title: Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program.
abstract: 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.
  
  
  BACKGROUND
  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 AC11 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.
authors.affiliation: Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada. andrea.senay@umontreal.ca.|Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada. andrea.senay@umontreal.ca.|Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada. andrea.senay@umontreal.ca.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-4863-477X
authors.initials: A
authors.lastname: Senay
authors.affiliation: Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada.|Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Delisle
authors.affiliation: Hôpital Notre-Dame of the Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montreal, QC, H2L 4M1, Canada.|Institut de Rhumatologie de Montréal, 1551 rue Ontario Est, Montreal, QC, H2L 1S6, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Raynauld
authors.affiliation: Department of Medicine, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: S N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.|Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada.|Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003657:Decision Making; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards*; D010024:Osteoporosis / Q000175:diagnosis / Q000451:nursing*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control; D010044:Outpatient Clinics, Hospital; D011792:Quebec; D012017:Referral and Consultation / Q000592:standards; D055502:Secondary Prevention / Q000458:organization & administration / Q000592:standards
keywords: Fracture liaison service; Fragility fracture; Management; Nurse; Osteoporosis