骨折联络服务（4iFLS）管理中医生与护士临床决策的一致性：幸运骨™项目。
Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program.
作者信息
Senay A, Delisle J, Raynauld J P, Morin S N, Fernandes J C
机构信息
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.
出版信息
Osteoporos Int. 2016 Apr;27(4):1569-1576. doi: 10.1007/s00198-015-3413-6. Epub 2015 Nov 24.
UNLABELLED
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 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.
未标注
我们通过请一位风湿病学家和一位内科医生评估护士的临床决策，来确定护士是否能够在骨折联络服务中管理骨质疏松性骨折。对于525例脆性骨折患者，专家对护士的所有行动的认可度超过94%，这表明他们的管理是有效且安全的。
引言
在对发生脆性骨折的个体进行骨脆性调查和开始治疗方面存在重大护理缺口。由护士管理的骨折联络服务（FLS）的实施可能是解决这一问题的关键。本项目的目的是使医生和护士的临床决策达成一致，并评估护理算法对FLS管理是否有效且可靠。
方法
2010年至2013年期间，两位具有骨质疏松症治疗专业知识的独立医生对骨折联络服务中525名受试者的护士临床决策进行了评估。
结果
护士成功识别了所有有风险的患者，需要将27%的患者转诊给医生。因此，他们自主管理了73%的脆性骨折患者。根据评估医生的意见，没有进行不必要的转诊。每位评估者与护士之间的一致性超过97%。医生的决策一致性超过96%，Gwet AC11系数超过0.960（几乎达到完美的一致水平）。所有主要合并症都得到了妥善管理。
结论
护士和医生临床决策之间的高度一致性表明，护士对骨折联络服务的独立管理是安全的，在脆性骨折患者的护理中应强烈推荐。这种干预措施有助于解决骨脆性护理中现有的护理缺口以及与脆性骨折预防和治疗相关的社会经济负担。
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