txbmZcEntqJ0WzY8EzILHl0fokuJNSFSQkVpZ9v3t8fXwQekjJU0qIeJYIoUoWhNZFxWhV8FtoQVlVFaXi9W20IKoShWL00wG6l9IpyT1KibvooOSclIrWC_T9aB0BBvAjbmD8AuDxdrNLzjrj08XXH9j4FvspJtjvbO-8s6bHLViXXPAJdyHicQN4MN6sZ6XQ7U-6aOw4RcC9My4FjxPEc2cBHzJ3snr_5PmeWk328w6_DB4uvv3E2xjW0Qz30Z3O9AkeXK1L9PHk1YfjN8Xq3eu3x0erwtaiGouO2Ybb2gguOS05sXW2gRnb1oTKrpWKCytbKlnTKklaWQshgYnsmhEll021RC9m3e3UDNDaPH00vd5GN5i408E4_WfFu41eh3PNRLaPVlng8EoghrMJ0qgHlyz0vfEQpqSpEJwzRqj4H7SSlIj8g0v0-C_0NEzRZyc0laWqec1kmSk6UzaGlCJ013NToi8DoueA6BwQfRkQzXPPo5sPvu74nYgMlDOQcsmvId64-p-qvwCUBsoA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1829565482</pqid></control><display><type>article</type><title>Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Senay, A. ; Delisle, J. ; Raynauld, J. P. ; Morin, S. N. ; Fernandes, J. C.</creator><creatorcontrib>Senay, A. ; Delisle, J. ; Raynauld, J. P. ; Morin, S. N. ; Fernandes, J. C.</creatorcontrib><description>Summary
We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses’ actions for 525 fragility fracture patients, showing that their management is efficient and safe.
Introduction
A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians’ and nurses’ clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS.
Methods
Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment.
Results
Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians’ decisions were the same in >96 %, and Gwet AC1
1
coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.
Conclusions
High agreement between nurses’ and physicians’ clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-015-3413-6</identifier><identifier>PMID: 26602915</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adult ; Aged ; Clinical Competence ; Decision Making ; Delivery of Health Care - organization & administration ; Delivery of Health Care - standards ; Endocrinology ; Female ; Fractures ; Humans ; Male ; Medical Staff, Hospital ; Medicine ; Medicine & Public Health ; Middle Aged ; Nurses ; Nursing care ; Nursing Staff, Hospital - organization & administration ; Nursing Staff, Hospital - standards ; Original ; Original Article ; Orthopedics ; Osteoporosis ; Osteoporosis - diagnosis ; Osteoporosis - nursing ; Osteoporotic Fractures - diagnosis ; Osteoporotic Fractures - nursing ; Osteoporotic Fractures - prevention & control ; Outpatient Clinics, Hospital ; Quebec ; Referral and Consultation - standards ; Rheumatology ; Secondary Prevention - organization & administration ; Secondary Prevention - standards</subject><ispartof>Osteoporosis international, 2016-04, Vol.27 (4), p.1569-1576</ispartof><rights>The Author(s) 2015</rights><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-f4cb6c5a76861260c54134acd5018fd8967c8d184bd980d85778e47019a7268b3</citedby><cites>FETCH-LOGICAL-c573t-f4cb6c5a76861260c54134acd5018fd8967c8d184bd980d85778e47019a7268b3</cites><orcidid>0000-0002-4863-477X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-015-3413-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-015-3413-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26602915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Senay, A.</creatorcontrib><creatorcontrib>Delisle, J.</creatorcontrib><creatorcontrib>Raynauld, J. P.</creatorcontrib><creatorcontrib>Morin, S. N.</creatorcontrib><creatorcontrib>Fernandes, J. C.</creatorcontrib><title>Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>Summary
We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses’ actions for 525 fragility fracture patients, showing that their management is efficient and safe.
Introduction
A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians’ and nurses’ clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS.
Methods
Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment.
Results
Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians’ decisions were the same in >96 %, and Gwet AC1
1
coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.
Conclusions
High agreement between nurses’ and physicians’ clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.</description><subject>Adult</subject><subject>Aged</subject><subject>Clinical Competence</subject><subject>Decision Making</subject><subject>Delivery of Health Care - organization & administration</subject><subject>Delivery of Health Care - standards</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Fractures</subject><subject>Humans</subject><subject>Male</subject><subject>Medical Staff, Hospital</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nurses</subject><subject>Nursing care</subject><subject>Nursing Staff, Hospital - organization & administration</subject><subject>Nursing Staff, Hospital - standards</subject><subject>Original</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Osteoporosis - diagnosis</subject><subject>Osteoporosis - nursing</subject><subject>Osteoporotic Fractures - diagnosis</subject><subject>Osteoporotic Fractures - nursing</subject><subject>Osteoporotic Fractures - prevention & control</subject><subject>Outpatient Clinics, Hospital</subject><subject>Quebec</subject><subject>Referral and Consultation - standards</subject><subject>Rheumatology</subject><subject>Secondary Prevention - organization & administration</subject><subject>Secondary Prevention - standards</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNks1u1DAUhS0EosPAA7BBltiURcBOHP-wQCoVBaSRWAASO8txbmZcEntqJ0WzY8EzILHl0fokuJNSFSQkVpZ9v3t8fXwQekjJU0qIeJYIoUoWhNZFxWhV8FtoQVlVFaXi9W20IKoShWL00wG6l9IpyT1KibvooOSclIrWC_T9aB0BBvAjbmD8AuDxdrNLzjrj08XXH9j4FvspJtjvbO-8s6bHLViXXPAJdyHicQN4MN6sZ6XQ7U-6aOw4RcC9My4FjxPEc2cBHzJ3snr_5PmeWk328w6_DB4uvv3E2xjW0Qz30Z3O9AkeXK1L9PHk1YfjN8Xq3eu3x0erwtaiGouO2Ybb2gguOS05sXW2gRnb1oTKrpWKCytbKlnTKklaWQshgYnsmhEll021RC9m3e3UDNDaPH00vd5GN5i408E4_WfFu41eh3PNRLaPVlng8EoghrMJ0qgHlyz0vfEQpqSpEJwzRqj4H7SSlIj8g0v0-C_0NEzRZyc0laWqec1kmSk6UzaGlCJ013NToi8DoueA6BwQfRkQzXPPo5sPvu74nYgMlDOQcsmvId64-p-qvwCUBsoA</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Senay, A.</creator><creator>Delisle, J.</creator><creator>Raynauld, J. P.</creator><creator>Morin, S. N.</creator><creator>Fernandes, J. C.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4863-477X</orcidid></search><sort><creationdate>20160401</creationdate><title>Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program</title><author>Senay, A. ; Delisle, J. ; Raynauld, J. P. ; Morin, S. N. ; Fernandes, J. C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-f4cb6c5a76861260c54134acd5018fd8967c8d184bd980d85778e47019a7268b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Clinical Competence</topic><topic>Decision Making</topic><topic>Delivery of Health Care - organization & administration</topic><topic>Delivery of Health Care - standards</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Fractures</topic><topic>Humans</topic><topic>Male</topic><topic>Medical Staff, Hospital</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nurses</topic><topic>Nursing care</topic><topic>Nursing Staff, Hospital - organization & administration</topic><topic>Nursing Staff, Hospital - standards</topic><topic>Original</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Osteoporosis - diagnosis</topic><topic>Osteoporosis - nursing</topic><topic>Osteoporotic Fractures - diagnosis</topic><topic>Osteoporotic Fractures - nursing</topic><topic>Osteoporotic Fractures - prevention & control</topic><topic>Outpatient Clinics, Hospital</topic><topic>Quebec</topic><topic>Referral and Consultation - standards</topic><topic>Rheumatology</topic><topic>Secondary Prevention - organization & administration</topic><topic>Secondary Prevention - standards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Senay, A.</creatorcontrib><creatorcontrib>Delisle, J.</creatorcontrib><creatorcontrib>Raynauld, J. P.</creatorcontrib><creatorcontrib>Morin, S. N.</creatorcontrib><creatorcontrib>Fernandes, J. C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Senay, A.</au><au>Delisle, J.</au><au>Raynauld, J. P.</au><au>Morin, S. N.</au><au>Fernandes, J. C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>27</volume><issue>4</issue><spage>1569</spage><epage>1576</epage><pages>1569-1576</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>Summary
We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses’ actions for 525 fragility fracture patients, showing that their management is efficient and safe.
Introduction
A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians’ and nurses’ clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS.
Methods
Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment.
Results
Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians’ decisions were the same in >96 %, and Gwet AC1
1
coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.
Conclusions
High agreement between nurses’ and physicians’ clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.</abstract><cop>London</cop><pub>Springer London</pub><pmid>26602915</pmid><doi>10.1007/s00198-015-3413-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4863-477X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0937-941X |
| ispartof | Osteoporosis international, 2016-04, Vol.27 (4), p.1569-1576 |
| issn | 0937-941X 1433-2965 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Clinical Competence Decision Making Delivery of Health Care - organization & administration Delivery of Health Care - standards Endocrinology Female Fractures Humans Male Medical Staff, Hospital Medicine Medicine & Public Health Middle Aged Nurses Nursing care Nursing Staff, Hospital - organization & administration Nursing Staff, Hospital - standards Original Original Article Orthopedics Osteoporosis Osteoporosis - diagnosis Osteoporosis - nursing Osteoporotic Fractures - diagnosis Osteoporotic Fractures - nursing Osteoporotic Fractures - prevention & control Outpatient Clinics, Hospital Quebec Referral and Consultation - standards Rheumatology Secondary Prevention - organization & administration Secondary Prevention - standards |
| title | Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program |
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